Efficacy of very early medical abortion
Isabella Bizjak1, Christian Fiala2, Helena Kopp Kallner1, Ingrid Sääv1, Kristina Gemzell-Danielsson1
1WHO CCR, Department of Women´s and Children´s Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden, 2GynMed Clinic, Vienna, Austria
Background: In countries which have introduced medical abortion an increasing number of women present very early for their abortion. However due to limited data and fear of an adverse effect on a possible ectopic pregnancy many health care providers are reluctant to initiate the abortion treatment before an intrauterine pregnancy can be visualised and therefore tend to delay the treatment. This study was conducted to assess the effectiveness and safety of medical abortion in women with very early pregnancy (VEMA) and no confirmed intrauterine gestation (IUG).
Methods: Register based multicentree cohort study comparing women undergoing very early medical abortion (gestations ≤49 days) with or without a confirmed intrauterine pregnancy (i.e. yolk sac or foetal structure) at the initiation of the abortion treatment. 435 women without confirmed IUG were identified and compared with 870 controls with confirmed IUG, matched with regard to age, parity and date of initiation of abortion treatment.
Results: Women with no confirmed IUG were not more likely to experience VEMA failure (i.e. ongoing pregnancy or incomplete abortion) than those with gestations ≤49 days and confirmed IUG. Ectopic pregnancies (n=3) were diagnosed and treated without any serious adverse events.
Conclusion: VEMA failure is not more likely in women with very early pregnancy and no confirmed IUG on ultrasound than those with gestations ≤49 days and confirmed IUG. Hence our findings support that VEMA is both effective and safe for terminating pregnancies in women with no confirmed IUG. Women should, therefore, not be subject to unnecessary delay but should be offered medical abortion accordingly.