Home self-administration of vaginal misoprostol for medical abortion at 50-63 days compared with gestation of below 50 days.
BACKGROUND
Home use of misoprostol for termination of pregnancy is still controversial in many countries. Acceptability of home use of misoprostol has been investigated in pregnancies below 49 days gestation. In this study, we aimed to assess efficacy, feasibility and acceptability of home use of vaginal misoprostol for medical termination of pregnancy at 50-63 days compared with gestation of below 50 days among women who chose to administer misoprostol at home.


METHODS
In this prospective study, mifepristone 200 mg was given in hospital under nursing supervision in the university hospital outpatient family planning clinic. Women self-administered misoprostol 800 microg vaginally 36-48 h later at home. Follow-up was 2 weeks later. Women with gestation of 50-63 days on the day of mifepristone administration were compared with women with gestation of below 50 days. Efficacy and feasibility were assessed by review of patient records and questionnaires. Acceptability was assessed using questionnaires where women reported on future choice of abortion method were they to have another abortion.


RESULTS
Among the 2992 women who had a medical abortion during the study period, 395 women chose to administer misoprostol at home and were included in the study. A total of 203 women were below 50 days gestation and 192 were between 50 and 63 days gestation. Efficacy was 97.5% and did not differ between the groups. Surgical intervention was needed in 10 patients, of whom four were in the lower gestational band (P = 0.36). No serious adverse events or blood transfusions were reported. Preference for home administration of misoprostol, were they to have another induced abortion in the future, was high, 92.3 and 86.6% respectively, and did not differ between the groups (P = 0.097). Need for extra analgesia significantly influenced women's experiences in both gestational groups.


CONCLUSIONS
Medical abortion with mifepristone followed by home administration of vaginal misoprostol is safe and highly acceptable also to women with gestational length of 50-63 days as compared with shorter gestations. Efficacy, acceptability and preference for future place of administration of misoprostol, were women to have another abortion, did not differ between women with gestation below 50 days or between 50 and 63 days.
Kopp Kallner
H
H
Division of Obstetrics and Gynaecology, Department of Women's and Children's Health, Karolinska Institutet/Karolinska University Hospital, 171 76 Stockholm, Sweden.
Fiala
C
C
Stephansson
O
O
Gemzell-Danielsson
K
K
D000020:Abortifacient Agents, Nonsteroidal / Q000008:administration & dosage* / Q000009:adverse effects; D000021:Abortifacient Agents, Steroidal / Q000008:administration & dosage; D000028:Abortion, Induced / Q000379:methods*; D000282:Administration, Intravaginal; D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D005260:Female; D005865:Gestational Age; D006699:Home Care Services; D006801:Humans; D008875:Middle Aged; D015735:Mifepristone / Q000008:administration & dosage; D016595:Misoprostol / Q000008:administration & dosage* / Q000009:adverse effects; D010044:Outpatient Clinics, Hospital; D017060:Patient Satisfaction; D011247:Pregnancy; D011446:Prospective Studies; D012646:Self Administration; D011795:Surveys and Questionnaires; D055815:Young Adult
D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D016595:Misoprostol; D015735:Mifepristone