Available online 25 November 2023, 102705

Author links open overlay panel, , ABSTRACTBackground

The National French Assembly promoted a law in 2022 allowing an extension of the period of abortion up to 16 week's amenorrhea. Medication protocols vary internationally, and there are no French data on medical management between 14- and 16-weeks’ amenorrhea.

Objective

To assess effectiveness and feasibility of a medical management abortion between 14 to 16 weeks of amenorrhea.

Study design

We retrospectively collected data from women undergoing medical abortion between 14 to 16 weeks’ amenorrhea from April 2022 to April 2023 in Archet's University hospital, Nice, France. Medical protocol consisted in a single dose of oral mifepristone 600 mg and 36–48 h later, vaginal gemeprost 1mg. Three hours after gemeprost, oral 400µg of misoprostol were administered every three hours, to a maximum of three doses. Success was defined as fetal expulsion.

Results

Thirty women were enrolled in the study. Twenty-nine (96.7%) patients aborted successfully. The median dose of misoprostol required was 800 µg (400 µg -1200 µg) and the median induction-to-abortion interval after first prostaglandin administration was 7 hours (5.5-11.6). One patient (3.3%) didn't expulse the fetus after 3 doses of misoprostol. Nine patients (30.0%) had additional surgical aspiration for retained product of conception within 24 hours. We encountered one post-abortum hemorrhage controlled only with surgical intra uterine aspiration. We did not need complementary hemostatic procedure and we reported no immediate or late complication.

Conclusions

Medical abortion between 14 and 16 weeks of amenorrhea provides a noninvasive and effective management for a daycare mid trimester abortion in 96.7% of cases, with a 36.7% of risk of staying in hospital overnight and 30.0% to have additional surgery for retained product of conception (RPOC).

Section snippetsINTRODUCTION

Nowadays, number of abortions worldwide is estimated at 73 million, or 29.0% of pregnancies (1). Second-trimester abortions account for 6.2% in the US and 5.0% of abortions in the UK (2,3). In France, 223 300 abortions were registered in 2021, PACA region is the 3rd one recording the largest number of abortions in the metropolitan France with a total number of 22 663 abortions performed during the year 2021 (4). There are 2 methods described in the literature to performed second trimester

METHODS

This study included women with pregnancies between 14 and 16 weeks of amenorrhea undergoing induced abortion between April 2022 and April 2023 in Archet's University hospital, Nice, France. Terms of pregnancies were systematically evaluated on the first trimester ultrasound by a fetal medicine specialist with a measurement of the crown rump length (CRL). We noticed if there is a context of congenital anomalies on ultrasound.

RESULTS

Between April 2022 and April 2023, 30 patients were referred for mid trimester abortion to the Archet's University Hospital, Nice, France. Characteristics of our population were reported in Table 1. Median age of the enrolled patients was 27 years (22-34), and the median BMI (body mass index) was 24.3 kg/m2 (20.3-31.9). Seventeen (56.7%) patients were multiparous. Three (10.0%) patients requested an abortion in the context of congenital fetal anomalies or chromosomal defects, because they did

DISCUSSION

This study confirms in a small but first cohort in France the feasibility, the efficacy and the safety of our medical protocol. Abortion was achieved in 29 patients (96.7%); median induction to abortion interval was 7 hours (5.5-11.6) (12). In a study of 1002 cases conducted by Ashok et al., 97.1% of patients aborted successfully within 15 hours with mifepristone and vaginal misoprostol protocol (13). Tang et al. reported that 68.6% of women undergoing medical abortion with mifepristone and

Author Contribution

All authors contributed to the study conception and design. H Carpentier had the idea for the article and collected data. H Carpentier and PA Gauci performed data analysis. PA Gauci and J Delotte critically revised the work. All the authors approved the final manuscript.

Declaration of Competing Interest

None

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