Clinical Outcomes and Women’s Experiences before and after the Introduction of Mifepristone into Second-Trimester Medical Abortion Services in South Africa
Publication Date
September 01, 2016
Journal
PLOS ONE
Authors
Deborah Constant, Jane Harries, Thokozile Malaba, Landon Myer, et al
Volume
11
Issue
9
Pages
e0161843
DOI
https://dx.plos.org/10.1371/journal.pone.0161843
Publisher URL
http://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0161843
Scopus
84991270963
Mendeley
http://www.mendeley.com/research/clinical-outcomes-womens-experiences-before-after-introduction-mifepristone-secondtrimester-medical
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Mendeley | Further Information

{"title"=>"Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa", "type"=>"journal", "authors"=>[{"first_name"=>"Deborah", "last_name"=>"Constant", "scopus_author_id"=>"54790550400"}, {"first_name"=>"Jane", "last_name"=>"Harries", "scopus_author_id"=>"36438341700"}, {"first_name"=>"Thokozile", "last_name"=>"Malaba", "scopus_author_id"=>"57009090200"}, {"first_name"=>"Landon", "last_name"=>"Myer", "scopus_author_id"=>"7006272201"}, {"first_name"=>"Malika", "last_name"=>"Patel", "scopus_author_id"=>"57191522600"}, {"first_name"=>"Gregory", "last_name"=>"Petro", "scopus_author_id"=>"57189855316"}, {"first_name"=>"Daniel", "last_name"=>"Grossman", "scopus_author_id"=>"13204525300"}], "year"=>2016, "source"=>"PLoS ONE", "identifiers"=>{"scopus"=>"2-s2.0-84991270963", "pmid"=>"27583448", "sgr"=>"84991270963", "issn"=>"19326203", "pui"=>"612507787", "doi"=>"10.1371/journal.pone.0161843"}, "id"=>"b94e24bc-6e5b-3add-ae7b-7cb4abe6bcb6", "abstract"=>"OBJECTIVE To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. METHODS Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. RESULTS The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts. CONCLUSION The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.", "link"=>"http://www.mendeley.com/research/clinical-outcomes-womens-experiences-before-after-introduction-mifepristone-secondtrimester-medical", "reader_count"=>18, "reader_count_by_academic_status"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Student > Doctoral Student"=>2, "Researcher"=>5, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>2, "Student > Master"=>3, "Student > Bachelor"=>2, "Professor"=>1}, "reader_count_by_user_role"=>{"Unspecified"=>1, "Professor > Associate Professor"=>1, "Student > Doctoral Student"=>2, "Researcher"=>5, "Student > Ph. D. Student"=>1, "Student > Postgraduate"=>2, "Student > Master"=>3, "Student > Bachelor"=>2, "Professor"=>1}, "reader_count_by_subject_area"=>{"Unspecified"=>3, "Nursing and Health Professions"=>4, "Biochemistry, Genetics and Molecular Biology"=>1, "Medicine and Dentistry"=>6, "Agricultural and Biological Sciences"=>1, "Business, Management and Accounting"=>1, "Pharmacology, Toxicology and Pharmaceutical Science"=>1, "Social Sciences"=>1}, "reader_count_by_subdiscipline"=>{"Medicine and Dentistry"=>{"Medicine and Dentistry"=>6}, "Social Sciences"=>{"Social Sciences"=>1}, "Agricultural and Biological Sciences"=>{"Agricultural and Biological Sciences"=>1}, "Nursing and Health Professions"=>{"Nursing and Health Professions"=>4}, "Business, Management and Accounting"=>{"Business, Management and Accounting"=>1}, "Biochemistry, Genetics and Molecular Biology"=>{"Biochemistry, Genetics and Molecular Biology"=>1}, "Unspecified"=>{"Unspecified"=>3}, "Pharmacology, Toxicology and Pharmaceutical Science"=>{"Pharmacology, Toxicology and Pharmaceutical Science"=>1}}, "reader_count_by_country"=>{"United States"=>1, "Ghana"=>1}, "group_count"=>3}

Scopus | Further Information

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