Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa

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dc.contributor.authorConstant, Deborahen_ZA
dc.contributor.authorHarries, Janeen_ZA
dc.contributor.authorMalaba, Thokozileen_ZA
dc.contributor.authorMyer, Landonen_ZA
dc.contributor.authorPatel, Malikaen_ZA
dc.contributor.authorPetro, Gregoryen_ZA
dc.contributor.authorGrossman, Danielen_ZA
dc.date.accessioned2016-10-31T07:37:11Z
dc.date.available2016-10-31T07:37:11Z
dc.date.issued2016en_ZA
dc.description.abstractObjective To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. METHODS: Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. RESULTS: The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts. CONCLUSION: The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed.en_ZA
dc.identifier.apacitationConstant, D., Harries, J., Malaba, T., Myer, L., Patel, M., Petro, G., & Grossman, D. (2016). Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa. <i>PLoS One</i>, http://hdl.handle.net/11427/22349en_ZA
dc.identifier.chicagocitationConstant, Deborah, Jane Harries, Thokozile Malaba, Landon Myer, Malika Patel, Gregory Petro, and Daniel Grossman "Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa." <i>PLoS One</i> (2016) http://hdl.handle.net/11427/22349en_ZA
dc.identifier.citationConstant, D., Harries, J., Malaba, T., Myer, L., Patel, M., Petro, G., & Grossman, D. (2016). Clinical outcomes and women’s experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa. PloS one, 11(9), e0161843. doi:10.1371/journal.pone.0161843en_ZA
dc.identifier.ris TY - Journal Article AU - Constant, Deborah AU - Harries, Jane AU - Malaba, Thokozile AU - Myer, Landon AU - Patel, Malika AU - Petro, Gregory AU - Grossman, Daniel AB - Objective To document clinical outcomes and women's experiences following the introduction of mifepristone into South African public sector second-trimester medical abortion services, and compare with historic cohorts receiving misoprostol-only. METHODS: Repeated cross-sectional observational studies documented service delivery and experiences of women undergoing second-trimester medical abortion in public sector hospitals in the Western Cape, South Africa. Women recruited to the study in 2008 (n = 84) and 2010 (n = 58) received misoprostol only. Those recruited in 2014 (n = 208) received mifepristone and misoprostol. Consenting women were interviewed during hospitalization by study fieldworkers with respect to socio-demographic information, reproductive history, and their experiences with the abortion. Clinical details were extracted from medical charts following discharge. Telephone follow-up interviews to record delayed complications were conducted 2-4 weeks after discharge for the 2014 cohort. RESULTS: The 2014 cohort received 200 mg mifepristone, which was self-administered 24-48 hours prior to admission. For all cohorts, following hospital admission, initial misoprostol doses were generally administered vaginally: 800 mcg in the 2014 cohort and 600 mcg in the earlier cohorts. Women received subsequent doses of misoprostol 400 mcg orally every 3-4 hours until fetal expulsion. Thereafter, uterine evacuation of placental tissue was performed as needed. With one exception, all women in all cohorts expelled the fetus. Median time-to-fetal expulsion was reduced to 8.0 hours from 14.5 hours (p<0.001) in the mifepristone compared to the 2010 misoprostol-only cohort (time of fetal expulsion was not recorded in 2008). Uterine evacuation of placental tissue using curettage or vacuum aspiration was more often performed (76% vs. 58%, p<0.001) for those receiving mifepristone; major complication rates were unchanged. Hospitalization duration and extreme pain levels were reduced (p<0.001), but side effects of medication were similar or more common for the mifepristone cohort. Overall satisfaction remained unchanged (95% vs. 91%), while other acceptability measures were higher (p<0.001) for the mifepristone compared to the misoprostol-only cohorts. CONCLUSION: The introduction of a combined mifepristone-misoprostol regimen into public sector second-trimester medical abortion services in South Africa has been successful with shorter time-to-abortion events, less extreme pain and greater acceptability for women. High rates of uterine evacuation for placental tissue need to be addressed. DA - 2016 DB - OpenUCT DO - 10.1371/journal.pone.0161843 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa TI - Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa UR - http://hdl.handle.net/11427/22349 ER - en_ZA
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0161843en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/22349
dc.identifier.vancouvercitationConstant D, Harries J, Malaba T, Myer L, Patel M, Petro G, et al. Clinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africa. PLoS One. 2016; http://hdl.handle.net/11427/22349.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_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 License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2016 Constant et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherTermination of pregnancyen_ZA
dc.subject.otherRoutes of administrationen_ZA
dc.subject.otherPhysiciansen_ZA
dc.subject.otherGynecologic surgeryen_ZA
dc.subject.otherHospitalsen_ZA
dc.subject.otherObstetric proceduresen_ZA
dc.subject.otherSouth Africaen_ZA
dc.titleClinical outcomes and women's experiences before and after the introduction of mifepristone into second-trimester medical abortion services in South Africaen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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