tailieunhanh - Labor induction abortion in the second trimester

 Labor induction abortion is effective throughout the second trimester. Patterns of use and gestational age limits vary by locality. Earlier gestations (typically 12 to 20 weeks) have shorter abortion times than later gestational ages, but differences in complication rates within the second trimester according to gestational age have not been demonstrated. The combination of mifepristone and misoprostol is the most effective and fastest regimen. Typically, mifepristone 200 mg is followed by use of misoprostol 24–48 h later. Ninety-five percent of abortions are complete within 24 h of misoprostol administration. | ARTICLE IN PRESS Sn SOCIETY of FAMILY PIANNING I research education and leadership Contraception xx 2011 xxx - xxx Clinical Guidelines Labor induction abortion in the second trimester Release date February 2011 SFP Guideline 20111 Abstract Labor induction abortion is effective throughout the second trimester. Patterns of use and gestational age limits vary by locality. Earlier gestations typically 12 to 20 weeks have shorter abortion times than later gestational ages but differences in complication rates within the second trimester according to gestational age have not been demonstrated. The combination of mifepristone and misoprostol is the most effective and fastest regimen. Typically mifepristone 200 mg is followed by use of misoprostol 24-48 h later. Ninety-five percent of abortions are complete within 24 h of misoprostol administration. Compared with misoprostol alone the combined regimen results in a clinically significant reduction of 40 to 50 in time to abortion and can be used at all gestational ages. However mifepristone is not widely available. Accordingly prostaglandin analogues without mifepristone most commonly misoprostol or gemeprost or high-dose oxytocin are used. Misoprostol is more widely used because it is inexpensive and stable at room temperature. Misoprostol alone is best used vaginally or sublingually and doses of 400 mcg are generally superior to 200 mcg or less. Dosing every 3 h is superior to less frequent dosing although intervals of up to 12 h are effective when using higher doses 600 or 800 mcg of misoprostol. Abortion rates at 24 h are approximately 80 -85 . Although gemeprost has similar outcomes as compared to misoprostol it has higher cost requires refrigeration and can only be used vaginally. High-dose oxytocin can be used in circumstances when prostaglandins are not available or are contraindicated. Osmotic dilators do not shorten induction times when inserted at the same time as misoprostol however their use prior to induction .