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11- ABSTRACT:
A group of 120 women with gestations from 64 to 84 days received 800 micrograms of vaginal misoprostol every 24 h for a maximum of three doses without performing postexpulsion systematic preventive curettage. Outcome measures included successful abortion (complete abortion without requiring a surgical procedure), side effects, and mean time of expulsion and vaginal bleeding.
Complete abortion occurred in 104 of 120 (87%, 95% CI 79, 92) subjects. The decrease of hemoglobin was statistically significant (p = 0.0001) but clinically unimportant: 12.2 mg/dL (SD 1.1) before treatment and 11.6 mg/dL (SD 1.0) after treatment. Statistically significant differences were found only between the success rates for white women in comparison with nonwhite women, in which case the success rates were higher for white than for nonwhite women. Vaginal bleeding lasted 8 +/- 5 days, spotting 4 +/- 3, and total bleeding 12 +/- 4 days. The acceptable expulsion time, the fact that postabortion systematic curettage was not needed, the clinically insignificant hemoglobin loss, and the success rate obtained show that misoprostol administered vaginally may be a valid method for interrupting gestations of 10-12 weeks.
NLM PUBMED CIT. ID: 9673840
SOURCE: Contraception 1998 May;57(5):329-33.
12-ABSTRACT:
Pregnancy was terminated by repeated doses of vaginal misoprostol in 20 women at a gestational age of less than 9 weeks.
The women were given 800 microg of vaginal misoprostol as an initial dose followed by 400 microg of vaginal misoprostol every 3 h for 4 doses.
Fourteen women (70%, 95% confidence interval: 48 85%) had a complete abortion. Two women (10%) had a missed abortion, and two (10%) had an ongoing pregnancy. Two women ( 10%) had an incomplete abortion. The interval between the first dose of misoprostol and the passage of tissue mass was 25.3 +/- 34.4 h (median: 15 h).The duration of vaginal bleeding was 23.6 +/- 20.4 days (median: 14 days). Side-effects were mild and there was no significant drop in hemoglobin level.
Repeated doses of vaginal misoprostol may be an alternative for women who do not want surgical abortion and who live in an area where mifepristone is not available.
NLM PUBMED CIT. ID: 11019952
SOURCE: Adv Contracept 1999;15(3):211-6.
13- ABSTRACT:
Increased access to medical methods of abortion could significantly reduce maternal mortality, especially in developing countries.
In light of the political and commercial difficulties in distributing the abortifacient mifepristone, the widely studied mifepristone-misoprostol regimen may not be sufficiently available in the near future. Thus, researchers have begun to look for alternative regimens, including regimens using misoprostol alone.
This article reviews the current available evidence on the potential of a misoprostol-alone regimen for medical abortion. Although the data are varied and difficult to compare, recent studies indicate that a misoprostol-alone regimen could be safe and effective as a method of medical abortion. Misoprostol is widely marketed around the world for its other indications and is inexpensive, stable in tropical climates, easy to transport, and simple to administer. A misoprostol-alone regimen of medical abortion could thus greatly improve the access to safe medical abortion services by women in developing countries.
NLM PUBMED CIT. ID: 10457864
SOURCE: Contraception 1999 Apr;59(4):209-17.
14- ABSTRACT:
This study evaluated the effectiveness of a single dose of the abortifacient effect of vaginal misoprostol followed by prolonged observation.
Women with < or =42 days of amenorrhea, pregnancy confirmed by ultrasound, and approved request for termination received 800 microg of vaginal misoprostol once and were observed for 1 week. The gestational sac was measured before misoprostol administration, and 24 h and 7 days afterward. Women reported bleeding, expulsion of sac, and other complaints.
After 1 week, those who had not aborted received a second dose of 800 microg. Those who had not aborted by 24 h later were treated by vacuum aspiration of the endometrial cavity.
Twenty-four hours after treatment, 71.8% had aborted, and 87.1% aborted 3 days after treatment. After the second dose, 7 days later, the cumulative abortion rate reached 92.1%. None of the subjects who aborted required curettage or vacuum aspiration.
