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Biomedical subjects

M S Burnhill

Publications and source records attributed to M S Burnhill.

At least 19 recordsLinked to original sources
PubMed2001

Early medical abortion with methotrexate and misoprostol.

OBJECTIVE: To evaluate the introduction of an early medical abortion program with methotrexate and misoprostol, using a standardized protocol. METHODS: A total of 1973 women at 34 Planned Parenthood sites participated in a case series of early medical abortion. Ultrasound was used to confirm gestational age of less than 49 days from the first day of the last menstrual period. Women were given intramuscular methotrexate 50 mg/m(2) of body surface area on day 1, and then they inserted misoprostol 800 microg vaginally at home on day 5, 6, or 7. Women were advised to have a suction curettage if the pregnancy appeared viable 2 weeks after methotrexate or if any gestational sac persisted 4 weeks after methotrexate. Outcomes were complete medical abortion and suction curettage. RESULTS: Sixteen hundred fifty-nine women (84.1%) had a complete medical abortion, and 257 (13.0%) had suction curettage. The most common reason for curettage was patient option (8.9%). At 2 weeks after methotrexate use, 1.4% of women had curettage because of a viable pregnancy; at 4 weeks, 1.6% of women had curettage because of a persistent but nonviable pregnancy. One percent of women had curettage because of physician recommendation, most commonly for bleeding. Suction curettage rates decreased with site experience (P <.006) and were lower at early gestational ages (P <.004) and in nulliparous women (P <.004). CONCLUSION: Medical abortion with methotrexate and misoprostol is safe and effective and can be offered in a community setting.

Abortifacient Agents, Nonsteroidal↗
PubMed2001

Early medical abortion with methotrexate and misoprostol: outcomes and satisfaction among women aged 15-21 years.

STUDY OBJECTIVE: To compare the outcomes of women aged 15-21 yr to those of older women in a multicenter case series of early medical abortion. DESIGN, SETTING, PARTICIPANTS: We enrolled 1973 women at 34 outpatient Planned Parenthood sites in a case series for medical abortion in the first seven weeks of pregnancy. We used methotrexate (50 mg/m(2)) and misoprostol (800 mg vaginally, repeated as needed). We compared women who started the abortion prior to their 22(nd) birthday to older women. Outcomes of abortion were classified as documented or presumed complete medical abortion, and documented or presumed suction curettage. During the first half of the study, we did an exit interview assessing patient satisfaction. RESULTS: A total of 330 women were under 22 yr and 1641 women over 21 yr. Younger women presented for abortion at the same gestational ages. Overall, younger women had a higher rate of complete medical abortion than did older women (89.4% vs 83%). However, the multiple regression model demonstrated a significant adverse effect of prior live birth (P = 0.006), but not patient age, on outcome. Younger women were less likely to have had prior live births. Younger women were more likely to return for follow-up (96.4% vs 92.9%); the regression model demonstrated a significant effect (P = 0.001) of prior birth on rates of follow-up. Side effects and satisfaction were similar for older and younger women. CONCLUSIONS: Younger women having medical abortion with methotrexate and misoprostol have better outcomes and similar satisfaction levels as do older women.

Abortifacient Agents, Nonsteroidal↗
PubMed1995

Compliance and oral contraceptives: a review.

Compliance difficulties are more common among oral contraceptive (OC) users than generally appreciated by clinicians, in part because unintended pregnancy is a relatively infrequent consequence and in part because more common manifestations such as spotting and bleeding may not be recognized as resulting from poor compliance. While improving compliance is a shared responsibility of patients, clinicians, and manufacturers, the clinician is the focal point for these efforts. Counseling must be individualized, which requires knowledge of factors that predict compliance and an understanding of the patient's decision-making process as it relates to medications. Most OC compliance research has focused on adolescents, where predictors of poor compliance include multiple sex partners, low evaluation of personal health, degree of concern about pregnancy, and previous abortion. Good compliance has been linked with patient satisfaction with the clinician, the absence of certain side effects, establishing a regular daily routine to take OCs, and reading information distributed with OC packaging.

Contraceptives, Oral↗
PubMed1990

Complications of first-trimester abortion: a report of 170,000 cases.

One hundred seventy thousand first-trimester abortions were performed in three free-standing clinics of Planned Parenthood of New York City from 1971-1987. Seventy percent of the procedures were done under local anesthesia; the remainder under intravenous methohexital. No preoperative medications or routine postoperative antibiotics were given. High-risk patients were referred to a hospital. The clinics operated under uniform written guidelines. Experienced physicians performed the procedures. There were no deaths in this series of patients. One hundred twenty-one patients were hospitalized (0.71 per 1000) for suspected perforation, ectopic pregnancy, hemorrhage, sepsis, or recognized incomplete abortion. There was no major extirpative surgery performed. There were an additional 1438 minor complications (8.46 per 1000). Overall, there were 9.05 complications per 1000 abortions. The complication rates for procedures done under general anesthesia and local anesthesia were similar. We conclude that outpatient abortion on selected patients to the 14th week from the last menstrual period is a safe procedure.

Abortion, Induced↗
PubMed1986

Risk management in pregnancy termination.

This chapter reminds those who provide abortion services that crises are inevitable in the medical, counselling and administrative areas of the facility. After more than 10 years of providing safe, legal abortions, the author notes that the different types of crises that occur are already known and that it is possible to prepare for them. Indeed, it is necessary to prepare for a crisis before it occurs. The essence of crisis management is to: (a) identify each possible crisis and prepare a plan to cope with it, (b) train personnel to avert and/or manage a crisis, and to be sure that this training is carried out at appropriate intervals to provide sufficient trained staff at all times and (c) have on hand an up-to-date, adequate stock of the appropriate supplies and equipment to deal with medical and other emergencies. Four crisis management 'dicta' are given: Prepare yourself, your personnel, and your facility to be able to handle crisis. When a medical crisis, as listed, has occurred, the patient should be rapidly transported to the hospital and observed there for a suitable period of time. A medical crisis must be treated as the life-threatening event that it is, regardless of personal ego damage, social disruptions and/or financial considerations. The more personnel trained in cardiopulmonary resuscitation, the better.

Abortion, Induced↗
PubMed1985

Treatment of women who have undergone chemically induced abortions.

The pathophysiology of abortion induced by the transcervical introduction of compounds containing mixtures of soap, cresol and phenol is complex. A plan is necessary for the treatment of such critically ill women. The complex, multisystem damage produced by those compounds requires an extremely sophisticated treatment approach to avoid the many pitfalls that beset those cases.

Abortifacient Agents↗
PubMed1978

Reduced dose of Rh immunoglobulin following first trimester pregnancy termination.

The efficacy and safety of a 50-microgram dose of Rh immune globulin for prevention of Rh isosensitization following first trimester vacuum abortion are evaluated in this study. A total of 1027 women undergoing abortion at three outpatient facilities participated in the study; 755 (73.5%) completed follow-up serologic screening 6 months after termination of pregnancy. None showed serologic evidence of Rh sensitization at the time of followup. No serious adverse reactions to the drug were observed.

Abortion, Induced↗