{
    "abstract": "To evaluate the safety, acceptability and feasibility of a one-day outpatient medication abortion service at gestations 13-18\u202fweeks.\nOpen-label prospective study in which participants received mifepristone 200\u202fmg orally to swallow at home or at the clinic followed 24\u202fh later by misoprostol 400\u202fmcg buccally. They presented to the outpatient clinic 24-48\u202fh after mifepristone for misoprostol 400 mcg buccally every three hours (no maximum dose). The primary outcome was successful abortion without transfer to overnight inpatient care. Secondary outcomes included time to abortion from initial misoprostol dose, safety, additional interventions and side effects.\nWe enrolled 230 women from December 2017 to November 2018. Approximately nine of ten (n\u202f=\u202f206, 89.6%) achieved a successful abortion without transfer to overnight care. Twenty-four were transferred to overnight inpatient care; of these 18 were to manage a complication, five for incomplete abortion and two by choice. Among these 24, three women experienced an SAE. The median time to successful abortion from time of the first misoprostol dose was 7.2\u202fh (range: 0.75-92.3), with an average of three misoprostol doses. Most participants expelled the fetus and the placenta at or around the same time; median time between fetal and placental expulsion was 15 minutes (range: 0-4.5\u202fh). Fifteen participants (6.6%) received more than five misoprostol doses and were transferred to inpatient care. Administration of more than five doses of misoprostol was associated with nulliparity. Provision of antibiotics (27.9%, n\u202f=\u202f64), manual removal of placenta (15.3%, n\u202f=\u202f35), uterotonics (4.4%, n\u202f=\u202f10) and surgical interventions (4.4%, n\u202f=\u202f10) were also reported. About one in four participants experienced nausea, vomiting and chills; fever was infrequent (2.5%, n\u202f=\u202f5).\nFor gestations 13-18\u202fweeks, an outpatient day process for medication abortion is safe, effective and feasible.\nMedication abortion in 13 - 18 weeks need not be limited to inpatient care; nine of ten cases can be managed as an outpatient day service.",
    "authors": [
        {
            "affiliation": "Gynuity Health Projects, USA. Electronic address: jblum@gynuity.org.",
            "firstname": "Jennifer",
            "initials": "J",
            "lastname": "Blum"
        },
        {
            "affiliation": "Kathmandu Medical College, Nepal.",
            "firstname": "Chanda",
            "initials": "C",
            "lastname": "Karki"
        },
        {
            "affiliation": "CREHPA, Nepal.",
            "firstname": "Anand",
            "initials": "A",
            "lastname": "Tamang"
        },
        {
            "affiliation": "Gynuity Health Projects, USA.",
            "firstname": "Tara",
            "initials": "T",
            "lastname": "Shochet"
        },
        {
            "affiliation": "CREHPA, Nepal.",
            "firstname": "Achala",
            "initials": "A",
            "lastname": "Shrestha"
        },
        {
            "affiliation": "KIST Medical College, Teaching Hospital, Nepal.",
            "firstname": "Heera",
            "initials": "H",
            "lastname": "Tuladhar"
        },
        {
            "affiliation": "Kathmandu Model Hospital, Nepal.",
            "firstname": "Aruna",
            "initials": "A",
            "lastname": "Karki"
        },
        {
            "affiliation": "Kathmandu Medical College, Nepal.",
            "firstname": "Jyotsna",
            "initials": "J",
            "lastname": "Sharma"
        },
        {
            "affiliation": "Gynuity Health Projects, USA.",
            "firstname": "Dina F",
            "initials": "DF",
            "lastname": "Abbas"
        },
        {
            "affiliation": "Gynuity Health Projects, USA.",
            "firstname": "Monica",
            "initials": "M",
            "lastname": "Dragoman"
        },
        {
            "affiliation": "Gynuity Health Projects, USA.",
            "firstname": "Beverly",
            "initials": "B",
            "lastname": "Winikoff"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2019 Elsevier Inc. All rights reserved.",
    "doi": "10.1016/j.contraception.2019.08.007",
    "journal": "Contraception",
    "keywords": [
        "Medical abortion",
        "Medication abortion",
        "Mifepristone",
        "Misoprostol",
        "Second trimester",
        "Task-sharing"
    ],
    "methods": null,
    "publication_date": "2019-09-07",
    "pubmed_id": "31491379",
    "results": "We enrolled 230 women from December 2017 to November 2018. Approximately nine of ten (n\u202f=\u202f206, 89.6%) achieved a successful abortion without transfer to overnight care. Twenty-four were transferred to overnight inpatient care; of these 18 were to manage a complication, five for incomplete abortion and two by choice. Among these 24, three women experienced an SAE. The median time to successful abortion from time of the first misoprostol dose was 7.2\u202fh (range: 0.75-92.3), with an average of three misoprostol doses. Most participants expelled the fetus and the placenta at or around the same time; median time between fetal and placental expulsion was 15 minutes (range: 0-4.5\u202fh). Fifteen participants (6.6%) received more than five misoprostol doses and were transferred to inpatient care. Administration of more than five doses of misoprostol was associated with nulliparity. Provision of antibiotics (27.9%, n\u202f=\u202f64), manual removal of placenta (15.3%, n\u202f=\u202f35), uterotonics (4.4%, n\u202f=\u202f10) and surgical interventions (4.4%, n\u202f=\u202f10) were also reported. About one in four participants experienced nausea, vomiting and chills; fever was infrequent (2.5%, n\u202f=\u202f5).",
    "title": "Feasibility of a hospital outpatient day procedure for medication abortion at 13-18\u202fweeks gestation: Findings from Nepal",
    "xml": "<Element 'PubmedArticle' at 0x788503f13380>"
}