The main complaints were pain (84.5%), nausea (21.4%), and headache (17.5%). No clinical differences between responders and nonresponders was found.
Vaginal misoprostol, 800 microg, is effective in inducing early termination of pregnancy, and there is no need for an additional dose within 72 h after the first administration of misoprostol.
NLM PUBMED CIT. ID: 10745069
SOURCE: Contraception 2000 Jan;61(1):47-50.
15- ABSTRACT:
OBJECTIVE: The effectiveness and safety of misoprostol have been reported for abortion up to 22 weeks' gestation.
The objective of this study was to demonstrate the effectiveness and safety of self-administration of misoprostol every 12 h, without the need of postexpulsion systematic curettage, in late first-trimester abortions (10-13 weeks' gestation).
METHODS: A group of 180 women with gestations from 64 to 91 days, self-administered 800 micrograms of vaginal misoprostol every 12 h for a maximum of three doses without performing postexpulsion systematic preventive curettage. Outcome measures included successful abortion (complete and incomplete abortion without requiring a surgical procedure), side-effects, mean expulsion time and vaginal bleeding.
RESULTS: Successful abortion occurred in 153/180 (85%) subjects (95% confidence interval (CI) 79-90). The decrease of hemoglobin was statistically significant (p = 0.0001) but clinically unimportant: 12.1 mg/dl (SD 1.1) before treatment and 11.7 mg/dl (SD 1.1) afterwards. The mean expulsion time for patients who aborted after the first dose was 8.3 +/- 3.6 h (median 8 h, range 2-12 h). Vaginal bleeding lasted 6 +/- 3 days, spotting 7 +/- 3 days and total bleeding 13 +/- 4 days. The median dose of misoprostol administered was 1780 micrograms (range 1400-3000 micrograms).
CONCLUSIONS: The high degree of acceptability, its efficacy and the fact that postabortion systematic curettage was not needed make misoprostol a suitable alternative to the currently available methods for termination of pregnancy at 10-13 weeks' gestation.
NLM PUBMED CIT. ID: 10367194
SOURCE: Eur J Contracept Reprod Health Care 1999 Mar;4(1):35-40
16- ABSTRACT:
The objective of this study was to confirm the effectiveness and safety of self-administration of misoprostol every 24 h, for abortion up to 9 weeks of gestation.
A group of 720 volunteer subjects with gestations from 35 to 63 days received 800 micrograms of vaginal misoprostol every 24 h up to a maximum of three main doses for abortion.
Outcome measures assessed included successful abortion (complete abortion without requiring surgery), side effects, decrease in hemoglobin, mean time of vaginal bleeding, and mean time of return of menses.
Complete abortion occurred in 644 of 720 (89.4%, 95% CI 87, 92) subjects. The mean decrease in hemoglobin was statistically significant (p = 0.0001). There were 14 subjects with clinically significant decreases in hemoglobin, but only two required transfusions. Vaginal bleeding lasted 6.7 +/- 3.9 days, spotting 8.1 +/- 4 days, and total bleeding 14 +/- 5.3 days. Mean expulsion time was 8.0 +/- 3.4 h.
Although mifepristone remains unavailable, given the low price and availability of misoprostol in > 72 countries of the world, this latter drug constitutes an abortion alternative, provided that a minimum clinical network is nearby or accessible.
NLM PUBMED CIT. ID: 10457865
SOURCE: Contraception 1999 Apr;59(4):219-25.
17- ABSTRACT:
Misoprostol shows promise for early termination of pregnancy. The drug is widely available, inexpensive, and easy to administer.
Current evidence on the efficacy of potential regimens for early abortion, though, is hard to decipher and often contradictory.
Research on a safe, effective, acceptable regimen of misoprostol alone for early abortion is underway. Available data show a wide range in efficacy of various regimens, and additional research is needed to understand this variability. A framework for additional research on misoprostol alone for medical abortion is presented with a focus on the need to evaluate benefits and risks of new regimens in the context of women's options for termination of pregnancy.
