Outpatient medical abortion is safe and effective through 70days gestation

Abbas, Dina; Chong, Erica; Raymond, Elizabeth G.

doi:10.1016/j.contraception.2015.06.018

Cited by 39 publications

(36 citation statements)

References 11 publications

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“…Some received other medication, including misoprostol (13,9.2%) or antibiotics (15, 10.6%). Most received information or reassurance (24/142, 16.9%), or were given or advised to take pain medication (37, 26.1%).…”

Section: Resultsmentioning

confidence: 99%

Mifepristone–misoprostol for menstrual regulation in public sector facilities in Bangladesh

Alam

Lotarevich

Das³

et al. 2017

Intl J Gynecology & Obste

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Section: Resultsmentioning

confidence: 99%

Mifepristone–misoprostol for menstrual regulation in public sector facilities in Bangladesh

Alam

Lotarevich

Das³

et al. 2017

Intl J Gynecology & Obste

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“…Increased availability of medical abortion is attributed to declines in mortality and morbidity of unsafe abortion [19]. Medical abortion with evidence-based mifepristone and misoprostol protocols is safe and effective for pregnancy termination up to 70 days gestation [20][21][22][23][24]. A 2015 retrospective cohort study including over 30,000 women undergoing early abortion found similar efficacy and low complication rates when comparing surgical abortion with medical abortion [25].…”

Section: Introductionmentioning

confidence: 96%

Update on Medical Abortion: Expanding Safe and Equitable, Patient-Centered Care

Whaley

Betstadt

2016

Curr Obstet Gynecol Rep

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Addressing disparities in abortion access and efforts to end the global problem of unsafe abortion are key public health and human rights priorities. Optimizing the role of various health workers in supporting safe medical abortion practices and working to remove unnecessary barriers to care are key strategies that address inequities in outcomes after abortion worldwide. Medical abortion using evidence-based protocols is effective through 70 days gestation and can safely be provided by non-physician providers in outpatient settings. Removing barriers of in-office administration of mifepristone and simplifying follow-up protocols are evidence-based approaches to expanding access to medical abortion, particularly in settings where access to surgical abortion is limited. Research supports expanding the role of women themselves, as well as task-shifting among health worker teams in providing safe abortion and postabortion care. Simplifying the process of medical abortion, including allowing prescription and home administration of mifepristone and utilizing telemedicine for follow-up protocols are safe and feasible, can optimize use of health resources and improve patient experience with medical abortion.

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“…5 The caution advocated by Chen and Creinin in the 10th week of gestation should simply take the form of counseling. Women seeking medical abortion in the 10th week of gestation should know efficacy rates and then make their decisions accordingly.…”

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confidence: 99%

Mifepristone With Buccal Misoprostol for Medical Abortion

Blumenthal

2015

Obstetrics &Amp; Gynecology

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I read with interest the systematic review on medical abortion by Chen and Creinin and was concerned by their conclusion that "more data are needed to evaluate clinical outcomes.beyond 63 days of gestation." 1 In fact, more data have been published since this review, 2 but additional data should not be a prerequisite for offering the safe and effective regimen of mifepristone plus misoprostol between 64 and 70 days of gestational age.To be sure, mifepristone is not a new drug with unknown properties: using it beyond 63 days of gestation is an addition to an established, proven procedure. The review authors indicate that the data from 332 patients identified between 64 and 70 days of gestation offer insufficient evidence to recommend clinical use, yet this sample provides a confidence interval (CI) of 89.6-95.5 in which even the lower limit represents a highly efficacious procedure that women should be allowed to choose. Doctors Chen and Creinin even note that the review demonstrates a higher efficacy through 63 days of gestation than the pivotal trial for U.S. Food and Drug Administration (FDA) approval. 3 This statement is also true through 70 days of gestation. Indeed the CIs are almost precisely the same (FDA approval to 49 days of gestation: 92% CI 90-94; 10th week review data: 93% CI 90-96%).Two substantial clinical trials have directly compared efficacy in the 9th and 10th weeks of gestation and find no statistically significant differences, 2,4 and a new summary of the literature in the 10th week (more than 900 women) reaches the same conclusion. 5 The caution advocated by Chen and Creinin in the 10th week of gestation should simply take the form of counseling. Women seeking medical abortion in the 10th week of gestation should know efficacy rates and then make their decisions accordingly. Indeed, how much data do the authors feel would be enough to recommend this regimen in the 10th week of gestation? With what width of a CI? Let's not allow excessive caution to distort our understanding of the evidence or inhibit us from providing the care our patients deserve. REFERENCES1. Chen MJ, Creinin MD. Mifepristone with buccal misoprostol for medical abortion. Obstet Gynecol 2015;126:12-27. 2. Sanhueza Smith P, Peña M, Dzuba IG, Garcia Martinez ML, Aranguré Peraza AG, Bousiéguez M, et al. Safety, efficacy and acceptability of outpatient mifepristonemisoprostol medical abortion through 70 days since last menstrual period in public sector facilities in Mexico City. Reprod Health Matters 2015;22(44 suppl 1):75-82. 3. Spitz IM, Bardin CW, Benton L, Robbins A. Early pregnancy termination with mifepristone and misoprostol in the United States. N Engl J Med 1998;338:1241-7. 4. Winikoff B, Dzuba IG, Chong E, Goldberg AB, Lichtenberg ES, Ball C, et al. Extending outpatient medical abortion services through 70 days of gestational age. Obstet Gynecol 2012;120:1070-6. 5. Abbas D, Chong E, Raymond EG. Outpatient medical abortion is safe and effective through 70 days gestation. Contraception 2015;92:197-9.In Reply: Our system...

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Outpatient medical abortion is safe and effective through 70days gestation

Cited by 39 publications

References 11 publications

Mifepristone–misoprostol for menstrual regulation in public sector facilities in Bangladesh

Mifepristone–misoprostol for menstrual regulation in public sector facilities in Bangladesh

Update on Medical Abortion: Expanding Safe and Equitable, Patient-Centered Care

Mifepristone With Buccal Misoprostol for Medical Abortion

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