title: [Mid trimester pregnancy termination--review of the caseload for 2012 of Maternity University Hospital 'Maichin Dom', Sofia, Bulgaria].
abstract: Midtrimester pregnancy termination is yet an ongoing clinical issue in spite of the hard work on the matter in the recent years. There is a significant withdrawal from the surgical methods, absence of adequate drug preparations for medical termination and absence of guidelines for such form the Bulgarian Society of Obstetricians and Gynaecologists. In order to obtain a clear view on the current situation, we made a review on all the cases of midtrimester induced abortion in Maternity University Hospital 'Maichin dom' for the year of 2012. We found that the mid trimester abortions represent 11.7% of all abortions performed in the hospital in 2012. Most widely used are the following methods: vaginal application of prostaglandin E2 vag. tabl. 3 mg--33.5%, intrauterine balloon-catheter application after priming of the cervix with prostaglandin E2 3 mg--18%, prostaglandin F 2alpha as intrauterine extraamniotic continuous infusion through a balloon catheter, noweighton--9%, vaginal application of Prostaglandin E1--5.4%. Surgical termination was used in as little as 6% of the cases. The shortest interval for expulsion had been registered with the application of PG E1--19'55", compared with the most widely spread method of application of PG E2, which was more than twice longer--42'12". Application of balloon catheter, after priming of the cervix with 3 mg PG E2 vag. tabl. proved to be inefficient with mean interval for expulsion of 88'42". Surgical termination for midtrimester pregnancy is seen as the last alternative, it is rarely applied and mostly as anurgent procedure. In conclusion, the existing regimes for medical termination of midtrimester pregnancy are inefficient; application of 3 mg PG E2 is ineffective during the second trimester, insertion of balloon catheter attached to a weight is unacceptable. It is highly recommended that more attention is paid to the surgical termination with regards to residence training programmes and maintaining of qualification. This is needed as the procedure is usually performed to stop life threatening bleeding and is hence urgent. We underline the necessity of adequate guidelines for midtrimester medical termination. They should be based on Misoprostol as this is the gold standard for this gestational age. We believe there is enough clinical and scientific evidence for its safety and efficacy. Moreover, we are happy to announce that Misoprostol is already registered in Bulgaria.
authors.forename: A
authors.initials: A
authors.lastname: Andreeva
authors.forename: B
authors.initials: B
authors.lastname: Marinov
mesh_terms: D000019:Abortifacient Agents; D000028:Abortion, Induced / Q000379:methods* / Q000706:statistics & numerical data; D000527:Alprostadil / Q000627:therapeutic use; D002031:Bulgaria; D015232:Dinoprostone / Q000627:therapeutic use; D005260:Female; D006801:Humans; D016595:Misoprostol; D010120:Oxytocics / Q000627:therapeutic use; D011247:Pregnancy; D011262:Pregnancy Trimester, Second
chemical_list: D000019:Abortifacient Agents; D010120:Oxytocics; D016595:Misoprostol; D000527:Alprostadil; D015232:Dinoprostone