I Had an Abortion With Twins and Now Im Pregnant Again With Twins

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Contraception. Author manuscript; bachelor in PMC 2022 April 8.

Published in last edited form as:

PMCID: PMC3979718

NIHMSID: NIHMS400699

Outcomes of medical abortion through 63 days in women with twin gestations

Jennifer L. Hayes

¹Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family unit Planning Enquiry, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213

Sharon 50. Achilles

¹Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family Planning Research, Academy of Pittsburgh School of Medicine, Pittsburgh, PA, 15213

Mitchell D. Creinin

¹Section of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family unit Planning Inquiry, University of Pittsburgh Schoolhouse of Medicine, Pittsburgh, PA, 15213

ⁱⁱDepartment of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA 15213

Matthew F. Reeves

¹Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for Family unit Planning Research, University of Pittsburgh School of Medicine, Pittsburgh, PA, 15213

Abstract

Groundwork

Twin gestation is not considered a contraindication to medical abortion with mifepristone and misoprostol. However, data comparing the efficacy of medical abortion for singleton gestations as compared with multiple gestations are limited. Nosotros examined medical abortion outcomes for twin gestations through 63 days.

Study Design

We performed a secondary analysis of treatment efficacy and side furnishings using pooled data from 2 randomized medical abortion trials. All subjects received mifepristone 200 mg orally and misoprostol 800 mcg vaginally. Outcomes in women with singleton and twin gestations were compared.

Results

Of 2208 subjects, 24 (1.1%) women had twins. Handling success was not statistically different for twin and singleton gestations (91% vs. 97%, p=0.xix). Perceived haemorrhage and pain were non significantly unlike between groups.

Conclusions

Treatment success of medical abortion for twins is not significantly different than for singletons, although small differences cannot be excluded due to the express number of twins.

Keywords: mifepristone, misoprostol, medical ballgame, twin pregnancy, multiple gestations

Introduction

Medical abortion with mifepristone and misoprostol is oftentimes used for termination of twin gestations as a twin gestation is non considered a contraindication [1]. Data comparing the efficacy of medical abortion when used for singleton gestations every bit compared with multiple gestations are currently express to 1 retrospective accomplice study examining the effectiveness of medical ballgame that included twin gestations [2]. In this study, 1349 women were given mifepristone and buccal misoprostol through 59 gestational days and included for analysis, of which 19 (ane.iv%) were twin gestations [2]. 2 (ten.5%) of the 19 subjects with twin gestations in this report required uterine evacuation for successful completion of abortion equally compared to 1.vi% of singleton pregnancies [2]. We could not identify any prospective studies that reported medical abortion outcomes specifically for twin gestations using mifepristone and misoprostol. We performed a secondary analysis using pooled data from two randomized controlled trials to decide medical abortion outcomes for twin gestation through 63 days.

Methods

This is a secondary analysis of data pooled from two multicenter randomized trials of medical abortion. Both trials were approved past the University of Pittsburgh Institutional Review Board every bit a central board. The studies were designed to evaluate the timing of misoprostol administration following mifepristone. In both trials, all subjects received oral mifepristone 200 mg followed by vaginal misoprostol 800 mcg. Subjects were randomly assigned to the timing for vaginal misoprostol use post-obit mifepristone. Time intervals were fifteen min, 6-8 hr, or 23-25 60 minutes. The first trial included 1080 women [iii] and the 2d trial included 1,128 women [4]. All trial participants were scheduled to render for follow-upwardly evaluation 6-8 days afterwards taking mifepristone. Transvaginal ultrasonography was performed at each visit. Women who had not expelled the gestational sac were given a second dose of 800 mcg misoprostol vaginally. Subjects who received a second dose of misoprostol had another follow-up visit scheduled 6-8 days later (12-sixteen days afterwards mifepristone administration). Women with an ongoing pregnancy, equally defined by a persistent sac with gestational cardiac activeness, later two doses of misoprostol were treated with uterine aspiration. Women with a non-viable persistent gestational sac were offered uterine aspiration or expectant management. Subjects with a complete medical abortion were contacted by phone 5 weeks after initiating the written report to inquire nearly any problems since the abortion. The medical abortion was considered unsuccessful if uterine aspiration was performed for any indication.

At the final follow-up visit, all subjects completed visual analog scales (VAS) [5,6] designed to measure the amounts of perceived bleeding and hurting experienced during the ballgame process. On a 100-mm line with 0 equaling no haemorrhage and 100 equaling heavy bleeding, subjects were asked to mark the amount of haemorrhage they experienced. In a like fashion, pain was recorded with 0 equaling no pain and 100 representing severe pain. Each field of study also completed a questionnaire regarding her acceptability of the medical ballgame procedure.

