Pregnancy termination: techniques, risks, and complications and their management.

Full Abstract

This article outlines the current modalities of pregnancy termination, as well as their risks and complications, in 3 phases of pregnancy: 1) up to 49 days past the last menstrual period, 2) 8-15 weeks, and 3) 16-24 weeks. Before 8 weeks of pregnancy, suction dilatation and curettage (D and C) is the preferred method. However, a medical approach, possibly self-administered, is viewed as more satisfactory and requires only an improvement in side effects. From 8-15 weeks' gestation, suction D and C and dilatation and evacuation (D and E) are the methods of choice. The use of laminaria tents improves both the facility and safety of these procedures in nulliparous patients and perhaps in multiparous patients. Priming of the cervix with prostaglandin could further decrease the difficulty and risks of these procedures. The use of a hydrogel compound is especially worthy of consideration. There is controversy about the preferred method between 16-20 weeks' gestation. D and E appears to have fewer complications and to be more cost-effective than hypertonic saline injection. Urea-prostaglandin has fewer and less severe complications than saline injection, and seems to be more cost-effective than saline injection in terms of duration of hospitalization. The high frequency of failure and side effects, combined with the possibility of expulsion of a live fetus, make prostaglandin-only injection less desirable. After 20 weeks' gestation, urea-prostaglandin injection is probably the safer method. Given the rapid increase in complications with passing weeks, any delay in providing late abortion services should be avoided. 2nd trimester pregnancy terminations, especially those after 18 weeks' gestation, are associated with increased mortality and morbidity and should be performed at specialized centers where providers are better equipped to manage complications.

Author information

Author/s: Castadot, R G (RG);

Journal and publication information

Publication Type: Comparative Study; Journal Article; Review

Journal: Fertility and sterility (Fertil Steril), published in UNITED STATES. (Language: eng)

Reference: 1986-Jan; vol 45 (issue 1) : pp 5-17

Dates: Created 1986/03/10; Completed 1986/03/10; Revised 2006/11/15;

PMID: 3510916, status: MEDLINE (last retrieval date: 2/18/2009, IMS Date: )

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Associated Chemicals: Abortifacient Agents (0) ; Hypertonic Solutions (0) ; Progestins (0) ; Prostaglandins E (0) ; Prostaglandins E, Synthetic (0) ; Prostaglandins F (0) ; Saline Solution, Hypertonic (0) ; Carboprost (35700-23-3) ; Dinoprostone (363-24-6) ; 16,16-Dimethylprostaglandin E2 (39746-25-3) ; Oxytocin (50-56-6) ; Arbaprostil (55028-70-1) ; Dinoprost (551-11-1) ; Urea (57-13-6) ; sulprostone (60325-46-4) ; meteneprost (61263-35-2) ; gemeprost (64318-79-2) ; Alprostadil (745-65-3)

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