Ellen Wiebe

Pain control in abortion

Objective: To reduce the pain experienced during abortion. Methods: A four‐phase study was conducted at a free‐standing abortion clinic. Phase 1: a double‐blind, randomized, placebo‐controlled trial of 600 mg ibuprofen given preoperatively was carried out in 193 women. Pain during the procedure and 30 min postoperatively was compared. Phase 2: a double‐blind, randomized trial compared 1% lidocaine, buffered 1% lidocaine and 0.25% bupivacaine in terms of the pain of the injection and the pain of the procedure in 200 women. Phase 3: waiting times of 0, 3 and 10–20 min between the end of the injection and the beginning of the procedure were compared in terms of pain during the procedure in 139 women. Phase 4: local anesthetic was injected into one side of the cervix slowly and one side quickly and the pain of the injections was compared in 87 women. Results: Phase 1:ibuprofen reduced pain scores more than placebo with the improvement being greatest for the postoperative period. Phase 2: buffered lidocaine was significantly less painful to inject than plain lidocaine or bupivacaine. Phase 3: waiting between the injection and the procedure did not improve pain control. Phase 4: slower injections were found to be less painful than fast injections. Conclusions: Several methods were found to improve pain control during abortions.

Comparison of the efficacy of different local anesthetics and techniques of local anesthesia in therapeutic abortions.

OBJECTIVES The objectives of this study were to determine whether carbonated or plain lidocaine provides better pain control during abortions and to determine whether deep injections of lidocaine provide better pain control than regular injections of lidocaine. STUDY DESIGN Phase 1 was a prospective, randomized, double-blind trial comparing 10 cm3 of 2% carbonated lidocaine with plain lidocaine. In phase 2 the plain lidocaine group in phase 1 was compared prospectively with the next group of patients, in whom a new technique of deep injection was used. A pain scale was administered by the counselor after dilatation and at the end of the procedure. RESULTS The improvement in pain scores with carbonated lidocaine was 8%. The improvement with the deep injection technique was 25%. CONCLUSION The improvement in pain scores with deep injection was clinically significant and is recommended.

Comparison of Abortions Induced by Methotrexate or Mifepristone Followed by Misoprostol

OBJECTIVE To compare the effectiveness, side effects, and acceptability of medical abortions induced by methotrexate and misoprostol with abortions induced by mifepristone and misoprostol. METHODS This was a multicenter, randomized, non‐blinded, controlled trial comparing 50 mg/m2 of methotrexate followed 4–6 days later by 800 μg of vaginal misoprostol with 600 mg of oral mifepristone followed 36–48 hours by 400 μg of oral misoprostol. RESULTS There were 518 women in the methotrexate group and 524 women in the mifepristone group. In the methotrexate group, 21 women required suction curretage, two for continuing pregnancy, eight because of physician request (usually for excessive bleeding), and 11 because of patient request. In the mifepristone group, 22 women needed surgical termination, 17 because of physician request, and five because of patient request. By day 8, only 386 (74.5%) in the methotrexate group had completed the abortion compared with 474 (90.5%) in the mifepristone group, and the mean number of days from beginning to completion was 7.1 for methotrexate and 3.3 for mifepristone (P ≤ .001). There were no differences in complications, and side effects were similar. Acceptance was slightly higher with mifepristone (88.0%) than with methotrexate (83.2%). CONCLUSION Abortions induced with mifepristone completed faster than those induced with methotrexate, but the overall success rates, side effects, and complications were similar. Acceptance rates were slightly higher with mifepristone than methotrexate (P = .03).

Pain control in medical abortion

Objectives: In patients having medical abortions with methotrexate and misoprostol: (1) to determine if giving ibuprofen or acetaminophen plus codeine with misoprostol (prior to onset of pain) prevented severe pain; and (2) to determine if there were predictors of medical abortion pain. Methods: A group of 281 women randomized to receive placebo, ibuprofen or acetaminophen with codeine. This was taken at home with the misoprostol 4–6 days after the methotrexate. Results: There were no significant differences between the three groups with respect to age, gestational age, parity, anxiety, depression, worst period pain score, and ethnicity. There was no significant difference with respect to rates of severe pain scores. The mean pain score for the entire group was 6.2 on a scale of 0 to 10. Severe pain (scores of 9 or 10) were reported by 23.4% of women and in this group, the mean maternal age was lower (P=0.05), parity was lower (P=0.01), worst period pain scores were higher (P=0.001), anxiety scores were higher (P=0.05) and satisfaction was lower (P=0.01). Conclusions: The pain experienced in medical abortion causes significant distress and more research is needed to reduce it.

Cost savings from Emergency contraceptive pills in Canada

Objective To estimate cost savings from emergency contraceptive pills in Canada. Methods We modeled cost savings when a single emergency contraceptive treatment was provided after unprotected intercourse and when women were provided emergency contraceptive pills in advance. Results Each dollar spent on a single treatment saved

Abortion induced with methotrexate and misoprostol: A comparison of various protocols

1.19–

Regimens of misoprostol with mifepristone for early medical abortion: a randomised trial

2.35 (in Canadian currency), depending on the regimen and on assumptions about savings from costs avoided by preventing mistimed births. The dedicated products Preven (Shire Canada, Inc., Oakville, Ontario) and Plan B (Paladin Labs, Inc., Montreal) were cost-saving even under the least favorable assumption that mistimed births prevented today occur 2 years later. Each dollar spent on advance provision of Preven saved

The effect of lorazepam on pain and anxiety in abortion

1.24–

Arteriovenous malformations of the uterus associated with medical abortion

12.23, depending on the regular contraception method, on how consistently emergency contraception was used when needed, and on whether mistimed births were averted forever or simply delayed. Plan B was almost always cost-saving, although less so. Conclusion Emergency contraception was cost-saving whether provided when the emergency occurred or in advance to be used as needed. More extensive use of emergency contraception could save considerable medical costs by reducing unintended pregnancies.

Women's perceptions about seeing the ultrasound picture before an abortion

Seven hundred fifty-six women had abortions induced with methotrexate and misoprostol. Various protocols were compared. In Group 1, phase 1, after receiving 50 mg/m2 methotrexate IM, 289 women were randomized to receive either 750 or 500 micrograms of vaginal misoprostol. In Group 1, phase 2, 84 women who had failed to abort after one dose of misoprostol were randomized to receive either vaginal or oral routes for the second dose of misoprostol given on Day 8. In Group 2, a cohort of 226 women who received 60 mg/m2 methotrexate were compared to the 289 women who received 50 mg/m2 in Group 1. There were no differences in rates of effectiveness in the various trial groups. Side effects were greater with 60 mg/m2 of methotrexate. In Group 3, a cohort of 241 women received the misoprostol in three vaginal doses 8 hr apart starting on Day 5, and were compared to the 289 women in Group 1 receiving one vaginal dose. In women whose medical abortion failed, fetuses were found to have limb abnormalities In the total group of 756 women, 88.8% aborted successfully without surgical aspiration, with only minor side effects, and the acceptance rate was high. This study indicates that medical abortions induced with methotrexate and misoprostol are safe and effective, but more research is needed to find a more effective protocol.