Is medication abortion between 9 weeks and 16 weeks of gestation safe and effective?
In this moderate-sized prospective cohort, 75% of patients with gestational age of 9 weeks to 16 weeks were able to self-medicate a completed abortion without additional health care services. Only 5% underwent a vacuum aspiration or dilatation and curettage to complete the abortion, and less than 2% received a transfusion. Less than 10% did not have a completed abortion or were unsure whether the abortion was completed. Larger studies, including randomized controlled trials, are needed to confirm these findings.
Plan de l'etude:
This prospective cohort study included 264 pregnant individuals between 9 weeks and 22 weeks of gestation, based on ultrasound or last menstrual period, who contacted an abortion-accompaniment group in Argentina, Nigeria, or Southeast Asia seeking information about medication abortion. Trained counselors enrolled eligible callers, 13 years or older, without contraindication to medication abortion. The counselors provided step-by-step instructions on the World Health Organization–recommended protocol for medication abortion specific to their gestational age and medication access. A study coordinator contacted each patient 1 week and 3 weeks after taking the first dose of abortion medication to ascertain outcomes. Mifepristone plus misoprostol was used in 149 cases (56%) and misoprostol alone was used in the remaining 115 cases (44%). At the last follow-up call, 89% of the patients reported successful termination of pregnancy without intervention, and 5% (14/264) had a vacuum aspiration or dilatation and curettage. The most common reason to seek health care was to confirm completed abortion (24%; 62/264), the majority of whom were at more than 12 weeks' gestation. Four participants received a transfusion (1.5%). Only 6% (15/264) of callers had a gestational age of 16 to 22 weeks, and data were too scant to draw conclusions.
Linda Speer, MD
Professor and Chair, Department of Family Medicine
University of Toledo