We discuss the potential usefulness of a regimen with less efficacy than approved medical abortifacients.
Research is needed as well on women's ability to self-diagnose incomplete abortion or ongoing pregnancy and the potential for misoprostol to be used as treatment for incomplete abortion in order to evaluate the benefits and risks of misoprostol-alone regimens.
NLM PUBMED CIT. ID: 10846336
SOURCE: J Am Med Womens Assoc 2000;55(3 Suppl):189-90.
18- ABSTRACT:
The objective of this study was to evaluate the efficacy and safety of the vaginal self-administration of 600 microg misoprostol up to a maximum administration of three doses in a 24-h period, one every 8 h, for abortion up to 9 weeks' gestation.
A group of 90 voluntary
women with gestations from 35 to 63 days participated in the study. All women who aborted received a single additional dose of 600 microg misoprostol.
Outcome measures included successful abortion (complete abortion without requiring surgical procedure) and side-effects.
Complete abortion occurred in 57/89 (64%, 95% confidence interval 53-74%) subjects. The mean expulsion time was 7.4 +/- 3.8 h (median 7.2 h, range 3-20 h) for all women who aborted within the first 24 h of the administration of misoprostol. Thirty-two cases failed to abort, 28 cases due to failure of the method, of which 24 had a negative cardiac rhythm after the third dose, and four cases due to the doctor's decision. The results obtained in this study led us to the conclusion that the 600-microg misoprostol dose regimen was not adequate to produce a high or an acceptable abortive efficacy.
NLM PUBMED CIT. ID: 10836662
SOURCE: Eur J Contracept Reprod Health Care 2000 Mar;5(1):46-51.
19- ABSTRACT:
OBJECTIVE--To compare the safety and efficacy of early abortion by administration of methotrexate and misoprostol vs administration of misoprostol alone.
DESIGN--Randomized controlled trial.
SETTING--San Francisco (Calif) General Hospital.
PATIENTS--Pregnant women at 56 days' gestation or less seeking elective abortion. Sixty-three women volunteered for the trial; 61 completed the study and are included in the analysis.
INTERVENTION--Intramuscular administration of 50 mg of methotrexate per square meter of body surface area followed 3 days later by vaginal administration of 800 micrograms of misoprostol (group 1) or the same dose of misoprostol given alone (group 2). The misoprostol dose was repeated 24 hours later if abortion had not occurred.
MAIN OUTCOME MEASURES--Successful abortion, duration of vaginal bleeding, side effects, and change in beta-human chorionic gonadotropin (beta-hCG) level. An abortion was considered successful if the pregnancy ended without requiring a surgical procedure.
RESULTS--Complete abortion occurred in 28 (90%) of 31 patients in group 1 and 14 (47%) of 30 patients in group 2 (P < .001). Seventeen (61%) of the 28 women in group 1 who aborted did so the same day as misoprostol administration; vaginal bleeding lasted a mean (+/- SD) of 10 (+/- 4) days, and beta-hCG level was less than or equal to 10 IU/L by a mean of 31 (+/- 6) days after methotrexate administration. The 11 other women in group 1 who aborted did so after a mean delay of 29 (+/- 11) days; vaginal bleeding lasted 7 (+/- 4) days, and beta-hCG level was less than or equal to 10 IU/L by a mean of 24 (+/- 11) days after the abortion. There were three
treatment failures in group 1: two ongoing pregnancies (6%) and one incomplete abortion (3%). For the 14 women with successful abortions in group 2, vaginal bleeding lasted a mean of 10 (+/- 6) days and beta-hCG level was less than or equal to 10 IU/L by mean of 39 (+/- 18) days after the misoprostol. There were 16 treatment failures in group 2: eight ongoing pregnancies (27%), and eight incomplete abortions (27%). Methotrexate side effects were minimal. Misoprostol side effects were diarrhea in 18% and nausea and vomiting in 5%.
