Service users’ attributes associated with the uptake of medical versus surgical abortion at public health facilities in Vietnam

Objective

To investigate the attributes of service users associated with uptake of medical abortion (MA) versus manual vacuum aspiration (MVA) at public health facilities in Vietnam.

Methods

Structured exit interviews were conducted among women who underwent termination at 62 public health facilities in Hanoi, Khanh Hoa, and Ho Chi Minh City (HCMC) between August and December 2011. Data on sociodemographic, abortion-related, and service-related factors were compared between women who underwent MVA versus MA.

Results

Overall, 1233 women completed the study survey: 541 (43.9%) from Hanoi; 163 (13.2%) from Khanh Hoa; and 529 (42.9%) from HCMC. Almost one-quarter of women (23.1%) had chosen MA. After controlling for sociodemographic factors, women living in Khanh Hoa (odds ratio [OR], 13.4; 95% confidence interval [CI], 5.3–33.8) and HCMC (OR, 5.8; 95% CI, 2.1–15.9) were more likely to have undergone MA than women in Hanoi. Older women were less likely to have undergone MA (P < 0.05), and those who had previously heard of MA were twice as likely to have undergone MA (P = 0.020).

Conclusion

Uptake of MA was lower than that of MVA and varied by province. Women in Vietnam will make their own judgment about which method to choose if they have prior knowledge of both.     

Contraceptive behavior among women after abortion in Nepal

Objective

To investigate the timing of contraceptive use and estimate the discontinuation rates of temporary methods among women after abortion, or a live birth or stillbirth.

Methods

A sample of married women with detailed pregnancy and contraceptive histories was analyzed in a population-based cross-sectional study based on calendar data extracted from the 2011 Nepal Demographic and Health Survey. Kaplan–Meier cumulative and discrete-time hazard models were used to estimate the timing of contraceptive use and discontinuation rates among users of temporary methods.

Results

The final analysis sample included 3190 women. Of 684 women who had had an abortion, 298 (43.6%) had not initiated any contraceptive use in the 12 months afterwards. Women initiated contraceptive use significantly earlier after abortion (hazard ratio [HR] 2.25; 95% CI, 1.96–2.59; P < 0.001). The rate of discontinuation among contraceptive users was significantly higher in the postabortion group (HR 1.32; 95% CI, 1.05–1.65; P < 0.05). Women who were educated, wealthier, had used contraceptives before the index pregnancy, had two sons and had autonomy initiated contraceptive use significantly earlier in the post-abortion period than their counterparts.

Conclusion

Postabortion contraceptive use is low in Nepal. Postabortion family-planning counseling and related services should be strengthened with systematic monitoring and follow-up interventions.     

Postabortion contraception a decade after legalization of abortion in Nepal

Objective

To assess the contraceptive information received and methods chosen, received, and used among women having abortions one decade after legalization of abortion in Nepal.

Methods

We examined postabortion contraception with questionnaires at baseline and six months among women obtaining legal abortions (n = 838) at four facilities in 2011. Multivariate regression analysis was used to measure factors associated with method information, choice, receipt, and use.

Results

One-third of participants received no information on effective methods, and 56% left facilities without a method. The majority of women who chose to use injectables and pills were able to do so (88% and 75%, respectively). However, only 44% of women choosing long-acting reversible contraceptives and 5% choosing sterilization had initiated use of the method by six months. Levels of contraceptive use after medical abortion were on par with those after aspiration abortion. Nulliparous women were far less likely than parous women to receive information and use methods. Women living without husbands or partners were also less likely to receive information and supplies, or to use methods.

Conclusion

Improvements in postabortion counseling and provision are needed. Ensuring that women choosing long-acting and permanent contraceptive methods are able to obtain either them or interim methods is essential.     

Knowledge and provision practices regarding medical abortion among public providers in Hanoi,Khanh Hoa,and Ho Chi Minh City,Vietnam

Objective

To assess public service providers’ knowledge of medical abortion (MA) and practices, and perspectives on expanding the use of MA to primary and secondary health facilities in Vietnam.

