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Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality

2009; Wiley; Volume: 29; Issue: 5 Linguagem: Inglês

10.1002/pd.2236

1097-0223

Jan E. Dickinson, Dorota A. Doherty,

Maternal and fetal healthcare

Abstract Objective Evaluation of factors influencing the duration of second‐trimester pregnancy interruption with vaginal misoprostol for fetal abnormality. Methods All medical terminations ≥13 weeks of gestation 1/1997 to 12/2007 were prospectively identified. Cases receiving vaginal misoprostol 400 µg 6‐hourly were extracted from the database and outcomes reviewed. Results This consecutive case series comprised 1066 women. Median maternal age was 31 years [interquartile range (IQR) 26, 36] and 15.4% had at least one prior cesarean delivery. Principal indications for termination were aneuploidy (37.6%), neural tube defects (15.9%) and cardiac anomalies (9.4%). Median gestation at termination was 19.5 weeks (IQR 17.9, 21). Median abortion interval was 16.1 h (IQR 12, 23.5). Lower maternal age (median duration 17.6 vs 15.2 vs 13.6 h, age < 30 vs 30–39 vs > 40 years, p < 0.001), nulliparity (median duration 19 vs 14.3 h, nulliparous vs parous, p < 0.001) and increasing gestation (median duration 13 vs 17.8 h, <16 vs >20 weeks, p < 0.001) were associated with abortion prolongation. Controlling for gestation, age and parity, apart from musculoskeletal abnormalities (associated with abortion prolongation, p = 0.03), the specific fetal anomaly did not influence duration. Conclusions Three factors: nulliparity, younger maternal age and increasing gestation, were associated with abortion prolongation. Apart from musculoskeletal abnormalities, the fetal anomaly had no impact on abortion duration. Copyright © 2009 John Wiley & Sons, Ltd.