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Increased risk for medical abortion failure for multiparous women
International Journal of Gynecology and Obstetrics (2004) 87, 174–175
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Increased risk for medical abortion failure for multiparous women ¨ki*, H. Martikainen, A. Talvensaari-Mattila M. Niinima Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland Received 12 May 2004; received in revised form 25 June 2004; accepted 30 June 2004
KEYWORDS Medical abortion; Curettage; Multiparity
Medical pregnancy termination with mifepristone and misoprostol has shown to be an effective and safe alternative to surgical vacuum aspiration. The success rate is generally over 90%, and serious complications seem to be rare [1]. A failure in medical abortion is defined as the need for curettage for any reason. The success of the abortion has been routinely confirmed by transvaginal ultrasonography (TVS) about 2 weeks after medical abortion. The aim of this study was to find out predictive factors for failure in the first trimester medical abortion. We analyzed 2-year results with medical abortion using 200 mg mifepristone (Mifegyne; Exelgyn Laboratoires, France) orally and misoprostol (Cytotec; Pfizer, USA) 0.8 mg vaginally 1–3 days later. All 316 consecutive women with a gestation * Corresponding author. E-mail address: [email protected] (M. Niinima ¨ki).
63 days or less choosing medical abortion were analyzed by demographic data, complications and efficacy of the treatment. The gestation and the location of pregnancy were confirmed by TVS. Urine human chorion gonadotropin (U-hCG) testing was made 4–5 weeks later to control successful abortion. Demographic data is seen in Table 1. Curettage was needed in 29 (9.2%) cases. Age ( P=0.0003), previous pregnancies ( P=0.008) or live births ( P=0.0001) had statistically significant association with curettage. In logistic regression, the risk for curettage was 4.4-fold when a patient had three previous live births or more (Table 2). In previous studies, various factors have been found to indicate the success of the medical abortion. Parity has been associated in lower complete abortion rate in previous studies [2], but also gestation [3] and previous pregnancy terminations [4]. Medical abortion may not be the best choice for multiparous women when planning termination of pregnancy. In our study, the risk for curettage was more than fourfold when there were three live births or more. The limitation of this study is a quite small sample size, but as the risk factors for failure are still unclear, more studies emphasizing on this issue are needed. In our protocol, routine
0020-7292/$ - see front matter D 2004 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2004.06.025
Increased risk for medical abortion failure for multiparous women Table 1 The characteristics of the patients (n=316) and complete abortion rates by demographic data n
%
Complete abortion (%)
v 2-test significance
Age 19 years or less 20–39 years 40 years or more
66 238 12
20.9 75.3 3.8
93.9 91.6 58.3
Gestation (days) 49 or less 50–63
190 126
60.1 39.9
90.5 91.3
NS
Pregnancies One or two Three or more
192 124
60.8 39.2
94.3 85.6
0.008
Live births Zero One or two Three or more
167 109 40
52.8 34.5 12.7
94.0 92.7 72.5
0.0001
Miscarriages Zero One or two Three or more
284 31 1
89.9 9.8 0.3
91.5 83.9 100.0
NS
Induced abortions Zero 232 One or two 78 Three or more 6
73.4 24.7 1.9
91.4 91.0 66.7
NS
All
316
100
0.0003
Table 2
175
Logistic multivariate regression B
Age 40+ years Gestation 50+ days Live births 1 or 2 3+ Constant
S.E.
P-value
95%CL OR
lcl
ucl
1.473
0.683
0.031
4.36
1.14
16.63
0.03
0.421
0.943
1.03
0.45
2.35
1.15 4.44
0.43 1.61
3.04 12.21
0.008 0.139 1.491 2.782
0.497 0.516 0.373
0.78 0.004 0
clinical examination) were made. With this costeffective protocol, it is possible to save medical resources by avoiding routine gynecological controls and TVS examinations.
References
90.8
TVS examination was not used. All the patients had U-hCG test done within 5 weeks, and if the test was positive, further examinations (TVS, serum hCG,
[1] Hausknecht R. Mifepristone and misoprostol for early medical abortion: 18 months experience in the United States. Contraception 2003;67:463–5. [2] Child TJ, Thomas J, MacKenzie IZ. A comparative study of surgical and medical procedures: 932 pregnancy terminations up to 63 days gestation. Hum Reprod 2001;16: 67–71. [3] Kahn JG, Becker BJ, MacIsaa L, Amory JK, Neuhaus J, Olkin I, et al. The efficacy of medical abortion: a meta-analysis. Contraception 2000;61:29–40. [4] Ashok PW, Templeton A, Wagaarachchi PT, Flett GMM. Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases. BJOG 2002;109:1281–9.