Methods

A cross-sectional study was conducted via an interviewer-administered questionnaire among abortion providers (n = 905) from public health facilities between August 2011 and January 2012.

Results

Overall, 31.1% of providers performed both surgical and medical abortions; 68.9% offered only surgical abortion. Providers were knowledgeable about the regimen/dosage of mifepristone plus misoprostol regimen; however, knowledge scores were low for gestational age limits for MA, adverse effects of the combined drug regimen, and safety and effectiveness of MA compared with surgical abortion. Knowledge scores were significantly lower among providers in rural areas than among those in urban settings. A large proportion of providers (82.9%) thought that MA should be expanded to primary and secondary health facilities. Perceived barriers to MA expansion included lack of knowledge and training, qualified staff, adequate drug supplies, equipment, or facilities, guidelines and protocols on MA, and patient awareness.

Conclusion

Provision of MA in Vietnam was found to be disproportionate to surgical abortion provision and to vary by region. Knowledge of MA was moderate, but poorer among providers in rural settings.     

A pilot study on the combined use of letrozole,mifepristone and misoprostol in termination of first trimester pregnancy up to 9 weeks’ gestation

Objective

To assess the feasibility of adding letrozole to the standard regimen of mifepristone and misoprostol for termination of pregnancy up to 63 days.

Study design

We recruited 50 subjects who had requested legal termination of pregnancy up to 63 days. Medical abortion was performed with a singe dose of 200 mg mifepristone and 10 mg of letrozole daily for 3 days followed by 800 mcg vaginal misoprostol.

Results

The complete abortion rate was 98% (95% CI: 94–100%). The median induction-to-abortion interval of the regimen was 5.1 h (range 1.2–56 h). No serious adverse effects were reported.

Conclusions

The results of this pilot study suggest that a regimen of mifepristone, letrozole and misoprostol is associated with a high complete abortion rate without major adverse events.     

Laparoscopic appendectomy performed during pregnancy by gynecological laparoscopists

Objective

To evaluate the safety, feasibility, and pregnancy outcomes of laparoscopic appendectomy (LA) during pregnancy.

Study design

A retrospective review of eight pregnant women who underwent LA from January 2007 to December 2008.

Results

The median age of the patients and median parity were 29.5 years (range, 25–34 years) and 0 (range, 0–1), respectively. The median operating time of LA was 22.5 min (range, 15–40 min). The median length of hospital stay was 3 days (range, 2–4 days). There was no maternal or fetal mortality or morbidity, conversion to laparotomy, or uterine injury. Seven women delivered seven healthy infants. One patient chose to have an elective abortion in another hospital. The histopathological diagnoses of the resected appendices were of acute appendicitis.

Conclusion

LA performed by gynecologic laparoscopists in pregnant women is safe, feasible, and effective.     

Sexual dysfunction after a first trimester induced abortion in a Chinese population

Objective

To evaluate the short-term effect of a first trimester induced abortion on sexuality in a Chinese population.

Study design

This is a cross-sectional study. One hundred and four women attending the post-abortion clinic 3–4 months after a first trimester induced abortion were recruited. They completed a self-administered questionnaire anonymously. The associations of various factors with sexual behavior after abortion were analyzed by the Chi-square test.

Results

More than 30% of the women reported a reduction in both frequency of vaginal intercourse and sexual desire. Their partners also had a reduction in sexual desire. The reduction of vaginal intercourse is more significant among young, unmarried women and those not having sterilization (P = 0.01). In addition, the prevalence of reduction in sexual desire and enjoyment among those women who had repeated abortion was significantly higher (P < 0.01).

Conclusion

The sexuality of both women and their partners are affected after abortion. It may be due to both psychological trauma and the worry of another unwanted pregnancy. Proper counseling may relieve their anxiety and improve sexual lives.     

Mannan-binding lectin in women with a history of recurrent vulvovaginal candidiasis

Objectives

To determine the serum concentration of mannan-binding lectin (MBL), a component of the innate immune system, in women with a history of recurrent vulvovaginal candidiasis (RVVC) and to correlate the result to candida-cultures, contraceptive use, if any, and to different antifungal therapies.

