A clinical observational study on second-trimester abortion
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20201008Keywords:
Abortion, Complications, Epidemiology, Etiology, Methods, Second-trimesterAbstract
Background: Second-trimester abortion is an important component of the comprehensive women’s health care. Data’s regarding second-trimester abortion is still under-reporting. Though the percentage of induced second-trimester abortion is low, its morbidity is higher than the first-trimester induced abortion. The abortion related mortality usually increases with the age of gestation.
Methods: A retrospective observational study was conducted in the department of obstetrics and gynecology at Sree Balaji Medical College and Hospital, Chennai, over a period of one year. The data were collected from the medical case records and we have analyzed on the epidemiology, etiologies, complications and the methods of second- trimester abortion using statistical analysis.
Results: In this study, there was no standard regimen of mifepristone and misoprostol were used for second-trimester abortion. The dosages were varied based on the gestational age of pregnancy. As the gestational age progresses, the amount of misoprostol required for the induction of second trimester abortion decreases and the difference is statistically significant. There was no reported case of rupture uterus, but varied complications such as post-abortal hemorrhage, retained placenta, need for blood transfusion, uterine perforation and one maternal death were reported during the study period.
Conclusions: In order to reduce the morbidity and mortality of second trimester abortion, more policies and monitored services have to be rendered by the health system. Data regarding the second trimester abortion have to be improved.
References
The American College of Obstetricians and Gynecologists Women’s Health Care Physicians Practice Bulletin Clinical Management Guidelines for Obstetrician - Gynecologists Number 135 June 2013 Reaffirmed; 2019. Available at: https://www.acog.org/-/media/Practice-Bulletins/ Committee-on-Practice-Bulletins Gynecology/Public/pb135.pdf?dmc=1&ts=20190630T1739074502.
Gemzell-Danielsson K, Lalitkumar S. Second trimester medical abortion with mifepristone–misoprostol and misoprostol alone: a review of methods and management. Reprod Health Matters, 2008;16:sup31:162-72.
Dalvie SS. Second Trimester Abortions in India, Reprod Health Matters. 2008;16:sup31:37-45.
Gupte M, Bandewar S, Pisal H. Abortion needs of women in India: a case study of rural Maharashtra. Reprod Health Matters. 1997;9:77-86.
Ganatra B, et al. Induced abortions in a rural community in Western Maharashtra: prevalence and patterns. Pune King Edward Memorial Hospital and Research Centre, 1996. Available at: https://www.ncbi.nlm.nih.gov/pubmed/12369334. Accessed on 16th February 2020.
Pallikadavath S, Stones RW. Maternal and social factors associated with abortion in India: a population based study. Inter Family Plan Perspect. 2006;32(3):120-5.
Ravindran TKS. Gender gaps in research on abortion in India: a critical review of selected studies. Gender Reprod Health Res Initi. New Delhi: CREA. 2002:1-28.
The Medical Termination of Pregnancy Act, 1971. Available at: https://mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-act-1971. Accessed on 16th February 2020.
Ministry of Health and Family Welfare notification; 2003. Available at: https://mohfw.gov.in/acts-rules-and-standards-health-sector/acts/mtp-regulations. Accessed on 16th February 2020.
Unsafe abortion: global and regional estimates of the incidence of unsafe abortion and associated mortality in 2008. Available at: https://apps.who.int/iris/bitstream/handle/10665/44529/9789241501118_eng.pdf;jsessionid=36BABD6A044758930B8B3A35290E7865?sequence=1. Accessed on 16th February 2020.
Lalitkumar S, Bygdeman M, Gemzell-Danielsson K. Second trimester induced abortion: a review. Human Reprod Upd. 2007;13(1):37-52.
Armatage RJ, Luckas MJ. A randomized trial of 2 regimens for the administration of vaginal prostaglandins (gemeprost) for the induction of second trimester abortion. Australian and New Zealand J Obstet Gynecol. 1996;36(3):296-9.
Gemzell-Danielsson K, Östlund E. Termination of second trimester pregnancy with mifepristone and gemeprost: The clinical experience of 197 consecutive cases. Acta Obstet et Gynecol Scandina. 2000;79(8):702-6.
Ashok PW, Templeton A, Wagaarachchi PT, Flett GM. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contracept. 2004;69(1):51-8.
Thong KJ, Baird DT. An open study comparing two regimens of gemeprost for the termination of pregnancy in the second trimester. Acta Obstet et Gynecol Scandina. 1992;71(3):191-6.
