title: Early abortion in family medicine: clinical outcomes.
abstract: OBJECTIVE
  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 first-trimester medication and aspiration abortion procedures by family physicians.
  
  
  METHODS
  Prospective observational cohort study conducted from August 2001 to February 2005 of 2,550 women who sought pregnancy termination in 4 clinical practices of family medicine departments and 1 private office/training site.
  
  
  RESULTS
  The rate of successful uncomplicated procedures for medication was 96.5% (95.5%-97.1% [corrected] confidence 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).
  
  
  CONCLUSIONS
  Complications of medication and aspiration procedures occurred at a low rate, and most were minor and managed without incident.
authors.affiliation: Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 2nd Floor Gates Pavilion, 3400 Spruce St, Philadelphia, PA 19104-4283, USA. ian.bennett@uphs.upenn.edu
authors.forename: Ian M
authors.initials: IM
authors.lastname: Bennett
authors.forename: Margaret
authors.initials: M
authors.lastname: Baylson
authors.forename: Karin
authors.initials: K
authors.lastname: Kalkstein
authors.forename: Ginger
authors.initials: G
authors.lastname: Gillespie
authors.forename: Scarlett L
authors.initials: SL
authors.lastname: Bellamy
authors.forename: Joan
authors.initials: J
authors.lastname: Fleischman
mesh_terms: D000019:Abortifacient Agents / Q000627:therapeutic use; D000028:Abortion, Induced / Q000009:adverse effects / Q000193:education / Q000379:methods; D000293:Adolescent; D000328:Adult; D004502:Education, Medical, Continuing; D005194:Family Practice / Q000193:education; D005260:Female; D006801:Humans; D007396:Internship and Residency; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D011271:Pregnancy, Ectopic / Q000175:diagnosis; D011331:Private Practice; D014619:Vacuum Curettage; D055815:Young Adult
chemical_list: D000019:Abortifacient Agents