Abraham Fessehaye Sium, Amani Nureddin Abdu, Zerihun Beyene
{"title":"在中低收入国家，妊娠 15-24 周时进行扩宫和排空手术与药物流产的比较：回顾性队列研究","authors":"Abraham Fessehaye Sium, Amani Nureddin Abdu, Zerihun Beyene","doi":"10.1016/j.conx.2024.100110","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>To compare the effectiveness and safety of dilation and evacuation (D&E) to that of medication abortion at 15–24 weeks in a low-middle income country.</p></div><div><h3>Study design</h3><p>We conducted a retrospective cohort on effectiveness and safety of D&E vs medication abortion at 15–24 weeks in an Ethiopian setting over a year (January 1–December 31, 2023). We looked at success (need for additional procedure) of both abortion procedures and their complication rates. Hemorrhage, infection, uterine perforation/rupture, and cervical tear were the complications we compared between the groups (D&E group vs medication abortion group). <em>P</em>-value less than 0.05 and Adjusted odds ratio (AOR) with 95% CI were used to present results significance.</p></div><div><h3>Results</h3><p>A total of 225 abortion cases (162 medication abortion cases and 63 D&E cases) at gestational age of 15–24 weeks were included in the final analysis. The mean gestational age was 18 ± 2.8 weeks in the D&E group compared to 21 ± 3 weeks in the medication abortion group (<em>p</em>-value<!--> <!--><<!--> <!-->0.001). The overall procedure effectiveness between the abortion procedures was similar (95.2% vs 96.9% in the D&E group and medication abortion groups, <em>p</em>-value<!--> <!-->=<!--> <!-->0.542). D&E (AOR<!--> <!-->=<!--> <!-->2.92 [95% CI<!--> <!-->=<!--> <!-->0.62–13.69]) was not associated with increased overall complications compared to medication abortion, after controlling for parity, gestational age, and history of prior uterine scar.</p></div><div><h3>Conclusion</h3><p>We found both abortion methods (D&E and medication abortion) are effective with comparable complication rates.</p></div><div><h3>Implications</h3><p>D&E and medication abortion are safe and effective methods of abortion for gestations up to 24 weeks even in a low-middle income country (LMIC) setting; as such, greater resources are needed to ensure to increase availability of D&E in order for women to have a choice in their treatment options.</p></div>","PeriodicalId":10655,"journal":{"name":"Contraception: X","volume":"6 ","pages":"Article 100110"},"PeriodicalIF":0.0000,"publicationDate":"2024-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590151624000078/pdfft?md5=f4cf2c2381c0def0532e91cb2471a6ce&pid=1-s2.0-S2590151624000078-main.pdf","citationCount":"0","resultStr":"{\"title\":\"Dilation and evacuation versus medication abortion at 15–24 weeks of gestation in low-middle income country: A retrospective cohort study\",\"authors\":\"Abraham Fessehaye Sium, Amani Nureddin Abdu, Zerihun Beyene\",\"doi\":\"10.1016/j.conx.2024.100110\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>To compare the effectiveness and safety of dilation and evacuation (D&E) to that of medication abortion at 15–24 weeks in a low-middle income country.</p></div><div><h3>Study design</h3><p>We conducted a retrospective cohort on effectiveness and safety of D&E vs medication abortion at 15–24 weeks in an Ethiopian setting over a year (January 1–December 31, 2023). We looked at success (need for additional procedure) of both abortion procedures and their complication rates. Hemorrhage, infection, uterine perforation/rupture, and cervical tear were the complications we compared between the groups (D&E group vs medication abortion group). <em>P</em>-value less than 0.05 and Adjusted odds ratio (AOR) with 95% CI were used to present results significance.</p></div><div><h3>Results</h3><p>A total of 225 abortion cases (162 medication abortion cases and 63 D&E cases) at gestational age of 15–24 weeks were included in the final analysis. The mean gestational age was 18 ± 2.8 weeks in the D&E group compared to 21 ± 3 weeks in the medication abortion group (<em>p</em>-value<!--> <!--><<!--> <!-->0.001). The overall procedure effectiveness between the abortion procedures was similar (95.2% vs 96.9% in the D&E group and medication abortion groups, <em>p</em>-value<!--> <!-->=<!--> <!-->0.542). D&E (AOR<!--> <!-->=<!--> <!-->2.92 [95% CI<!--> <!-->=<!--> <!-->0.62–13.69]) was not associated with increased overall complications compared to medication abortion, after controlling for parity, gestational age, and history of prior uterine scar.</p></div><div><h3>Conclusion</h3><p>We found both abortion methods (D&E and medication abortion) are effective with comparable complication rates.</p></div><div><h3>Implications</h3><p>D&E and medication abortion are safe and effective methods of abortion for gestations up to 24 weeks even in a low-middle income country (LMIC) setting; as such, greater resources are needed to ensure to increase availability of D&E in order for women to have a choice in their treatment options.</p></div>\",\"PeriodicalId\":10655,\"journal\":{\"name\":\"Contraception: X\",\"volume\":\"6 \",\"pages\":\"Article 100110\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-01-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.sciencedirect.com/science/article/pii/S2590151624000078/pdfft?md5=f4cf2c2381c0def0532e91cb2471a6ce&pid=1-s2.0-S2590151624000078-main.pdf\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Contraception: X\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2590151624000078\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"Medicine\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Contraception: X","FirstCategoryId":"1085","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2590151624000078","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
Dilation and evacuation versus medication abortion at 15–24 weeks of gestation in low-middle income country: A retrospective cohort study
Objective
To compare the effectiveness and safety of dilation and evacuation (D&E) to that of medication abortion at 15–24 weeks in a low-middle income country.
Study design
We conducted a retrospective cohort on effectiveness and safety of D&E vs medication abortion at 15–24 weeks in an Ethiopian setting over a year (January 1–December 31, 2023). We looked at success (need for additional procedure) of both abortion procedures and their complication rates. Hemorrhage, infection, uterine perforation/rupture, and cervical tear were the complications we compared between the groups (D&E group vs medication abortion group). P-value less than 0.05 and Adjusted odds ratio (AOR) with 95% CI were used to present results significance.
Results
A total of 225 abortion cases (162 medication abortion cases and 63 D&E cases) at gestational age of 15–24 weeks were included in the final analysis. The mean gestational age was 18 ± 2.8 weeks in the D&E group compared to 21 ± 3 weeks in the medication abortion group (p-value < 0.001). The overall procedure effectiveness between the abortion procedures was similar (95.2% vs 96.9% in the D&E group and medication abortion groups, p-value = 0.542). D&E (AOR = 2.92 [95% CI = 0.62–13.69]) was not associated with increased overall complications compared to medication abortion, after controlling for parity, gestational age, and history of prior uterine scar.
Conclusion
We found both abortion methods (D&E and medication abortion) are effective with comparable complication rates.
Implications
D&E and medication abortion are safe and effective methods of abortion for gestations up to 24 weeks even in a low-middle income country (LMIC) setting; as such, greater resources are needed to ensure to increase availability of D&E in order for women to have a choice in their treatment options.
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