武功密笈

小黃藏書

Termination of Pregnancy

　

I. Have intrauterine pregnancy and meet the criteria of medical abortion.

II. Are able and willing to have a surgical abortion if medication fails.

III. Understand the protocol and consent form.

IV. Do not have a contraindication to the drugs used.

　

< Recommendations for Termination in First Trimester >

1. Misoprostol (PGE1 analogue)

800��g for vaginal administration every 24-48 hours, up to 3 doses

(up to 56-84 days )

2. Mifepristone in combination with prostaglandin:

Mifepristone single oral dose of 600mg

Misoprostol 800��m vaginally at 36-48 hours

(up to 63 days )

1. Surgical methods:

Suction D & C

à The preparation of cervix with hydrophilic dilators, prostaglandins,

or mifepristone can enhance the safety and efficacy.

(esp: nulliparous: > 9wk; all women: > 12wk )

　

< Recommendations for Termination in Second Trimester>

1. Vaginal prostaglandin:

• Gemeprost: (PGE1 analogue)

1mg for vaginal pessary every 3 hours on up to 2 occasions in the first 24 hours and repeated the next day if necessary.

• Misoprostol: (PGE1 analogue)

I. 200��g inserted intracervically or vaginally q12h (13–27 weeks )

II. 800��g inserted vaginally (13-28weeks )

　

　

　

　

　

1. Extra-amniotic injection of prostaglandin:

1. Dinoprost (PGF2��n�w��

• Insertion of Foley catheter into intrauterine cavity and inject N/S 50cc in to Foley to fix it.
• Dilute 1 vial PGF2�� (5mg/1cc) with N/S 4cc
• PGF2�� 1mg/cc + N/S 3cc and injected this mixture 1cc into the Foley followed by N/S 5cc, if patient’s condition is stable, inject the remaining 3cc mixture following by N/S 5cc 30min later.
• PGF2�� 1mg/cc + N/S 3cc and injected this mixture into the Foley followed by N/S 5cc q1h X 4 times.

1. Surgical methods:

1. Dilatation and evacuation (D&E):

Cervical preparation before abortion is needed.

2. Hysterotomy :

This method is only necessary when abortion cannot be achieved safely through the vagina, uterine injury or hemorrhage during the abortion.

3. Hysterectomy

Bronchial asthma, severe cardiovascular disease, severe renal or liver diseases, cerebral convulsion, glaucoma (precaution with previous uterine surgery).

　

1. Medical methods for termination of pregnancy. Report of a WHO Scientific Group.

WHO Technical Report Series. 1997; 871: I-vii, 1-110

2. Medical abortion in early pregnancy: A review of the evidence.

Obstect Gynecol 1997; 89: 790-6

3. Misoprostol used alone for the termination of early pregnancy

Contraception 1999; 59: 209-217