Medical termination of pregnancy (MTP) is an induced abortion based on medical indications given by two independent experts in case of danger to the mother to continue the pregnancy or risk of giving birth to a child with a disease or malformation incompatible with life [1].

With the development of ultrasound and prenatal diagnostic techniques, the foetus has become a patient in its own right and the number of medical terminations of pregnancy is increasing [2]. Prenatal diagnosis in the first and second trimester is increasingly used and allows early detection of fetal anomalies [2]. Apart from foetal and maternal indications for termination, obstetric and exogenous indications are increasingly found [3]. This medical termination of pregnancy considerably reduces the number of obstetrical complications that can lead to maternal death and the number of births of children with a disease or malformation that is incompatible with life.

Nearly ten years after the start of maternity activities, this study is conducted to:

➢ determine the frequency of medical termination of pregnancy;

➢ describe the indications for medical termination of pregnancy;

➢ describe the different techniques used in medical termination of pregnancy.

This was a retrospective and descriptive study conducted at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF) covering the period from May 1st, 2012 to April 30th, 2021, i.e. a period of 9 years.

All patients who underwent a medical termination of pregnancy during the study period and whose term of pregnancy was <28 weeks of amenorrhea were included in this study. Information was collected on a survey form from the patients’ clinical records, admission and hospitalisation registers, referral forms and operative report registers.

Data were entered and analysed using Excel, World and epi-info 7.2.2.

The main variables studied were hospital frequency, diagnostic facilities, main indications, means of evacuation and maternal prognosis. For the study, the following were considered:

- Medical termination of pregnancy (MTP): any termination of pregnancy for medical reasons before 28 weeks of amenorrhoea on the basis of the date of the last menstrual period or on the basis of the ultrasound of the first trimester of pregnancy.

- Fetal termination when the cause was of fetal origin.

- Maternal termination when the cause was related to the mother’s health condition.

- Medical termination of pregnancy for obstetrical reasons when the cause was related to an obstetrical complication.

In the case of a situation requiring a Medical termination of pregnancy, the case was presented to the staff of all three gynaecologist-obstetricians, including the head of department and the seven midwives, before the decision was made. Once the decision was made, a discussion was held with the couple to obtain their consent. This consent was most often verbal and the length of this consent varied from patient to patient, especially when the clinical picture did not present an emergency situation. After having obtained the couple’s consent, the medical termination of pregnancy was carried out following the steps of the protocol in the department:

The first step consisted in carrying out a basic check-up such as a blood count, uremia, creatininemia, glycemia, prothrombin rate and activated partial thromboplastin time.

The second step was preparation for uterine evacuation. An emergency caesarean section was performed if the clinical picture did not allow evacuation by medical means.

When the clinical picture allowed it, medicated evacuation was performed: either with misoprostol alone or the combination of mifepristone and misoprostol. Three protocols were used in the center. The choice of protocol depended on the woman’s clinical condition, the term of the pregnancy, the parity and condition of the cervix, and the history of surgery on the uterus.

When the term of the pregnancy was less than 24 weeks of amenorrhoea, the protocol was used:

- Mifepristone and misoprostol protocol

This protocol consisted of 200 mg of Mifepristone administered orally followed 36 hours later by 400 µg of Misoprostol administered sub lingually. If after 3 - 6 hours there was no contraction or expulsion, a further 400 μg of misoprostol could be given every 6 hours up to a maximum of five doses.

- Sublingual Misoprostol Protocol

This protocol consists of giving 400 µg of Misoprostol sub lingually. If after 3 - 6 hours there is no contraction or expulsion, another 400 μg of misoprostol can be given every 6 hours up to a maximum of five doses.

When the term of pregnancy is greater than 24 weeks of amenorrhoea, only misoprostol was used according to the Intravaginal Misoprostol Protocol

- Intravaginal Misoprostol Protocol

This protocol consists of using misoprostol at 25 to 50 μg in the posterior vaginal pouch every 6 hours up to a maximum of five doses.

Regardless of the protocol used, to decrease the duration of labour, an active attitude of amniotomy is recommended as soon as the membranes are accessible, regardless of the term and presentation, and even if the cervix is still long and posterior.

An emergency caesarean section was performed if the clinical picture did not allow evacuation by medical means. The Pfannenstiel technique was used. The type of anaesthesia was determined by the patient’s haemodynamic status. As the lower segment was not formed in the 2nd trimester, the caesarean section was low transverse corporal.

- Psychological support

Women who had to undergo a medical termination of pregnancy were given psychological support by the psychologist, midwives and obstetricians before and after the operation.

Medical termination of pregnancy is a type of abortion that is performed in the centre. The indications are fetal, maternal and obstetric. The most commonly used evacuation technique is the medicated route. Despite some differences, our practices remain in line with the literature. This series has allowed us to highlight our singularities, and will allow us to improve the management of our patients, in the prevention of haemorrhage and other complications.

The authors declare no conflicts of interest regarding the publication of this paper.

M’bortche, B.K., Douaguibe, B., Logbo-Akey, K.E., Ajavon, D.R., Ketevi, T.A., Bassowa, A., Baramna-Bagou, F., Toovi-Madjé, K., Aboubakari, A.-S. and Akpadza, K. (2022) Medical Interruption of Pregnancy in the Second Trimester at the Principal Clinic of the Togolese Association of Family Well-Being Planning Center (ATBEF): About 25 Cases. Open Journal of Obstetrics and Gynecology, 12, 81-92. https://doi.org/10.4236/ojog.2022.121008

1. SOCIO-DEMOGRAPHIC CHARACTERISTICS

· Age (years):

· Occupation:

· Level of education:

· Marital status:

· Place of origin:

2. BACKGROUND INFORMATION

Personal history

· Medical (illnesses): .......................................

· Obstetrical: Gestity:..................Parity:..................A history of abortion:...............

· Surgical: Caesarean section Yes□ No□

· If yes, specify: Date ............ Number of times......

· Specific Family History: ......................................................

3. INDICATION/CAUSAL PATHOLOGY:

Maternal indication:

· terminal stage maternal cancer □

· Cardiac disease □

· Eclampsia□

· Preclampsia □

· HELLP Syndrome □

· Other □ If other, specify:……………………..

Fetal indication:

· Fetal malformations□ if malformation, specify:……………………………..

· Chromosomal□

· Genetic□

· Other □ If other, specify:……………………..

Obstetrical indication:

· low inserted hemorrhagic placenta □

· rupture of membranes □

· anamnios/oligoamnios □

· Chorioamniotitis □

· other □ if other, specify:…………………….

Diagnosis methods:

· ultrasound □

· clinical examination: □

· clinical examination and ultrasound □

· Specify gestational age .............

4. INTERVENTION

Medication evacuation: Yes □ No □

If yes specify protocol used..........................................

Specify time in hours from 1st dose of misoprostol to expulsion:……................

Caesarean section: yes □ no □

Specify indication for caesarean section

Incidents: ..............................................

Pathology workup: Yes □ No □

5. COMPLICATIONS:

· None □

· Delivery haemorrhage□

· Placental retentions□

· Endometritis□

· Uterine rupture□

· other □ if other, specify:…………………….

6. PROGNOSIS

Maternal morbidity:

· Anemia □

· Blood transfusion: Yes□ No□ If yes, specify the number of packed red blood cells: .............

· Infections □

· Hysterectomy □

· other □ if other, specify:…………………….

Maternal Mortality:

· Deceased □

· Alive □