Study design

Twenty-nine women with a history of RVVC were investigated. Cultures of vulvar and vaginal samples were grown on chromogenic agar. Serum levels of MBL were determined by a sandwich time-resolved immunofluorometric assay, using anti-MBL coated microtiter wells containing samples, which were washed, incubated with biotinylated anti-MBL followed by europium-labeled streptavidin and measured by time-resolved flourometry.

Results

The median MBL level was higher in the RVVC cases than in 30 women with no history of genital candida infection who served as a comparison group (p = 0.006). It was also higher in the candida-positive than in the culture-negative RVVC (p = 0.02). The median concentration of MBL was also higher in hormonal contraceptive users as compared to condom-users and those using no contraceptive at all (p = 0.03).

Conclusion

The result indicates a role of MBL in RVVC and the production may correlate to vulvar/vaginal colonization by Candida, hormonal contraceptive use, and antifungal therapies.     

Efficacy and acceptability of a mifepristone–misoprostol combined regimen for early induced abortion among women in Mexico City

Objective

To evaluate the experience of women receiving mifepristone–misoprostol for early induced abortion in public sector facilities in the Federal District of Mexico City.

Methods

An open-label prospective study was conducted with 1000 pregnant women who sought induced abortion with a pregnancy of up to 63 days of gestation, as measured from the date of their last menstrual period. The study was conducted in three public sector healthcare facilities: two secondary level hospitals and one primary care clinic. Women ingested 200 mg mifepristone on day 1, followed by 800 μg buccal misoprostol 24 hours later, and they returned for follow-up on day 8. The primary outcome was complete abortion without recourse to surgical intervention.

Results

A total of 971 women received mifepristone–misoprostol and were included in the analysis for efficacy of treatment. The overall efficacy of the combined medical abortion regimen studied was 97.3% (n = 945); the success rate did not vary significantly by gestational age (95.9%–100%; P = 0.449). Most women (n = 922, 95.0%) had a successful induced abortion with only one dose of misoprostol.

Conclusion

The combined mifepristone and buccal misoprostol regimen was found to be highly effective and acceptable among Mexican women. www.ClinicalTrials.gov: NCT00386282.     

Abortion care for adolescent and young women

Background

Unintended pregnancy among adolescents (10–19 years) and young women (20–24 years) is a global public health problem. Adolescents face challenges in accessing safe abortion care.

Objective

To determine, via a systematic data review, whether abortion care for adolescent and young women differs clinically from that for older women.

Methods

In a comprehensive data review, the Cochrane Central Register of Controlled Trials, MEDLINE, and POPLINE databases were searched from the earliest data entered until November 2012. Randomized controlled trials and observational studies comparing effectiveness, safety, acceptability, and long-term sequelae of abortion care between adolescent/young women and older women were identified. Two reviewers independently extracted data, and the Cochrane guidelines and Newcastle–Ottawa Scale were used for quality assessment.

Results

In total, there were 25 studies including 346 000 women undergoing first- and second-trimester medical abortion, vacuum aspiration, or dilation and evacuation. Effectiveness and overall complications were similar among age groups. However, younger women had an increased risk for cervical laceration and a decreased risk of uterine perforation and mortality. Satisfaction and long-term depression were similar between age groups. Except for less uptake of intrauterine devices among adolescents, age did not affect post-abortion contraception.

Conclusions

Evidence from various healthcare systems indicates that abortion is safe and efficacious among adolescent and young women. Clinical services should promote access to safe abortion for adolescents.     

Is induced abortion with misoprostol a risk factor for late abortion or preterm delivery in subsequent pregnancies?

Objective

To examine whether a first or second trimester induced abortion with misoprostol influences the risk of late abortion or preterm delivery in subsequent pregnancies.

