title: Second-trimester postabortion care for ruptured membranes, fetal demise, and incomplete abortion.
abstract: BACKGROUND
  Guidance for postabortion care (PAC) is established for the first trimester but limited in the second trimester.
  
  
  OBJECTIVE
  To establish evidence-based recommendations for PAC in the second trimester.
  
  
  METHODS
  Medline, POPLINE, and the Cochrane Central Register of Controlled Trials were searched with terms related to second-trimester PAC, including fetal demise, ruptured membranes, and incomplete abortion. The reference lists of retrieved articles were also searched.
  
  
  METHODS
  Clinical trials and comparative studies of women presenting in the second trimester (12-28weeks) were included if more than 50% of participants met PAC criteria or if outcomes for PAC were analyzed separately.
  
  
  METHODS
  Data were extracted from included studies. When interventions in at least two articles were comparable, a meta-analysis was performed.
  
  
  RESULTS
  Overall, 17 studies of 1419 women met inclusion criteria. Misoprostol given vaginally, sublingually, or buccally was associated with shorter expulsion times than was oral misoprostol. Additionally, 200μg of misoprostol was more effective than lower doses. Pretreatment with mifepristone decreased expulsion time. Misoprostol was more effective than oxytocin.
  
  
  CONCLUSIONS
  Misoprostol with or without mifepristone is an effective treatment for second-trimester PAC. The minimum misoprostol dose is 200μg vaginally, sublingually, or buccally every 6-12hours.
authors: Ipas, Chapel Hill, NC, USA. Electronic address: marka@ipas.org.
authors: Alice G
authors: AG
authors: Mark
authors: Ipas, Chapel Hill, NC, USA; Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA.
authors: Alison
authors: A
authors: Edelman
authors: Department of Obstetrics and Gynecology, Boston University, Boston, MA, USA.
authors: Lynn
authors: L
authors: Borgatta
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000027:Abortion, Incomplete / Q000188:drug therapy*; D000359:Aftercare / Q000379:methods*; D015331:Cohort Studies; D005260:Female; D005313:Fetal Death; D005322:Premature Rupture of Fetal Membranes / Q000188:drug therapy*; D006801:Humans; D015735:Mifepristone; D016595:Misoprostol; D010120:Oxytocics; D010121:Oxytocin; D011247:Pregnancy; D011262:Pregnancy Trimester, Second; D016032:Randomized Controlled Trials as Topic
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D010120:Oxytocics; D016595:Misoprostol; D015735:Mifepristone; D010121:Oxytocin
keywords: Abortion; Intrauterine fetal death; Mifepristone; Misoprostol; Postabortion care; Premature rupture of membranes; Second trimester; Unsafe abortion