D. Halleb


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    Medical termination of pregnancy by mifepristone
    and sublingual misoprostol: preliminary results of
    their use in reproductive health centre of Nabeul
    in Tunisia
    Halleb, D1; Temimi, F2; Belcaid, A1; Ben Khedija,
    W1; Wahbi, H1
    1 Centre de la Sante´ de la Reproduction, Nabeul, Tunisia; 2 Office
    National de la Famille et de la Population, Tunis, Tunisia
    Introduction: Medical termination of pregnancy (TOP) is a
    method increasingly used worldwide. It was introduced in Tunisia
    by the National Office of Family and Population, since 1994 as
    part of research. Then it was extended in 22 of the 24
    reproductive health centres. Medical TOP was introduced in the
    Nabeul Centre since November 2002. We used three different
    protocols; the third protocol was introduced since March 2010.
    The aim of the study was to describe the effects of this protocol
    on medical TOP effectiveness; frequency of side effects, and
    frequency of TOP failure.
    Methods: We conducted a retrospective observational study
    performed in the reproductive health centre of Nabeul from April
    2010 to June 2010 about women who chose medical TOP.
    For all women consulting for TOP, the medical staff explained
    the interest of medical TOP and the risks of this method
    compared to the surgical one.
    On the first day, counselling was conducted, clinical and
    ultrasound examinations were made to identify no exclusion
    factors: anaemia, ectopic pregnancy, and pregnancy off the pill,
    kidney failure and liver failure. Then 200 mg of mifepristone was
    administered by the midwife or the physician.
    On the second day, 400 lg of misoprostol was administered by
    the sublingual route. On the fifteenth day, a check was performed
    by a clinical and ultrasound examination.
    We considered as method failure: surgical aspiration for
    ongoing pregnancy, a total retention or significant bleeding.
    Withdrawals were not recorded as such.
    The study analysis was performed by SPSS with statistical
    verification by the v2 and ANOVA at a significance level of 5%
    (P £ 0.05).

    Results: We included 562 women (27.48% single and 72.52%
    married) who have chosen medical TOP during the study period.
    The average age was 32 years, ranging from 18 to 50. Educational
    level was illiterate for 5.1%, elementary or secondary for 78.8%
    and university for 16%. In 77% of cases women had not had a
    medical TOP before, 16.5% of them had one previously, 4.7%
    twice and 1.9% three or more times. The age of pregnancy was in
    60% of cases <6 weeks of gestation, in 34.7% of cases between 6
    and 7 weeks of gestation, and in 6.9% of cases between 8 and
    9 weeks. The expulsion occurred in 54.2% of cases before 4 hours
    and in 44.4% after 4 hours. Pain was reported in 10.5% of cases
    and need appropriate treatment. Surgical abortion was used in
    1.2% (ongoing pregnancy in 1% of cases and bleeding 0.2% of

    Statistical analysis showed: (i) a significant relationship between
    gestational age and the period of expulsion (P = 0.047); no
    significant relationship between the gestational age and the failure
    of the TOP; no significant relationship between educational level
    and gestational age at the time of first consultation (P = 0.243).
    Conclusion: The protocol adopted in this study appeared to be
    safe, effective and acceptable to women. However we must be
    aware and explain to women that the use of medical TOP does
    not replace contraception, contrary to popular belief.