title: Rates of serious infection after changes in regimens for medical abortion.
abstract: BACKGROUND
  From 2001 through March 2006, Planned Parenthood health centers throughout the United States provided medical abortion (abortion by means of medication) principally by a regimen of oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In response to concern about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration from vaginal to buccal and required either routine provision of antibiotics or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine treatment with antibiotics for all medical abortions.
  
  
  METHODS
  We performed a retrospective analysis assessing the rates of serious infection after medical abortion during a time when misoprostol was administered vaginally (through March 2006), as compared with rates after a change to buccal administration of misoprostol and after initiation of additional infection-reduction measures.
  
  
  RESULTS
  Rates of serious infection dropped significantly after the joint change to buccal misoprostol from vaginal misoprostol and to either testing for sexually transmitted infection or routine provision of antibiotics as part of the medical abortion regimen. The rate declined 73%, from 0.93 per 1000 abortions to 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidence interval [CI], 0.44 to 0.94; P<0.001). The subsequent change to routine provision of antibiotics led to a further significant reduction in the rate of serious infection - a 76% decline, from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction, 0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03).
  
  
  CONCLUSIONS
  The rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with routine administration of antibiotics.
authors: Planned Parenthood Federation of America, New York, USA. fjerstadm@ipas.org
authors: Mary
authors: M
authors: Fjerstad
authors: James
authors: J
authors: Trussell
authors: Irving
authors: I
authors: Sivin
authors: E Steve
authors: ES
authors: Lichtenberg
authors: Vanessa
authors: V
authors: Cullins
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage*; D000028:Abortion, Induced / Q000009:adverse effects*; D000278:Administration, Buccal; D000282:Administration, Intravaginal; D019072:Antibiotic Prophylaxis; D001424:Bacterial Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D002690:Chlamydia Infections / Q000175:diagnosis; D005260:Female; D006801:Humans; D016595:Misoprostol / Q000008:administration & dosage*; D011247:Pregnancy; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000175:diagnosis
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D016595:Misoprostol