Medication abortion is safe before 6 weeks of pregnancy, ET HealthWorld

Written by Nancy Lapid

BENGALURU: Medical abortion can be performed safely from the fourth week of pregnancy, researchers reported Wednesday in the New England Journal of Medicine.

Medication abortions are usually not performed until the fifth or sixth week, when an ultrasound can confirm the pregnancy in the uterus.

We cannot exclude the possibility that the embryo may have attached itself to a site outside the uterus before that time. Such an ectopic pregnancy does not end for any reason. medical abortion and can be life-threatening.

Study leader Dr. Kristina Gemsel Danielsson of Sweden's Karolinska University Hospital said the large-scale trial showed that very early medical abortions are just as effective and safe for undiagnosed ectopic pregnancies. It said in a statement that it was found to be possible.

Co-author Dr. Karin Blundell, also from Karolinska University Hospital, said in a statement that some U.S. states ban abortions after six weeks.

“It was therefore important to show that early abortion is equivalent to the current standard of care in the second trimester.”

The study involved more than 1,500 women from 26 clinics in nine countries who sought abortions before an ultrasound confirmed an intrauterine pregnancy.

They either underwent late medical abortion after the pregnancy was confirmed in utero at 5 to 6 weeks, or early abortion at 4 to 6 weeks. Both groups were given two standard drugs used in medical abortion: mifepristone and misoprostol.

Some participants reported symptoms of ectopic pregnancy, such as abdominal pain and bleeding, or a history of ectopic pregnancy, such as getting pregnant despite using an intrauterine device or having had an ectopic pregnancy in the past. None had pregnancy risk factors.

More than 95% of women in both groups had a complete abortion. Women in the early group reported less pain and bleeding.

The pregnancy continuation rate was 3.0% in the early group and 0.1% in the standard group.

Continued pregnancy after medical abortion can be treated with repeated doses of misoprostol or uterine aspiration according to medical guidelines.

Surgical intervention for incomplete abortion was required in 4.5% of the standard group compared with 1.8% in the early group.

Use of type 2 diabetes drugs increases among people with type 1 diabetes

A new study shows that even though the drug is only approved for the more common type 2 diabetes, it also has cardioprotective effects and causes significant weight loss in lower blood sugar-lowering prescriptions in the U.S. It is increasing among diabetics.

The drugs include GLP-1 drugs such as Novo Nordisk's Ozempic and Eli Lilly's Trulicity, and SGLT2 drugs such as Boehringer Ingelheim's Jardiance, Eli Lilly's Jardiance and AstraZeneca's Farxiga.

Researchers analyzed electronic medical records of 943,456 patients with type 1 diabetes in 50 states and found that the proportion of patients prescribed either GLP-1 or SGLT2 drugs increased from 0.7% in 2010 to 2023. It was found that in 2017 it rose to 8.3%.

Researchers reported in JAMA that during this period, the proportion prescribed GLP-1 drugs increased from 0.3% to 6.6%, while the proportion receiving SGLT2 drugs increased from 0.1% to 2.4%. .

The largest increase in SGLT2 prescriptions occurred in the subgroup of patients with cardiovascular disease, whereas the largest increase in GLP-1 prescriptions was in obese patients.

GLP-1 and SGLT2 drugs are not approved for type 1 diabetes in the United States and Europe due to safety concerns.

GLP-1 can increase the risk of dangerously low blood sugar levels, and SGLT-2 can increase the risk of life-threatening diabetic ketoacidosis. People with type 1 diabetes are usually already taking insulin.

However, the researchers noted the heart and kidney protection these new drugs offer, saying, “The use of these new drugs in type 1 diabetes is likely to continue due to their significant weight management and cardiorenal benefits.'' “There is,” he said.

Until reliable studies demonstrate their effectiveness and safety in patients with type 1 diabetes, “caution should be used when prescribing these treatments,” the researchers said.

Failure to remove blood clot filter increases complications

Filters placed in the chest to prevent blood clots from entering the lungs should ideally not remain there forever, but very few actually get removed, a new study shows. Ta.

The filter is inserted into the inferior vena cava, a large vein that leads to the heart. Professional societies and the U.S. Food and Drug Administration recommend that patients have them removed as soon as they are no longer at high risk for pulmonary emboli or blood clots in the lungs.

The longer a filter is left in place, the greater the risk of serious complications, but it is debatable whether the benefits outweigh the risks.

The study included more than 270,000 U.S. adults aged 65 and older who received IVC filters between 2013 and 2021.

The number of annual listings has decreased rapidly over time, from 44,680 in 2013 to 19,501 in 2021. However, the response rate remained stable, reaching 15.3% with a median of 1.2 years and 16.8% with up to 9 years of follow-up, the researchers said. Reported in JAMA.

Among patients whose filters were not removed, 1.4% experienced filter-related complications during a median follow-up of 1.4 years.

An editorial published with the research report said the search efforts were highly successful with few complications, especially when done within the first few months after filter insertion.

“It is concerning that the recovery rate remained low throughout the study period,” the editorial states, given that the risk of many filter-related complications increases over time. (Reporting by Nancy Lapid; Editing by Bill Berkrot)

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