TY - JOUR
T1 - Second-trimester postabortion care for ruptured membranes, fetal demise, and incomplete abortion
AU - Mark, Alice G.
AU - Edelman, Alison
AU - Borgatta, Lynn
N1 - Publisher Copyright:
© 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ltd.
PY - 2015/5/1
Y1 - 2015/5/1
N2 - Background Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester. Objectives To establish evidence-based recommendations for PAC in the second trimester. Search strategy Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched. Selection criteria Clinical trials and comparative studies of women presenting in the second trimester (12-28 weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately. Data collection and analysis Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed. Main results Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200 μg of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin. Conclusion Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200 μg vaginally, sublingually, or buccally every 6-12 hours.
AB - Background Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester. Objectives To establish evidence-based recommendations for PAC in the second trimester. Search strategy Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched. Selection criteria Clinical trials and comparative studies of women presenting in the second trimester (12-28 weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately. Data collection and analysis Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed. Main results Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200 μg of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin. Conclusion Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200 μg vaginally, sublingually, or buccally every 6-12 hours.
KW - Abortion
KW - Intrauterine fetal death
KW - Mifepristone
KW - Misoprostol
KW - Postabortion care
KW - Premature rupture of membranes
KW - Second trimester
KW - Unsafe abortion
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U2 - 10.1016/j.ijgo.2014.11.011
DO - 10.1016/j.ijgo.2014.11.011
M3 - Review article
C2 - 25660084
AN - SCOPUS:84926520615
SN - 0020-7292
VL - 129
SP - 98
EP - 103
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - 2
ER -