DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20162129

Case control study of supervised and unsupervised medical abortion in first trimester of pregnancy

Shikha Verma, Rita Ranjan, Megha Batra

Abstract


Background: The MTP act of India 1971 provides for the termination of pregnancy up to 20 weeks of gestation, by a registered medical practitioner, provided all the prerequisites are fulfilled. The objective of this study was to conduct case control study of supervised and unsupervised medical abortion in first trimester of pregnancy.

Methods: A case control study was conducted with two groups of patients with period of gestation <9 weeks. Case group consist of 30 patients presenting to emergency department with unsupervised intake of medical abortion pill. Control group consist of 30 patients presenting to family planning outpatient department want medical abortion pill under supervision. The main outcome variables were comparison of success rate, failure rate, complications like pain, fever, heavy bleeding, shock, requirement of blood transfusion. Interventions required were compared in both the groups in terms of medical management, surgical evacuation and laparotomy.

Results: In our study, the success rate achieved in terms of complete abortion was 66.7% in the supervised and 13.3% in the unsupervised group with (p value <0.001). The complication rate was 60% in the supervised group in contrast to 93.3% in the unsupervised group. 56.7% patients in unsupervised group required blood transfusion which was nil in supervised groups. 71.4% patients in the supervised group did not require intervention. In the unsupervised group, 13.8% required medical management, 65.5% required surgical evacuation and 6.7% had to undergo laparotomy for ectopic pregnancy.

Conclusions: In present study we conclude that first trimester medical abortion under supervision is more effective, safe and convenient as compared to unsupervised medical abortion. We recommend that government must stop over the counter sell of medical abortion pills.


Keywords


Medical abortion, Ultrasound, Mifepristone, Misoprostol

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References


Kulier R, Gülmezoglu AM, Hofmeyr GJ, Cheng LN, Campana A. Medical methods of first trimester abortion. Cochrane Database of Systematic review. 2011;(2):CD002855.

International consensus conference on non-surgical medical abortion in early first trimester on issues related to regimens and service delivery. Frequently asked questions about medical abortion, Geneva; 2006.

Ellertson C, Waldman SN. The Mifepristone- misoprostol regimen for early abortion. World Health Rep. 2011;1;184-90.

Clinical practice guideline: miscarriage management from Royal Women’s Hospital; 2010.

Ojha N, Bista KD. Situation analysis of patients attending TU teaching hospital after medical abortion with problems and complications JNMAN Nepal. Med Association. 2013;53(19):466-70.

Thakar RV, Deliwala KJ, Shah PT. Self-medication of abortion pill. Women Health in Jeopardy. NHL Journal of Medical Sciences. 2014;3(1):26-31.

Mishra N. Unpreceded use of medical abortion can be injurious to health. Journal of Evaluation of Medical and Dental Sciences. 2013;2:856.

Deshpande S, Yelikar K, Deshmukh A, Kanade K. Comparative study of medical abortion by mifepristone with vaginal misoprostol in women <49 days versus 50-63 days of amenorrhea. J of Obstetrics and Gynaecology of India. 2010;60(5):403-7.

Faucher P, Baunot N, Madelenet P. The efficacy and acceptability of mifepristone medical abortion with home administration of misoprostol provided by private providers linked with the hospitals. Gynecol Obstet Fertility. 2005;33(4):220-7.

Schaff EA, Stadalius LS, Eisingr SH, Franks P. Vaginal misoprostol self-administered at home after mifepristine for abortion. J fam ptarc. 1997;44(4):353-60.