Survey on spontaneous miscarriage and induced abortion surgery safety at less than 12 weeks of gestation in Japan

Abstract

Aim: In Japan, dilatation and curettage (D&C) is a common procedure for spontaneous miscarriage and induced abortion, and its safety has long been an issue. Electric vacuum aspiration (EVA) is also common, but manual vacuum aspiration (MVA) was introduced recently, with medical abortions using mifepristone or misoprostol which are not yet legally accepted. This nationwide retrospective study surveyed the surgical methods and complications associated with spontaneous miscarriage and induced abortion at less than 12 weeks of gestation in Japan to assess their safety, in comparison with a similar survey for induced abortions in 2012. Methods: Questionnaires were sent to 4176 facilities with a license for induced abortion surgeries in 2019. The questions included were the methods used, number of spontaneous miscarriages and induced abortions, and number of complications (uterine perforation, incomplete abortion, and gross bleeding requiring blood transfusion). Results: Responses were received from 1706 facilities (40.9%). Although EVA with sharp curettage was the most common surgical method, which was used for 11 953 spontaneous miscarriages (28.9%) and 24 045 induced abortions (37.3%), the most common surgical method per facility was D&C, and the rates of D&C for spontaneous miscarriages (38.4%) and induced abortions (44.7%) performed in general hospitals were significantly higher than those in clinics (24.1% and 22.0%, respectively). There was no significant difference in the complication incidence rate among surgical methods for spontaneous miscarriages. However, in induced abortion surgery, the total complication and incomplete abortion incidence rates for D&C were significantly higher than those for EVA without sharp curettage (47/15 162 [0.31%] vs. 29/18 693 [0.16%], p = 0.00362, 45/15 162 [0.30%] vs. 27/18 693 [0.14%], p = 0.00285, respectively). There was no significant difference in the complication incidence rate between MVA and other surgical methods for each abortion surgery. Conclusion: In Japan, especially in general hospitals, D&C is still widely used for miscarriage and induced abortion surgery. Its complication-incidence rates significantly decreased compared with that of the nationwide survey in 2012, but were still significantly higher than EVA without sharp curettage. Few facilities used MVA, but its complication rate was comparable with those of other surgical methods.

Two pills and women’s health in Japan

“…The World Health Organization (WHO) includes medical abortion in its Model List of Essential Medicines and recommends avoiding curettage, 3 which is used for one-fourth of early abortions in Japan. 4 The Phase III study of medical abortion pills in Japan reported a high success rate (93.3%) and a low frequency of bleeding as a severe complication (0.8%). 5 In addition, a study in the Netherlands reported a higher satisfaction (answering “very much”) among women choosing medical abortion (45%) compared to vacuum aspiration (31%).…”

Response: Japan foresees early‐stage medical abortion approval: Will this reduce barriers to access safe abortion?

“…Indeed, in 2015, a Japanese nationwide survey reported that D&C resulted in higher risk of uterine perforation compared to VA (36.4/100 000 vs. 4.9/10 0000, P = 0.047) 11 . However, in 2019, 23.5% of induced abortions were still performed by D&C, 40.3% by VA with curettage, and only 36% by VA only 12 …”

“…11 However, in 2019, 23.5% of induced abortions were still performed by D&C, 40.3% by VA with curettage, and only 36% by VA only. 12 Obstetricians and gynecologists should provide sexual and reproductive health and rights services, including safe abortion care, based on scientific evidence within the framework of rights. JSOG's strong leadership is expected.…”