Question: In a pregnant woman with pulmonary hypertension, what is the best method of abortion?
Answer: No systematic reviews or controlled trials were found on the method of abortion in women with pulmonary hypertension. One case study1 (Evidence level III) reported the use of dilation and evacuation for the second trimester termination. The article describes:
“Prior to dilation and evacuation an arterial line and central venous pressure catheter were inserted. Laminara tents were placed, and dilation and evacuation were performed under epidural anesthesia 18 hours later. Immediately afterwards, a bilateral tubal ligation was performed through a minilaparotomy incision. The estimated blood loss for the procedures was 200mL, and there were no postoperative complications”
References
1. Bowers C, Devine PA, Cervenak FA. Dilation and evacuation during the second trimester of pregnancy in a woman with primary pulmonary hypertension. Journal of Reproductive Medicine. 1988; 33:787-8.
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
Search date: July 2009.
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