Second-trimester postabortion care for ruptured membranes, fetal demise, and incomplete abortion

摘要

Background: Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester. Objectives: To establish evidence-based recommendations for PAC in the second trimester. Search strategy: Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched. Selection criteria: Clinical trials and comparative studies of women presenting in the second trimester (12-28 weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately. Data collection and analysis: Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed. Main results: Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200 mu g of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin. Conclusion: Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200 mu g vaginally, sublingually, or buccally every 6-12 hours. (C) 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ltd.