For this analysis, we compared outcomes in women with twin and singleton gestations undergoing medical abortion through 63 days. Demographic and upshot variables were compared using the Mann-Whitney rank-sum test for continuous variables and Fisher exact exam for categorical variables, as appropriate. Multivariable regression was not performed because of the small sample size. For all tests, p-values less than 0.05 were considered statistically significant. All statistical analyses were performed using Stata 10 (StataCorp, College Station, TX).

Results

Of the 2208 women enrolled in the two studies, 24 (i.one%) women had twin gestations. Outcome data were available for 2156 (97.half dozen%) women including 23 of the women with twin gestations. None of the women had triplet or higher society gestations. Demographic characteristics of the study populations are summarized in Tabular array 1.

Table 1

Demographics

	Singleton north=2133	Twin n=23	p
Median historic period (years)	25	24	0.6
Gestational age (days)	n (%)	n (%)	0.9
48 days or less	877 (41.1)	10 (43.5)
49-55 days	675 (31.7)	8 (34.8)
56-63 days	581 (27.2)	5 (21.7)
Gravidity	n (%)	n (%)	0.vii
1	500 (23.four)	four (17.iv)
two	442 (20.7)	6 (26.1)
three or more	1191 (55.8)	13 (56.5)
Parity	n (%)	n (%)	0.5
0	819 (38.4)	vii (30.iv)
1	579 (27.1)	9 (39.1)
2 or more	735 (34.4)	7 (30.iv)
Medication interval	n (%)	northward (%)	0.eight
< 15 min	547 (25.6)	7 (30.4)
6-8h	519 (24.three)	6 (26.1)
23-25h	1067 (50.0)	10 (43.5)

Overall, 21 women (91.three%) with twins and 2060 women (96.6%) with singletons were successfully treated with medical abortion (p=0.19). Complete expulsion following a single dose of misoprostol occurred in 78.iii% of women with twin gestations compared to 88.1% of women with singleton gestations (p=0.18). Merely ane woman (4.three%) with a twin pregnancy and 14 women (0.seven%) with singletons had pregnancies with continuing cardiac activity present at the one-week follow-up visit (p=0.xv). Suction aspiration procedures were performed for two women with twin gestations, one for persistent cardiac activity at the one-week follow-upward visit, and the other for heavy bleeding on the 14th twenty-four hours after misoprostol assistants. Suction aspiration procedures were performed for 72 women with singleton gestations for reasons such as prolonged bleeding, persistent cardiac activity, persistent nonviable pregnancy, and subject request.

Women with singleton and twin gestations cocky-reported a broad range of haemorrhage and pain (Fig one). There were no differences based on VAS assessments for bleeding (p=0.40) or pain severity (p=0.31). Women in both groups found medical ballgame adequate, with 89% of the singleton grouping and 82% of the twin group proverb they would cull a medical abortion again (p=0.29). In improver, 95% of both groups said they would refer a friend for a medical abortion (p=i.00).

Visual Analog Score (VAS) past number of gestations. Part A shows the amount of bleeding VAS ratings (p=0.40). Role B shows the severity of hurting VAS ratings (p=0.31). The lower and upper limits of the boxes show the 25th and 75th percentiles, respectively. The line inside the box shows the median or 50th percentile. The whiskers bear witness the range of all values. The betoken values outside the whiskers show values that are more than one.v times the inter-quartile range, the interval between the 25th and 75th percentiles.

Word

Overall, twins occurred in about 1% of subjects in these two studies which is consequent with the charge per unit of spontaneous twinning in the full general population [vii]. Previous research on medical abortion for twin gestations is quite limited due to their infrequency. We pooled data from ii large studies, totaling over 2200 women, to obtain information on 23 twin gestations. To detect a deviation in overall success between the two groups, we would have needed 14545 subjects. For our current study, the likelihood nosotros would achieve statistical significance with our sample size is simply 23 percent.

Our assay differs from those previously published as our information come up from randomized, controlled studies with additional divers follow-upwards evaluations compared to data from case reports or retrospective accomplice studies.

These results provide some ground for women with twin gestations seeking medical abortions. Our analysis, while limited by small numbers, suggests that neither the overall efficacy nor side effects (pain and haemorrhage) of medical abortion are significantly different for women with twin and singleton gestations. Therefore, women requesting an ballgame of a twin gestation upward to 63 days should exist offered the option of medical ballgame. Compared with singleton gestations, our data propose that patients with twin gestations may more oftentimes demand a second dose of misoprostol to achieve complete expulsion. Patients should be counseled about this possibility but reassured that the process will most probable be successful. Like medical termination of singleton gestations, our data suggest that the need for follow-up to ensure successful completion of medical termination of twin gestations is necessary and that a second dose of misoprostol or suction aspiration will exist needed in some cases. Follow-up procedures for medical abortion should be advisedly followed, every bit per routine, to identify all patients who require farther handling.

Acknowledgments

In that location was no funding provided for this study.

Footnotes

Presented in part at Reproductive Health 2008, Washington DC (Sep 17-20, 2008).

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3979718/

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