Determinants of induction-to-expulsion time and adverse maternal outcomes of second trimester medical abortion in Amhara Region, Ethiopia: Prospective follow-up study.

Abstract

Second-trimester medical abortion (STMA) accounts for 20-40% of abortions in Ethiopia and is associated with risks including uterine rupture, hemorrhage, infection, incomplete abortion, and prolonged hospitalization. This multicenter prospective study included 617 women undergoing STMA in three referral hospitals in the Amhara region from January to October 2024. Induction to-expulsion time and associated factors were analyzed using Cox proportional hazard modeling. Median fetal and placental expulsion times were 10 and 10.5 hours, respectively, with an 81.2% complete expulsion rate. Prolonged expulsion was associated with higher gestational age, wider misoprostol dosing intervals, and younger maternal age. Reported complications included vaginal bleeding (34.8%), pain (44%), diarrhea (24.1%), vomiting (24%), fever (11.5%), infection (2.4%), incomplete abortion (19.8%), cervical tear (0.49%), and uterine rupture (0.16%). optimizing misoprostol regimens, improving pain management, strengthening follow-up, and ensuring surgical readiness are essential to enhance STMA safety and effectiveness.