Factors influencing the duration of pregnancy termination with vaginal misoprostol for fetal abnormality.
OBJECTIVE
Evaluation of factors influencing the duration of second-trimester pregnancy interruption with vaginal misoprostol for fetal abnormality.


METHODS
All medical terminations >or=13 weeks of gestation 1/1997 to 12/2007 were prospectively identified. Cases receiving vaginal misoprostol 400 microg 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.
Dickinson
Jan E
JE
School of Women's and Infants' Health, The University of Western Australia, Perth, Western Australia, Australia. jan.dickinson@uwa.edu.au
Doherty
Dorota A
DA
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage / Q000009:adverse effects; D000025:Abortion, Eugenic / Q000379:methods*; D000030:Abortion, Missed / Q000453:epidemiology / Q000209:etiology; D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D000013:Congenital Abnormalities / Q000628:therapy; D005260:Female; D006801:Humans; D008875:Middle Aged; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol