Safety of medical abortion up to 10 weeks at home
Iolanda Ferreira, Filipa Coutinho, Manuel Fonseca, Elsa Vasco, Teresa Bombas, Maria Céu Almeida, Paulo Moura
Obstetrics Service A and B of Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
Introduction: In Portugal, abortion by women's request is legal until 76 days of pregnancy. The rate of medical abortion is nearly 96% in the National Health System.
Objectives: Evaluate the safety of medical abortion at home before and after 9 weeks of pregnancy.
Methods: Retrospective evaluation of 6735 women (Group1-before 9 weeks; Group2-after 9 weeks), who attended our department between January 2007 and December 2015. For abortion the protocol used was mifepristone 200 mg and vaginal misoprostol 800 mcg after 48 hours. Statistical analysis was made using Independent T-test; Chi-Square and Mann-Whitney U test in SPSS 20.0.
Results: Medical abortion was an option in 98.8% (n= 6650) of cases; 56 (0.8%) at hospital and 6594 (99.2%) at home. Regarding abortion at home, the mean age was higher in group 1 (28.9 vs 28.3; p= 0.05).
According to national guidelines, an abortion is complete when there is no need for additional medical or surgical intervention. There was no difference in efficacy between groups (Group 1: 97.4% vs Group 2; 96.5%; p= 0.3). The most common side effect was pain, which was moderate (Group1: 34.3% vs Group2: 30.9%) intense (32.3% vs 38.2%) and maximal (11.6% vs 18.2%). Pain scores were significantly higher after 9 weeks of gestation (p= 0.04).
There were no differences between groups regarding complication rate (Group1: 7.9% vs Group 9.9%; p= 0.2). The most common complication was retained abortion (6.1% vs 6.5%); method failure (1.2% vs 1.6%); endometritis (0.2% vs 0.8%) and severe blood loss (1% vs 1%). The rate of admission to hospital due to complications did not differ between groups (3.7% vs 4.4%; p= 0.5).
Conclusion: Medical abortion is equally effective and was proven to be safe at home in both groups. The most common side effect was pain and it was significantly more intense after 9 weeks of gestation.