The management of failed second-trimester termination of pregnancy

BackgroundManagement of failed medical second-trimester termination of pregnancy (TOP) is a challenge with best therapy not determined.Study DesignThis was a cross-sectional study using retrospective record review of all women requesting medical TOP in the second trimester from January to June 2005. A comparative analysis was done to determine differences in demography, surgical methods and complications between two groups: (a) women who successfully aborted (first-admission group) and (b) women who failed to abort during their first admission (repeat-admission group).ResultsStudy sample included 567 subjects [523 (92%) in the first-admission group and 44 (8%) in the repeat-admission group]. There were no significant differences in gestational age (p=.99), parity (p=.24) and previous history of cesarean section (p=.38) between the two groups. All of them successfully aborted, but the women in the repeat-admission Group 4 (9%) had more surgical interventions than those in the first-admission Group 6 (2%) (p<.0001).ConclusionFailure to abort pregnancies in the second trimester with misoprostol is not uncommon. Our hospital protocol of adequate counseling and early repeat admission with good clinical selection criteria might be an alternative in a resource-constraint environment where resources and skills to perform surgical dilatation and evacuation are not available.