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Human Reproduction Update Advance Access originally published online on October 17, 2006
Human Reproduction Update 2007 13(1):37-52; doi:10.1093/humupd/dml049
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© The Author 2006. Published by Oxford University Press on behalf of the European Society of Human Reproduction and Embryology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Mid-trimester induced abortion: a review

S. Lalitkumar, M. Bygdeman and K. Gemzell-Danielsson1

Department of Woman and Child Health, Division for Obstetrics and Gynaecology, Karolinska University Hospital/Karolinska Institute, Stockholm, Sweden

1 To whom correspondence should be addressed at: Department of Woman and Child Health, Division for Obstetrics and Gynecology, Karolinska University Hospital/Karolinska Institutet, SE 17176 Stockholm, Sweden. E-mail: kristina.gemzell{at}ki.se


  Abstract

Mid-trimester abortion constitutes 10–15% of all induced abortion. The aim of this article is to provide a review of the current literature of mid-trimester methods of abortion with respect to efficacy, side effects and acceptability. There have been continuing efforts to improve the abortion technology in terms of effectiveness, technical ease of performance, acceptability and reduction of side effects and complications. During the last decade, medical methods for mid-trimester induced abortion have shown a considerable development and have become safe and more accessible. The combination of mifepristone and misoprostol is now an established and highly effective method for termination of pregnancy (TOP). Advantages and disadvantages of medical versus surgical methods are discussed. Randomized studies are lacking, and more studies on pain treatment and the safety of any method used in patients with a previous uterine scar are debated, and data are scarce. Pain management in abortion requires special attention. This review highlights the need for randomized studies to set guidelines for mid-trimester abortion methods in terms of safety and acceptability as well as for better analgesic regimens.

Key words: dilatation and evacuation / mid-trimester induced abortion / mifepristone / misoprostol / vacuum aspiration


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