Pain management for medical abortion before 14 weeks’ gestation: A systematic review

Reynolds-Wright, John Joseph; Woldetsadik, Mulat A; Morroni, Chelsea; Cameron, Sharon

doi:10.1016/j.contraception.2022.08.005

Cited by 7 publications

(2 citation statements)

References 14 publications

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“…Guidance from the Royal College of Obstetricians and Gynaecologists and WHO specifies that those undergoing abortion should be offered pain relief 12 13. However, evidence on the most effective pharmacological interventions is minimal and unclear,14 and current approaches vary 11 15–18…”

Section: Introductionmentioning

confidence: 99%

Foregrounding pain in self-managed early medication abortion: a qualitative study

Purcell,

Newton,

Bloomer

et al. 2024

BMJ Sex Reprod Health

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ObjectiveTo explore experiences of pain in the context of early medical abortion (EMA) in the UK and to guide best practice around anticipatory guidance on pain.MethodsFrom late 2020 to early 2021, we recruited individuals from across the UK who had undergone abortion during the COVID-19 pandemic to participate in in-depth, semi-structured telephone interviews. A storytelling approach was used and data were analysed thematically using NVivo 12 software.ResultsFocused coding and thematic analysis addressed accounts of pain, which were prominent in many interviews. We constructed the following subthemes: expected pain is manageable for some; the problem with unexpected pain; pain (co)produces fear; and problematising ‘period-like pain’. The key issue which our analysis draws out is that while EMA pain experience might vary, for some it may be much worse than anticipated. Moreover, the common trope of likening it to ‘period pain’ can be misleading and a source of additional uncertainty at a potentially already challenging time.ConclusionsFor some individuals, pain experienced in EMA will be severe and/or worse than expected. Insufficient preparation for pain can result in extremely negative experiences of EMA. Alongside development of improved analgesia, improvements should be made to anticipatory guidance on pain, particularly for those self-manging EMA at home. Framings of ‘period-like pain’ do not clarify expectations and should be avoided.

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Section: Introductionmentioning

confidence: 99%

Foregrounding pain in self-managed early medication abortion: a qualitative study

Purcell,

Newton,

Bloomer

et al. 2024

BMJ Sex Reprod Health

View full text Add to dashboard Cite

show abstract

“… 2 , 3 Medical abortion is known as a painful process, as it involves the passing of the retained pregnancy conception through the cervix and the uterine smooth muscles contraction, with about 75% of women who have experienced early medical abortion before 9 weeks using opiate-based analgesia. 4 In two different studies by Wiebe, approximately 20% of the participants reported pain scores of 9 or 10 based on VAS, which means severe pain in medical abortion. 5 , 6 In addition, several studies have reported that 80%–100% of women required the use of analgesics.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Ibuprofen Lysine on First-Trimester AbortionRelated Pain and Hemorrhage: A Randomized TripleBlinded Clinical Trial

et al. 2023

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Background: Some recent trials have reported high efficacy for nonsteroidal anti-inflammatory drugs (NSAIDs) in relieving medical abortion-related pain. The aim of this study was to determine the beneficial effect of oral NSAIDs (ibuprofen lysine) in reduction of pain and hemorrhage in first-trimester medical abortion. Methods: This randomized triple-blinded clinical trial was performed on 98 pregnant women who were candidate for medical abortion within the first-trimester period (gestational age<12 weeks). The participants were randomly assigned to receive ibuprofen lysine (684 mg orally every 4 hours) or placebo. All patients were initially treated with misoprostol (800 µg every 3 hours). Pain intensity and rate of hemorrhage were assessed every hour up to 15 hours after receiving the first dose of misoprostol by visual analogue scaling (VAS) and pictorial blood loss assessment chart (PBAC), respectively. Results: Assessing the mean pain score within 15 hours of receiving misoprostol showed significantly lower pain intensity within the first 10 hours of assessment in the group receiving NSAID in comparison with the control group (P<0.001). The bleeding rate was also significantly lower in the NSAID group at the fifth (P=0.013) and ninth (P=0.040) hour of receiving misoprostol compared to the control group. We found no difference in abortion-related complication rate between the NSAID and placebo groups (8.3% versus 8.0%, P=0.952). Conclusion: The use of NSAIDs (ibuprofen lysine) is a good pharmacological analgesic option for relieving medical abortionrelated pain and hemorrhage.

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Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings

et al. 2023

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Introduction: Women frequently report pain associated with medical termination of pregnancy (MToP), and its management can differ largely between centres. This study aimed at evaluating in real-life settings pain related to MToP and its management in France. Methods: This was a non-interventional prospective, longitudinal study run in 23 centres between 2015 and 2016 that included 893 pregnant women. Pain was reported by women prior any curative analgesic intake (CAI)

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Pain management for medical abortion before 14 weeks’ gestation: A systematic review

Cited by 7 publications

References 14 publications

Foregrounding pain in self-managed early medication abortion: a qualitative study

Foregrounding pain in self-managed early medication abortion: a qualitative study

Efficacy of Ibuprofen Lysine on First-Trimester AbortionRelated Pain and Hemorrhage: A Randomized TripleBlinded Clinical Trial

Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings

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