www.elsevier.com/locate/ijgo
BRIEF COMMUNICATION
Increased risk for medical abortion failure for multiparous women ¨ki*, H. Martikainen, A. Talvensaari-Mattila M. Niinima Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland Received 12 May 2004; received in revised form 25 June 2004; accepted 30 June 2004
KEYWORDS Medical abortion; Curettage; Multiparity
Medical pregnancy termination with mifepristone and misoprostol has shown to be an effective and safe alternative to surgical vacuum aspiration. The success rate is generally over 90%, and serious complications seem to be rare [1]. A failure in medical abortion is defined as the need for curettage for any reason. The success of the abortion has been routinely confirmed by transvaginal ultrasonography (TVS) about 2 weeks after medical abortion. The aim of this study was to find out predictive factors for failure in the first trimester medical abortion. We analyzed 2-year results with medical abortion using 200 mg mifepristone (Mifegyne; Exelgyn Laboratoires, France) orally and misoprostol (Cytotec; Pfizer, USA) 0.8 mg vaginally 1–3 days later. All 316 consecutive women with a gestation * Corresponding author. E-mail address: [email protected] (M. Niinima ¨ki).
63 days or less choosing medical abortion were analyzed by demographic data, complications and efficacy of the treatment. The gestation and the location of pregnancy were confirmed by TVS. Urine human chorion gonadotropin (U-hCG) testing was made 4–5 weeks later to control successful abortion. Demographic data is seen in Table 1. Curettage was needed in 29 (9.2%) cases. Age ( P=0.0003), previous pregnancies ( P=0.008) or live births ( P=0.0001) had statistically significant association with curettage. In logistic regression, the risk for curettage was 4.4-fold when a patient had three previous live births or more (Table 2). In previous studies, various factors have been found to indicate the success of the medical abortion. Parity has been associated in lower complete abortion rate in previous studies [2], but also gestation [3] and previous pregnancy terminations [4]. Medical abortion may not be the best choice for multiparous women when planning termination of pregnancy. In our study, the risk for curettage was more than fourfold when there were three live births or more. The limitation of this study is a quite small sample size, but as the risk factors for failure are still unclear, more studies emphasizing on this issue are needed. In our protocol, routine
0020-7292/$ - see front matter D 2004 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijgo.2004.06.025
Increased risk for medical abortion failure for multiparous women Table 1 The characteristics of the patients (n=316) and complete abortion rates by demographic data n
%
Complete abortion (%)
v 2-test significance
Age 19 years or less 20–39 years 40 years or more
66 238 12
20.9 75.3 3.8
93.9 91.6 58.3
Gestation (days) 49 or less 50–63
190 126
60.1 39.9
90.5 91.3
NS
Pregnancies One or two Three or more
192 124
60.8 39.2
94.3 85.6
0.008
Live births Zero One or two Three or more
167 109 40
52.8 34.5 12.7
94.0 92.7 72.5
0.0001
Miscarriages Zero One or two Three or more
284 31 1
89.9 9.8 0.3
91.5 83.9 100.0
NS
Induced abortions Zero 232 One or two 78 Three or more 6
73.4 24.7 1.9
91.4 91.0 66.7
NS
All
316
100
0.0003
Table 2
175
Logistic multivariate regression B
Age 40+ years Gestation 50+ days Live births 1 or 2 3+ Constant
S.E.
P-value
95%CL OR
lcl
ucl
1.473
0.683
0.031
4.36
1.14
16.63
0.03
0.421
0.943
1.03
0.45
2.35
1.15 4.44
0.43 1.61
3.04 12.21
0.008 0.139 1.491 2.782
0.497 0.516 0.373
0.78 0.004 0
clinical examination) were made. With this costeffective protocol, it is possible to save medical resources by avoiding routine gynecological controls and TVS examinations.
References
90.8
TVS examination was not used. All the patients had U-hCG test done within 5 weeks, and if the test was positive, further examinations (TVS, serum hCG,
[1] Hausknecht R. Mifepristone and misoprostol for early medical abortion: 18 months experience in the United States. Contraception 2003;67:463–5. [2] Child TJ, Thomas J, MacKenzie IZ. A comparative study of surgical and medical procedures: 932 pregnancy terminations up to 63 days gestation. Hum Reprod 2001;16: 67–71. [3] Kahn JG, Becker BJ, MacIsaa L, Amory JK, Neuhaus J, Olkin I, et al. The efficacy of medical abortion: a meta-analysis. Contraception 2000;61:29–40. [4] Ashok PW, Templeton A, Wagaarachchi PT, Flett GMM. Factors affecting the outcome of early medical abortion: a review of 4132 consecutive cases. BJOG 2002;109:1281–9.