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Curr Opin Obstet Gynecol. 1992 Aug;4(4):506-12.

Abortion: epidemiology, safety, and technique.

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Department of Obstetrics and Gynecology, Francis Scott Key Medical Center, Baltimore, MD 21224.


In 1991, the abortion literature was characterized by articles relating to 1) epidemiologic issues in abortion care, 2) advances in knowledge and experience with medical abortifacients such as mifepristone (RU 486), and 3) cervical ripening prior to abortion with the use of both mifepristone and prostaglandins. Technical methods of achieving termination of pregnancy continue to be similar in the United States, the United Kingdom, and Europe, although induction-abortion times are generally slower in Europe than in the United States. Surgically, dilatation and evacuation procedures continue to be more common in the United States than in other countries. The effectiveness of mifepristone is undisputed, and the recommended dose for early first-trimester termination is being compared with lower dose alternative regimens. There is additional evidence that at least in the short term, the negative psychological sequelae of abortion are infrequent and are inconsequential as a public health issue.


In 1991, the abortion literature comprised articles on epidemiologic issues in abortion care advances in abortifacient such as mifepristone (RU-486) and cervical ripening prior to abortion with the use of both mifepristone and prostaglandins. A comprehensive analysis of American women having abortions indicated that although the overall abortion rate had declined since 1980, the rate of unintended pregnancies had remained the same since 1982. Among married, white women over age 30 and white, unmarried women in their twenties abortion rates declined. A prospective cohort study showed no overall differences in nonviable pregnancy outcome, birth weight, and length of gestation between 6188 women who had an abortion and 7073 who did not. In most developed countries prostaglandins are widely used for termination of pregnancy in the 2nd trimester, either as an intra-amniotic or extra-amniotic preparation. In a retrospective analysis, oxytocin was quite effective in achieving rapid, uncomplicated fetoplacental expulsion. It had a mean induction-to-delivery interval of 8.2 (+ or - 5.1) hours, which was significantly better than a mean induction-to-delivery interval of 13.1 (+ or - 7.8) hours in the group that had received prostaglandin E2 suppositories. The World Health Organization estimated that 22-56% of maternal mortality is directly attributable to abortion. In Enugu, Nigeria, the mortality rate from incomplete abortion amounted to 17.9%, and septicemia was documented in 49% of cases. Cervical pretreatment prior to a 2nd-trimester abortion has become standard in many institutions. In a double-blind, double-randomized trial both mifepristone and gemeprost resulted in a cervix that required less force to dilate to 9 mm (P 0.001). The gemeprost group had significantly more side effects than the mifepristone group. Mifepristone is a safe alternative for the termination of pregnancy when the beta human chorionic gonadotropin is below 20,000 IU/L. In spite of the small sample size (n = 50) and a rather high 12% rate of postabortal pelvic inflammatory disease, when the beta human chorionic gonadotropin decreased by at least 40% in the 1st week after receiving mifepristone, the abortion procedure was invariable complete.

[Indexed for MEDLINE]

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