Safe abortion
AbstractObjective: summarising individual and institutional characteristics of abortion-related severe maternal outcomes reported at health facilities by WHO unsafe abortion accounts for 13 % of maternal mortality. Abortion is most commonly complicated with bleeding and infection.
WHO recommends changing curettage with vacuum aspiration and medical abortion to make legal abortion safe.
Medical abortion with mifepristone and misoprostol application is widely spread and acceptable method during first and second trimester.
Contraceptive safety and adverse reactions of intrauterine device (IUD) inserted directly after first-trimester abortion for regulating fertility, abortion prophylaxis, avoiding unwanted pregnancy and its unfavourable complications is overviewed.
Aims: to evaluate the effectiveness of mifepristone and misoprostol combination in different ways of application in various gestational age (57–63 days, 64–70 days, 14–24 weeks) for safe medical abortion; to evaluate the acceptability and efficacy of medical abortion at home up to 63 days of gestation; to weigh up contraceptive safety and adverse reactions of IUD inserted directly after first-trimester abortion for rehabilitation.
Materials and methods: analysis of 2014 database, finding the issues of mifepristone and misoprostol application for medical abortion, IUD usage after medical abortion. Five randomized controlled studies are reported. 1732 cases of medical abortion in the first trimester, 302 in the second trimester are observed. 142 cases of IUD are also analyzed.
Results: a total of 703 cases (up to 70 days of gestation pregnancy) were analyzable for efficacy of mifepristone and misoprostol administration.
Home administration of misoprostol is an effective and acceptable method for abortion up to 63 days of gestation and women should be eligible for this treatment option regardless of their travel distance from hospital. Average surgical assistance was comparable (4,9 %) to WHO standards.
The overall abortion duration was longer in women receiving oral misoprostol: oral 9.5 hours (95 % confidence interval [CI] 8.5–11.4), vaginal 7.4 hours (95 % CI 6.5–8.2), and sublingual 7.8 hours (95 % CI 7.0– 9.2). Major gestational age, nulliparity and previous cesarean section are strongly connected with major duration of medical abortion in the second trimester.
UID insertion just at terminated with the abortion pregnancy has a row of advantages: contraceptive efficacy without extra charge, high defensive value, economic benefit, Conclusion: this analysis affirms a number of previously observed characteristics of women with abortion-related severe morbidity and mortality: low health service, unwanted pregnancy, unsafe abortion.
Development of vacuum aspiration and safe medical abortion with mifepristone and misoprostol is advisable. A medical abortion regimen of mifepristone followed by misoprostol is effective through the first and the second trimester of gestation and may be offered within existing outpatient abortion services. There were no differences between the groups either with respect to the security of the supplied UID contraceptive method or to the development of side effects.
Keywords:safe medical аbortion, mifepristone, misoprostol, intrauterine device (IUD) contraception