Early Abortion in Family Medicine: Clinical Outcomes

Abstract

PURPOSE Clinical innovations have made it more feasible to incorporate early abortion into family medicine, yet the outcomes of early abortion procedures in this setting have not been well studied. We wished to assess the outcomes of fi rsttrimester medication and aspiration abortion procedures by family physicians. METHODS RESULTSThe rate of successful uncomplicated procedures for medication was 96.5% (95% confi dence interval [CI], 95.5%-97.0%) and for aspiration was 99.9% (CI, 99.3%-1). Adverse events and complications of medication abortions were failed procedure (ongoing pregnancy; n = 19, 1.45%); incomplete abortion (n = 16, 1.22%); hemorrhage (n = 9, 0.69%); and patient request for aspiration (n = 1, 0.08%). One (0.08%) missed ectopic pregnancy was seen among patients receiving medication. Four types of adverse outcomes were encountered with aspiration: incomplete abortion requiring re-aspiration (n = 21, 1.83%); hemorrhage during the procedure (n = 4, 0.35%); missed ectopic pregnancy (n = 3, 0.26%); and minor endometritis (n = 1, 0.09%). Missed ectopic pregnancies were successfully treated in the inpatient setting without mortality (overall hospitalization rate of 0.16 of 100). All other complications were managed within outpatient family medicine sites. Rates of complication did not vary by experience of physician or by site of care (residency vs private practice). CONCLUSIONSComplications of medication and aspiration procedures occurred at a low rate, and most were minor and managed without incident.

A Study of Complications following Self-administration with Medical Abortion Pills

“…In another study conducted by Thaker et al 12 70.2% patient had incomplete abortion and 10.8% had failed abortion. In the study conducted by Bennett et al, 13 medical abortion using correct regimen of mifepristone and misoprostol was associated with high success rate of 96.5%, incomplete abortion as 1.2%, failed abortion as 1.45% and missed ectopic pregnancy as 0.08%.…”

Medical Abortion: Outcomes in a Family Medicine Setting

“…3 In addition, a prospective observational study at 5 family medicine sites, including 4 residency practices, found a success rate of 96.5% for early medical abortion. 8 There was one ruptured ectopic pregnancy in the family medicine group and one pulmonary embolus in the specialized clinic group. Both of these outcomes are secondary to pregnancy and should not be considered evidence that medical abortion is unsafe in either setting.…”

“…4 Family medicine sites have been involved in medical abortion research in the United States since the outset and several published studies have demonstrated good outcomes for medical abortion performed in family medicine settings. [5][6][7][8] (In patient education materials, we used the wording "medication abortion" to make it clear to patients that the abortion is caused by a pill; however, the convention used in the medical literature has been to call it "medical abortion," so to be consistent with the published literature we have used that term here.) No published studies have compared medical abortion outcomes in the family medicine setting versus outcomes in specialized reproductive health clinics.…”

A Prospective Trial of Oral Mifepristone and Vaginal Misoprostol in Termination of Pregnancies Upto 63 Days of Gestation

“…3 In a study by Bennett I.M et al, of 1309 patients 96.5% had a complete abortion. 8 In a study by Ashok P.W et al, out of 1961 subjects, 1912 had a complete abortion with no need of surgical intervention. Thus the success rate was 97.5%.…”