Sophie Gaudu, Hôpital Cochin-Saint Vincent de Paul, Centre d’orthogénie et de planification familiale
Co-authors: Drs I. Dagousset, L. Esterle, S. Eyraud, P. Faucher, D. Hassoun, and M. Teboul
The French legislation allows women to get a medical abortion at home under the control of GPs or gynecologists in private surgeries. In 2007, these abortions represented almost 9 % of induced abortions in France and 18% of the medical abortions (DREES, Etudes et résultats, n°712, 2009). The process is strictly defined by law. The termination of pregnancy (max 49 amenorrhea days) should be carried out by doctors who have signed a contract with a referral hospital. This hospital takes the charge of treating any complication that may arise. REVHO, a network of private physicians and hospitals, has been created in Paris and suburban areas in order to train the doctors, to set-up contract-based links with hospital family planning centers and to evaluate the quality of the method as well as the users’ satisfaction.
Five years after the creation of REVHO, 20 200 abortions at home using mifepristone and misoprostol have been performed within the network. This paper presents the results of 15 447 abortions carried out in the network. Data were entered on a PC held database and analyzed using EPI INFOTM Version 6. The women were 41 days of amenorrhea on average (90 % between 35 and 49 days) and their age varied from 14 to 55 (median: 28 years).
From 2005 to 2008, 162 physicians with private practices were involved: respectively 44 % and 56 % of abortions were carried out by GPs and gynecologists. The quantity of supervised abortions varied from 1 to more than 3600 per physician on the 4-year period. Twenty-three physicians (14%) performed more than 200 medical abortions and three, more than 1500.
About 80% of the abortions were followed up two weeks later. The success rate (as defined by the absence of surgical completion) was 97.9%, which is among the highest rates reported for medical abortion. There was a statistically significant difference between GPs (success rate of 98.2 %) and gynecologists (success rate 97.5 %) which can be discussed. The global rate of continuing pregnancy was 0.7%. No serious complication was observed.
These results demonstrate that medical termination of pregnancy at home can be performed under the control of physicians in their private practices without increasing the risks of failures or complications. GPs are efficient as well as gynecologists, which could allow an increase of the number of practitioners involved and contribute to health care proximity. Five years after its creation, REVHO demonstrated its capacity to incorporate the medical abortion into primary practices, with referral hospital services available for complications or surgical completions.