Termination of Pregnancy at Term

武功密笈

小黃藏書

OBS
GYN
Gyn Oncology
Infertility
Urogynecology

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Termination of Pregnancy

　

* Indications for medical abortion:

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. Medical methods:
  1. Misoprostol (PGE1 analogue)

    2. 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. Medical methods:
  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):

    2. Cervical preparation before abortion is needed.

  2. Hysterotomy :

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

  3. Hysterectomy

　

< Contraindications of Prostaglandins >

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

　

< References >

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

    2. 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