Surgical and medical second trimester abortion in South Africa: A cross-sectional study

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dc.contributor.authorGrossman, Danielen_ZA
dc.contributor.authorConstant, Deborahen_ZA
dc.contributor.authorLince, Naomien_ZA
dc.contributor.authorAlblas, Marijkeen_ZA
dc.contributor.authorBlanchard, Kellyen_ZA
dc.contributor.authorHarries, Janeen_ZA
dc.date.accessioned2015-10-28T06:55:39Z
dc.date.available2015-10-28T06:55:39Z
dc.date.issued2011en_ZA
dc.description.abstractBACKGROUND:A high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province. METHODS: We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery. RESULTS: Median gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience. CONCLUSIONS: As currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols.en_ZA
dc.identifier.apacitationGrossman, D., Constant, D., Lince, N., Alblas, M., Blanchard, K., & Harries, J. (2011). Surgical and medical second trimester abortion in South Africa: A cross-sectional study. <i>BMC Health Services Research</i>, http://hdl.handle.net/11427/14443en_ZA
dc.identifier.chicagocitationGrossman, Daniel, Deborah Constant, Naomi Lince, Marijke Alblas, Kelly Blanchard, and Jane Harries "Surgical and medical second trimester abortion in South Africa: A cross-sectional study." <i>BMC Health Services Research</i> (2011) http://hdl.handle.net/11427/14443en_ZA
dc.identifier.citationGrossman, D., Constant, D., Lince, N., Alblas, M., Blanchard, K., & Harries, J. (2011). Surgical and medical second trimester abortion in South Africa: A cross-sectional study. BMC health services research, 11(1), 224.en_ZA
dc.identifier.ris TY - Journal Article AU - Grossman, Daniel AU - Constant, Deborah AU - Lince, Naomi AU - Alblas, Marijke AU - Blanchard, Kelly AU - Harries, Jane AB - BACKGROUND:A high percentage of abortions performed in South Africa are in the second trimester. However, little research focuses on women's experiences seeking second trimester abortion or the efficacy and safety of these services.The objectives are to document clinical and acceptability outcomes of second trimester medical and surgical abortion as performed at public hospitals in the Western Cape Province. METHODS: We performed a cross-sectional study of women undergoing abortion at 12.1-20.9 weeks at five hospitals in Western Cape Province, South Africa in 2008. Two hundred and twenty women underwent D&E with misoprostol cervical priming, and 84 underwent induction with misoprostol alone. Information was obtained about the procedure and immediate complications, and women were interviewed after recovery. RESULTS: Median gestational age at abortion was earlier for D&E clients compared to induction (16.0 weeks vs. 18.1 weeks, p < 0.001). D&E clients reported shorter intervals between first clinic visit and abortion (median 17 vs. 30 days, p < 0.001). D&E was more effective than induction (99.5% vs. 50.0% of cases completed on-site without unplanned surgical procedure, p < 0.001). Although immediate complications were similar (43.8% D&E vs. 52.4% induction), all three major complications occurred with induction. Early fetal expulsion occurred in 43.3% of D&E cases. While D&E clients reported higher pain levels and emotional discomfort, most women were satisfied with their experience. CONCLUSIONS: As currently performed in South Africa, second trimester abortions by D&E were more effective than induction procedures, required shorter hospital stay, had fewer major immediate complications and were associated with shorter delays accessing care. Both services can be improved by implementing evidence-based protocols. DA - 2011 DB - OpenUCT DO - 10.1186/1472-6963-11-224 DP - University of Cape Town J1 - BMC Health Services Research LK - https://open.uct.ac.za PB - University of Cape Town PY - 2011 T1 - Surgical and medical second trimester abortion in South Africa: A cross-sectional study TI - Surgical and medical second trimester abortion in South Africa: A cross-sectional study UR - http://hdl.handle.net/11427/14443 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/14443
dc.identifier.urihttp://dx.doi.org/10.1186/1472-6963-11-224
dc.identifier.vancouvercitationGrossman D, Constant D, Lince N, Alblas M, Blanchard K, Harries J. Surgical and medical second trimester abortion in South Africa: A cross-sectional study. BMC Health Services Research. 2011; http://hdl.handle.net/11427/14443.en_ZA
dc.language.isoengen_ZA
dc.publisherBioMed Central Ltden_ZA
dc.publisher.departmentWomen's Health Research Uniten_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution Licenseen_ZA
dc.rights.holder2011 Grossman et al; licensee BioMed Central Ltd.en_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_ZA
dc.sourceBMC Health Services Researchen_ZA
dc.source.urihttp://www.biomedcentral.com/bmchealthservres/en_ZA
dc.subject.otherAbortionen_ZA
dc.titleSurgical and medical second trimester abortion in South Africa: A cross-sectional studyen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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