First trimester termination of pregnancy

Publication date: Available online 12 July 2019Source: Best Practice & Research Clinical Obstetrics & GynaecologyAuthor(s): Man-Wa Lui, Pak-Chung HoAbstractFirst trimester termination of pregnancy (TOP) is a safe and effective procedure. The complete abortion rates of surgical and medical abortion are around 97% and 95% respectively. Vacuum aspiration (VA) either by electrical suction or manual aspiration is the method of choice for surgical TOP. Risk of significant bleeding is <= 5% in VA while major complications occur in <1%. The risk of infection after VA can be reduced significantly by the use of prophylactic antibiotics or by the screen-and-treat strategy. Pre-operative administration of misoprostol can also reduce the risk of complications. The combination of 200mg mifepristone followed by 800microgram misoprostol 24-48 hours later is recommended for first trimester medical TOP. If mifepristone is not available, misoprostol can also be used alone but repeated doses may be required and the complete abortion rate may be lower. Due to the reduced efficacy in more advanced gestation, repeated doses of misoprostol may be required for medical TOP over 9 weeks of gestation. The complete abortion rate with this regimen is 95% or more. Gastrointestinal upsets can happen in up to 50% of women, but major complications are rare. There was no lower limit of gestational week for TOP, although extra precaution is required for confirmation of completion of procedures and exclu...
Source: Best Practice and Research Clinical Obstetrics and Gynaecology - Category: OBGYN Source Type: research