Misoprostol compared with laminaria before early second-trimester surgical abortion: a randomized trial. Similarities in women's perceptions and acceptability of manual vacuum aspiration and electric vacuum aspiration for first trimester abortion. The use of hypnosis to improve pain management during voluntary interruption of pregnancy: an open randomized preliminary study. Medical vs. surgical evacuation of first-trimester spontaneous abortion. [Curettage or not after spontaneous abortion?]. Comparison of medical abortion with surgical vacuum aspiration: women's preferences and acceptability of treatment.
To compare the efficacy and acceptability of same-day misoprostol and overnight laminaria for cervical ripening before early second-trimester surgical abortion.
                We performed a randomized, double-blinded, controlled trial comparing 400 microg of vaginal misoprostol, given 3-4 hours preoperatively, with overnight laminaria before early second-trimester surgical abortion among women at 13.0-16.0 weeks of gestation (n = 84). The primary outcome was procedure time, and the sample size was based on 95% power to detect a difference of 4.5 minutes between groups. Secondary outcomes included completion of the procedure on the first attempt, procedural difficulty, and patients' pain scores and preferences.
                The average gestational duration was 14 weeks 6 days. Procedures performed after laminaria were significantly faster than those after misoprostol (median 3.4 versus 7.2 minutes, respectively, P = .01). Laminaria patients had significantly greater dilation than misoprostol patients at abortion (mean 43 versus 33 French, P < .001), and more misoprostol patients required additional dilation (85% versus 21%, P < .001). Physicians rated 27% of the misoprostol procedures as moderate-markedly difficult versus 5% of laminaria procedures (P = .01). Differences in efficacy were pronounced among nulliparous patients. There were no significant differences in ability to complete the procedure on the first attempt or patients' intraoperative pain scores. More women in the misoprostol group would choose their assigned method again (93% versus 62%, P < .01), and 82% of all subjects preferred a 1-day procedure.
                Early second-trimester abortions take longer and are technically more challenging after cervical ripening with same-day misoprostol than with overnight laminaria, but patients prefer same-day misoprostol. This paper examines women's acceptability of and experiences with manual vacuum aspiration (MVA) as compared with electric vacuum aspiration (EVA) for first trimester abortion. Women requesting pregnancy terminations were randomly assigned to either MVA (n = 64) or EVA (n = 63). Participants completed questionnaires before and after their abortions and approximately 2-4 weeks later. We observed some differences by group in participants' ratings of the importance of method characteristics and in their perceptions of their abortion methods after their abortions. The two groups did not, however, differ in their reports of pain, anxiety or bleeding or in the acceptability of their method. This report describes an open randomized study that aims to determine whether a brief hypnotic intervention during first-trimester surgical abortion reduces requests for pain medication.
                Thirty women undergoing first-trimester surgical abortion at the family planning clinics of a large hospital in Quebec City were randomized into a control group that received standard care and a hypnosis group that received, in addition to standard care, an intervention of hypnosis, including analgesia suggestions 20 min before and throughout the surgical procedure. Patients in both groups were given the option to control their pain with nitrous oxide (N(2)O) sedation administered through a nose mask as often and for as long as they wanted during the procedure. N(2)O sedation as the primary outcome was assessed at each step of the procedure. The patient's self-reported anxiety and pain were also assessed during the procedure as secondary outcomes.
                Thirty-six percent of patients in the hypnosis group requested N(2)O sedation during the procedure versus 87% in the control group (p<.01). No differences between the groups were found in reports of pain and anxiety during the procedure.
                These results suggest that hypnosis can be integrated into standard care and reduces the need for N(2)O in patients undergoing first-trimester surgical abortion. This reduction in N(2)O consumption did not lead to significant changes in pain or anxiety, and a larger sample size is required to assess the possible effects of hypnosis on those variables. To determine whether management of incomplete first-trimester abortion with vaginal misoprostol in an under-resourced setting is a viable treatment option.
                A total of 94 women were randomized to 600 microg of misoprostol intravaginally or to surgical curettage. The women receiving misoprostol were administered a second dose if the abortion was incomplete; and if still not complete after a week, evacuation of retained products of conception was performed. All women had a follow-up visit 2 weeks following complete abortion.
                The overall success rate of medical management was 91.5%, with 15 of 47 successful cases after 1 dose of misoprostol; 8.5% of the 47 women required evacuation of retained products of conception after 1 week because of treatment failure. The success rate in the surgical arm was 100%. Patients in the medical arm had a longer duration of bleeding and a greater need for analgesia. There were no differences in hemoglobin levels, white blood cell count, adverse effects, pain score, and satisfaction with treatment at the follow-up visit. However, more women who received the medical treatment would recommend it or choose it in the future.
                Medical management using 600 microg of misoprostol in 2 doses is effective to treat incomplete first-trimester abortions in an under-resourced setting when there is no evidence of uterine sepsis. In most cases of miscarriage, standard procedure has until recently been surgical revision of the uterine cavity.
                94 women with first trimester miscarriage were randomized to surgical revision (n = 48) or expectation (n = 46) after informed consent. Women with unacceptable pain or bleeding, or uterine contents of more than 20 mm diameter on sonography were not included. The patients were followed up seven to ten days later with gynaecological examination, sonography, and determination of levels of haemoglobin, leukocytes, C-reactive protein and HCG.
                In the revision group there were no operative complications, no cases of infection, and no unscheduled consultations. Mean duration of bleeding was 4.8 days (range 1-11 days). In the observation group there were no cases of infection, surgical revision was carried out in seven patients, and there were six unscheduled consultations. Mean duration of bleeding was 7.3 days (range 2-27 days). The women undergoing surgical revision had less pain and bleeding.
                Women with first trimester miscarriage may safely be observed without surgical revision but may have somewhat more pain and more vaginal bleeding than if revision is carried out. To assess women's preferences for, and the acceptability of, medical abortion and vacuum aspiration in the early first trimester.
                Patient centred, partially randomised trial. Medical abortion was performed with mifepristone 600 mg followed 48 hours later by gemeprost 1 mg vaginal pessary. Vacuum aspiration was performed under general anaesthesia.
                Teaching hospital in Scotland.
                363 women undergoing legal induced abortion at less than nine weeks' gestation.
                Women's preferences for method of abortion before abortion; acceptability judged two weeks after abortion by recording the method women would opt to undergo in future and by semantic differential rating technique.
                73 (20%) women preferred to undergo medical abortion, and 95 (26%) vacuum aspiration; 195 (54%) were willing to undergo either method, and were allocated at random. Both procedures were highly acceptable to women with preferences. Gestation had a definite effect on acceptability in randomised women; at less than 50 days there were no differences, but between 50 and 63 days vacuum aspiration was significantly more acceptable.
                Women who wish to use a particular method should be allowed their choice, regardless of gestation. Women of 50-63 days' gestation without preferences for a particular method are likely to find vacuum aspiration more acceptable. A patient centred, partially randomised trial design may be a useful tool in pragmatic research.
Complications for surgical first trimester abortion are rare. The included studies do not indicate overall benefits of one over the other method. MVA can be used for early first trimester surgical abortion, but maybe more difficult when used later in the first trimester. Duration of procedure is shorter with VA compared to D&C, which may be of importance when using local anaesthetics or for busy clinics. Outcomes such as women's satisfaction, the need for pain relief or surgeons preference for the instrument have been inadequately addressed. No long-term outcomes, such as fertility after surgical abortion, are available.