Study design

Case–control study in a teaching hospital from January 2005 to June 2006. The cases had singleton pregnancies delivered at 16–36 weeks of gestation after spontaneous late abortions, preterm labor or preterm premature rupture of membrane, or induction of labor for preterm premature rupture of membrane before 37 weeks. The control group was composed of the two consecutive spontaneous singleton deliveries at ≥37 weeks of gestation after each new case (ratio 2/1). The principal outcome measure was late abortion or preterm delivery. The association between late abortion or preterm delivery and a previous induced abortion with misoprostol was first assessed with the Cochran-Mantel-Haenszel chi-square test. Conditional logistic regression models adapted for clustered data were then further used to quantify the effect size, measured by estimated odds ratios (ORs) with their 95% confidence intervals (95% CI).

Results

The study included 245 cases and 490 controls. There was no significant difference in mean maternal age, number of pregnancies, parity, smoking, or history of first trimester miscarriage between cases and controls. However, a history of late abortion or previous preterm delivery was significantly more frequent among cases than controls. Forty (16.3%) cases and 56 (11.5%) controls had a history of cervical ripening with misoprostol before vacuum curettage or evacuation, or of medical abortion by misoprostol alone or with mifepristone (OR 1.51, 95% CI: 0.95–2.39; p = 0.08). After adjustment for maternal age and number of pregnancies with a multivariable conditional regression model, the adjusted OR was estimated at 1.33 (95% CI: 0.81–2.17; p = 0.25).

Conclusion

Despite the need for prudence, these results provide some reassurance that induced abortion with misoprostol during the first or second trimester of pregnancy is safe for subsequent pregnancies.     

A comparison of intrauterine balloon,intrauterine contraceptive device and hyaluronic acid gel in the prevention of adhesion reformation following hysteroscopic surgery for Asherman syndrome: a cohort study

Objective

To compare the efficacy of intrauterine balloon, intrauterine contraceptive device and hyaluronic acid gel in the prevention of the adhesion reformation after hysteroscopic adhesiolysis for Asherman's syndrome.

Study design

Retrospective cohort study of 107 women with Asherman's syndrome who were treated with hysteroscopic division of intrauterine adhesions. After hysteroscopic adhesiolysis, 20 patients had intrauterine balloon inserted, 28 patients had intrauterine contraceptive device (IUD) fitted, 18 patients had hyaluronic acid gel instilled into the uterine cavity, and 41 control subjects did not have any of the three additional treatment measures. A second-look hysteroscopy was performed in all cases, and the effect of hysteroscopic adhesiolysis was scored by the American Fertility Society classification system.

Results

Both the intrauterine balloon group and the IUD group achieved significantly (P < 0.001) greater reduction in the adhesion score than that of the hyaluronic acid gel group and control group. The efficacy of the balloon was greater than that of the IUD (P < 0.001). There was no significant difference in results between the hyaluronic acid gel group and the control groups.

Conclusion

The insertion of an intrauterine balloon or intrauterine device is more effective than the use of hyaluronic acid gel in the prevention of intra-uterine adhesion reformation.     

A rescue management plan for ruptured balloons during balloon vaginoplasty

Objectives

To present the first repeat procedure and a simple way for management of balloon rupture during balloon vaginoplasty (BV) procedures.

Study design

Repeat BV (reBV) procedure was done for one case, and a ruptured catheter's end to new catheter's end (ENE) procedure was done for two cases. The anatomic and functional outcomes of reBV and ENE are presented.

Results

Balloon rupture and deflation were encountered in a total of 3/45 cases who had undergone BV procedures. Replacement time was 22 min for reBV, and 9 and 10 min for ENE. General anesthesia was needed in the reBV case. Post-operative course and final outcomes were generally good but objectively less favorable in the ENE than in the reBV case (neovaginal depths were 8.5 and 9.4 cm versus 11 cm, respectively). Penetration and satisfaction scores were increased up 85 points for both couples.

Conclusions

Balloon ruptures were reported in 3/45 cases undergoing balloon vaginoplasty. End to new catheter end replacement was a very fast and simple rescue procedure but its preliminary anatomical outcomes were less favorable than the outcomes obtained with the original or repeat procedure.     

Decentralizing postabortion care in Senegal with misoprostol for incomplete abortion

Objective

To expand access to postabortion care (PAC) services in Senegal by introducing misoprostol as a first-line treatment at the community level.