CONCLUSIONS--Methotrexate and vaginal misoprostol are more effective than misoprostol alone. Both drugs are available throughout the United States, and both drugs are inexpensive. This combination may offer an alternative to the use of antiprogestin and prostaglandin for medical abortion.
NLM PUBMED CIT. ID: 7523739
SOURCE: JAMA 1994 Oct 19;272(15):1190-5.
20- ABSTRACT:
OBJECTIVE: To compare the efficacy of intramuscular methotrexate plus vaginal misoprostol to vaginal misoprostol alone in completing abortion in women with non-viable early first trimester pregnancy.
METHOD: Twenty-one women with non-viable pregnancy up to 49 days gestation were randomized to receive intramuscular methotrexate, followed 2 days later by vaginal misoprostol or misoprostol alone. We also collected patient satisfaction information.
RESULT: Complete abortion occurred in all 12 (100%) women in the combined group and
eight of nine (89%, RR = 1.13, CI 0.89-1.42) women in the misoprostol only group. Of the women, 75% rated their experience as good and would choose medical management again.
CONCLUSION: Either methotrexate plus misoprostol or misoprostol alone effectively
completed abortion in women with non-viable early pregnancy and represent acceptable medical alternatives to surgery or expectant management.
NLM PUBMED CIT. ID: 10576234
SOURCE: Int J Gynaecol Obstet 1999 Oct;67(1):9-13.
| 21- ABSTRACT:
OBJECTIVE: We sought to compare the acceptability of suction curettage abortion with that of medical abortion with mifepristone and misoprostol in American women.
STUDY DESIGN: We performed a prospective, serially enrolled, cohort analysis. The study population consisted of 152 subjects receiving mifepristone and misoprostol and 174 subjects undergoing suction curettage abortion aged > or =18 years with intrauterine pregnancies of up to 63 days' estimated gestation. Questionnaires regarding expectations and experiences were administered before the abortion and at the 2-week follow-up visit.
RESULTS: Subjects undergoing medical abortions reported significantly greater satisfaction than those undergoing surgical abortions (mean rank, 121 vs 149; P <.01) but were no more likely to recommend the method they had just experienced to a friend (97% vs 93.3%). If a future abortion was required, however, 41.7% of subjects undergoing surgical abortions indicated they would opt for a medical abortion, whereas only 8.6% of subjects receiving medical abortions would choose a surgical abortion (P <.001). Failure of the abortion decreased satisfaction in the medical group and increased the likelihood of choosing a surgical abortion for a subsequent procedure (P <.001). Surgical subjects who experienced more anxiety than expected during the abortion were more likely to choose a medical procedure for a subsequent abortion (P <.01).
CONCLUSION: Women receiving mifepristone and misoprostol were more satisfied with their method and more likely to choose the same method again than were subjects undergoing surgical abortion. Failure of a medical abortion and increased anxiety during surgical abortion were associated with preference for the alternative technique in a future procedure.
NLM PUBMED CIT. ID: 10871441
SOURCE: Am J Obstet Gynecol 2000 Jun;182(6):1292-9 | OBJECTIFS:
Nous avons pensé comparer l'acceptabilité de l'aspiration chirurgicale avec l'avortement médical chez les femmes Américaines.
Des questionnaires concernant les attentes et vécus furent distribués avant l'avortement et 2 semaines plus tard.
RESULTATS:
Les personnes ayant pratiqué l'avortement médical dirent d'une manière claire leur plus grande satisfaction que celles ayant eu recours à l'aspiration. Si c'était à refaire, 41.7% des personnes ayant eu une interruption chirurgicale choisiraient l'option médicale et seulement 8.6% de celles ayant eu un avortement médical choisiraient l'option chirurgicale.
NLM PUBMED CIT. ID: 10871441
SOURCE: Am J Obstet Gynecol 2000 Jun;182(6):1292-9.
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