title: Intervention rates for placental removal following induction abortion with misoprostol.
abstract: BACKGROUND
  Second-trimester terminations can be performed via surgical or medical methods. It is essential to have the ability to safely and effectively perform induction terminations to offer a full range of services. Many studies of induction abortions report routine operative removal of the placenta after a set time period resulting in high rates of operative procedures.
  
  
  METHODS
  A retrospective chart review was performed for 233 women who underwent second-trimester induction abortions between November 2003 and November 2006. All women received intraamniotic injection of digoxin for feticide 1 day prior to induction. All inductions were performed using a schedule of 400 mcg of misoprostol initially followed by 200 mcg every 6 h for a maximum of 48 h. There were three methods of administering misoprostol: (1) vaginal administration for all doses, (2) vaginal and buccal used in combination and (3) buccal for all doses. Spontaneous expulsion of the placenta was expected. Operative intervention was performed for excessive bleeding or to expedite hospital discharge after a minimum of 4 h. No manual removal of placenta was done.
  
  
  RESULTS
  The rate of operative intervention for retained placentas was 6% (14/233). Most (11/14) of the patients who underwent operative extraction for retained placentas did so to expedite discharge from the hospital. Overall, expectant management to allow spontaneous expulsion of the placenta for at least 4 h was not associated with serious morbidity.
  
  
  CONCLUSIONS
  Our regimen of digoxin and misoprostol with a policy of expectant management of placental passage is associated with a very low rate of instrumented removal of the placenta. In the absence of bleeding, patients may be afforded intervals to at least 4 h for spontaneous expulsion of the placenta after fetal expulsion.
authors: Department of Obstetrics and Gynecology, Boston University School of Medicine, Boston, MA 02118, USA.
authors: Janis
authors: J
authors: Green
authors: Lynn
authors: L
authors: Borgatta
authors: Michelle
authors: M
authors: Sia
authors: Nathalie
authors: N
authors: Kapp
authors: Kelley
authors: K
authors: Saia
authors: Sacheen
authors: S
authors: Carr-Ellis
authors: Olivera
authors: O
authors: Vragovic
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000009:adverse effects*; D004077:Digoxin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D010920:Placenta / Q000187:drug effects*; D018457:Placenta, Retained / Q000601:surgery*; D011247:Pregnancy; D011262:Pregnancy Trimester, Second / Q000187:drug effects; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol; D004077:Digoxin