Methods

The present prospective study enrolled 481 women seeking treatment for incomplete abortion at 11 community health posts in Senegal between September 2011 and August 2012. Participants were given 400 μg of sublingual misoprostol and asked to return to the clinic 1 week later to confirm clinical status. At study completion, all women were asked to respond to a series of questions regarding their experience with this method. All care was provided by nurse midwives.

Results

All but three of the study women (99.4%; 474/477) had successful complete abortion after taking misoprostol. Almost all women were satisfied or very satisfied with the treatment (99.6%; 469/471), would select the method again if needed (98.9%; 465/470), and would recommend the method to a friend (99.8%; 468/469).

Conclusion

The results provide further evidence that 400 μg of misoprostol is highly effective for first-line treatment of incomplete abortion. Furthermore, this regimen can be fully provided by nurse midwives, and can be easily and successfully introduced in community health settings where other methods of PAC may not previously have been available. Clinicaltrials.gov: NCT01939457     

Acceptability and feasibility of medical abortion with mifepristone and misoprostol in Nigeria

Objective

To examine the acceptability and feasibility of medical abortion in Nigeria.

Methods

In total, 250 women who were eligible for legal pregnancy termination with a gestational age of up to 63 days since last menstrual period were enrolled in Benin City and Zaria between May 2005 and October 2006. Participants received 200 mg of oral mifepristone in the clinic and then took 400 μg of oral misoprostol 2 days later—choosing to either return to the clinic or take it at home. Women returned 2 weeks later for an assessment of abortion status.

Results

The vast majority (96.3%) of women had successful complete abortions. Ultrasound was used to determine outcome in less than one-third (28.9%) of participants. Most women (83.2%) took the misoprostol at home. Almost all (96.2%) participants were satisfied or very satisfied with the abortion method.

Conclusion

The introduction of medical abortion with mifepristone and misoprostol could greatly expand current method options and improve the quality of reproductive health care in Nigeria and other settings in which access to legal abortion services is limited.     

Índice de masa corporal y aumento de peso en el embarazo. Resultado obstétrico de la inducción de parto

Objective

To determine the obstetric results of labor induction in relation to body mass index (BMI) and gestational weight gain at the Leon Hospital between January and March, 2008.

Material and method

We conducted a prospective cohort study of 127 labor inductions. The variables included were the medical reason for induction, the procedures employed for cervical ripening and induction, maternal age at the end of pregnancy, type of labor, parity, initial Bishop's score, BMI, weight, height, gestational weight gain, neonatal weight and Apgar test at 1 and 5 minutes.

Results

Inductions were performed in 21.3% of births, while vaginal delivery was achieved in 81.1%. A total of 36.2% of the patients were overweight, 21.2% were obese and 4.7% were morbidly obese.

Conclusions

A non-statistically significant association was observed between failure of vaginal delivery and BMI (P = .08) and body weight gain (P = .07). These two variables seem to increase the chances of failure of cervical ripening and induction of labor, increasing the percentage of cesarean sections.     

Association between gestational age and induction-to-abortion interval in mid-trimester pregnancy termination using misoprostol

Objective

The study was aimed to evaluate the effectiveness, outcome, and pain intensity of the vaginal administration of misoprostol for the induction of abortion between 13 and 24 gestational weeks.

Study design

A retrospective study was conducted at our tertiary medical center from January 2006 to December 2009 on 122 consecutive women who underwent termination of pregnancy (TOP) in the mid-trimester. They were given 400 mcg of vaginal misoprostol every 6 h, up to four doses. The induction-to-abortion interval and the level of pain experienced during the process were assessed. Success was defined by the fetus being expelled within 48 h.

Results

Vaginal misoprostol was effective in 84% (98/122) of patients. The median duration of the induction-to-abortion interval was 16 (5-48) h. The induction-to-abortion interval was correlated with gestational age, while inversely correlated with parity. A correlation was also found between gestational age and pain intensity at 12 h from induction.

Conclusion

Misoprostol is safe and effective in mid-trimester abortion induction. The induction-to-abortion interval is shorter and abortion less painful with lower gestational age. Higher parity is also associated with shorter induction to abortion interval.