Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series
Objective: Document the clinical outcomes of an outpatient medical management with procedural evacuation backup procedure for abortions between 18 weeks zero days to 23 weeks six days gestation. Study design: We conducted a retrospective medical records review of adult patients who received mifepris...
| Main Authors: | , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2024-01-01
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| Series: | Contraception: X |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2590151624000017 |
| _version_ | 1797262873137774592 |
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| author | Sruthi Chandrasekaran Samantha Ruggiero Gabrielle Goodrick |
| author_facet | Sruthi Chandrasekaran Samantha Ruggiero Gabrielle Goodrick |
| author_sort | Sruthi Chandrasekaran |
| collection | DOAJ |
| description | Objective: Document the clinical outcomes of an outpatient medical management with procedural evacuation backup procedure for abortions between 18 weeks zero days to 23 weeks six days gestation. Study design: We conducted a retrospective medical records review of adult patients who received mifepristone and repeated misoprostol for second trimester abortion with procedural evacuation backup at an Arizona clinic between October 2017 and November 2021. We extracted patient demographics; pregnancy and medical history; and preoperative, intraoperative, and postoperative data. We assessed abortion outcomes, including procedure timing, mode of completion (medication alone or medications and procedural evacuation), and safety. Results: All 359 patients had a complete abortion with 63.5% of patients completing with medication alone and 36.5% with procedural evacuation backup. The median time from first dose of misoprostol to fetal expulsion was six hours, among those who completed the abortion with medications alone. Of those who received procedural evacuation as backup, the median time for procedural evacuation was 10 minutes. The vast majority of patients (99.4%) did not have any adverse events. Two safety incidents (0.6%) occurred, a broad right ligament tear and a uterine rupture. Conclusion: Patients in one outpatient setting safely and effectively received medical management of second trimester abortion with procedural evacuation backup, and two thirds completed with medications alone. Implications: Outpatient settings may consider medical management of abortion between 18 and 24 weeks with procedural evacuation back-up as a safe, effective, and manageable second trimester abortion option. Additional research is needed on patient experience and satisfaction. |
| first_indexed | 2024-04-25T00:04:01Z |
| format | Article |
| id | doaj.art-b2531ddad98843a0968139db75a3f00b |
| institution | Directory Open Access Journal |
| issn | 2590-1516 |
| language | English |
| last_indexed | 2024-04-25T00:04:01Z |
| publishDate | 2024-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Contraception: X |
| spelling | doaj.art-b2531ddad98843a0968139db75a3f00b2024-03-14T06:15:58ZengElsevierContraception: X2590-15162024-01-016100104Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case seriesSruthi Chandrasekaran0Samantha Ruggiero1Gabrielle Goodrick2Ibis Reproductive Health, Cambridge, MA, USAIbis Reproductive Health, Cambridge, MA, USA; Corresponding author.Camelback Family Planning, Phoenix, AZ, USAObjective: Document the clinical outcomes of an outpatient medical management with procedural evacuation backup procedure for abortions between 18 weeks zero days to 23 weeks six days gestation. Study design: We conducted a retrospective medical records review of adult patients who received mifepristone and repeated misoprostol for second trimester abortion with procedural evacuation backup at an Arizona clinic between October 2017 and November 2021. We extracted patient demographics; pregnancy and medical history; and preoperative, intraoperative, and postoperative data. We assessed abortion outcomes, including procedure timing, mode of completion (medication alone or medications and procedural evacuation), and safety. Results: All 359 patients had a complete abortion with 63.5% of patients completing with medication alone and 36.5% with procedural evacuation backup. The median time from first dose of misoprostol to fetal expulsion was six hours, among those who completed the abortion with medications alone. Of those who received procedural evacuation as backup, the median time for procedural evacuation was 10 minutes. The vast majority of patients (99.4%) did not have any adverse events. Two safety incidents (0.6%) occurred, a broad right ligament tear and a uterine rupture. Conclusion: Patients in one outpatient setting safely and effectively received medical management of second trimester abortion with procedural evacuation backup, and two thirds completed with medications alone. Implications: Outpatient settings may consider medical management of abortion between 18 and 24 weeks with procedural evacuation back-up as a safe, effective, and manageable second trimester abortion option. Additional research is needed on patient experience and satisfaction.http://www.sciencedirect.com/science/article/pii/S2590151624000017Dilation and evacuation (D&E)Induction abortionLater abortionMedication abortionMifepristoneSecond-trimester abortion |
| spellingShingle | Sruthi Chandrasekaran Samantha Ruggiero Gabrielle Goodrick Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series Contraception: X Dilation and evacuation (D&E) Induction abortion Later abortion Medication abortion Mifepristone Second-trimester abortion |
| title | Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series |
| title_full | Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series |
| title_fullStr | Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series |
| title_full_unstemmed | Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series |
| title_short | Outpatient medical management of later second trimester abortion (18–23.6 weeks) with procedural evacuation backup: A large case series |
| title_sort | outpatient medical management of later second trimester abortion 18 23 6 weeks with procedural evacuation backup a large case series |
| topic | Dilation and evacuation (D&E) Induction abortion Later abortion Medication abortion Mifepristone Second-trimester abortion |
| url | http://www.sciencedirect.com/science/article/pii/S2590151624000017 |
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