title: Reduction in infection-related mortality since modifications in the regimen of medical abortion.
abstract: BACKGROUND
  From 2001 to March 2006 Planned Parenthood health centers throughout the United States provided medical abortion by a regimen of oral mifepristone followed 24-48 h later by vaginal misoprostol. In response to concerns about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine antibiotic coverage for all medical abortions.
  
  
  METHODS
  We performed a retrospective analysis of Planned Parenthood cases assessing the rates of mortality caused by infection following medical abortion during a time period when misoprostol was administered vaginally (2001 through March 2006), as compared with the rate from April 2006 to the end of 2012 after a change to buccal administration of misoprostol and after initiation of new infection-reduction strategies.
  
  
  RESULTS
  The mortality rate dropped significantly in the 81-month period after the joint change to (1) buccal misoprostol replacing vaginal misoprostol and (2) either sexually transmitted infection (STI) screening or routine preventative antibiotic coverage (15 month period) or universal routine preventative antibiotic coverage as part of the medical abortion (66-month period), from 1.37/100,000 to 0.00/100,000, P=.013 (difference=1.37/100,000, 95% CI 0.47-4.03 per 100,000).
  
  
  CONCLUSIONS
  The infection-caused mortality rate following medical abortion declined by 100% following a change from vaginal to buccal administration of misoprostol combined with screen-and-treat or, far more commonly, routine antibiotic coverage.
  
  
  CONCLUSIONS
  Deaths from infection following medical abortion declined to zero after a change in the regimen.
authors.affiliation: Office of Population Research, Princeton University, Princeton, NJ 08544, USA; The Hull York Medical School, University of Hull, Hull HU6 1RX, England. Electronic address: trussell@princeton.edu.
authors.forename: James
authors.initials: J
authors.lastname: Trussell
authors.affiliation: Planned Parenthood Federation of America, New York, NY 10001, USA.
authors.forename: Deborah
authors.initials: D
authors.lastname: Nucatola
authors.affiliation: WomanCare Global, San Diego, CA 92122, USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Fjerstad
authors.affiliation: Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: E Steve
authors.initials: ES
authors.lastname: Lichtenberg
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal; D000028:Abortion, Induced / Q000009:adverse effects* / Q000379:methods*; D000278:Administration, Buccal; D000282:Administration, Intravaginal; D000554:Ambulatory Care Facilities; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D019072:Antibiotic Prophylaxis; D003015:Clostridium Infections / Q000401:mortality; D005260:Female; D006801:Humans; D017053:Infection Control / Q000379:methods; D007239:Infections / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality*; D008403:Mass Screening; D016595:Misoprostol / Q000008:administration & dosage; D011247:Pregnancy; D012189:Retrospective Studies; D012749:Sexually Transmitted Diseases / Q000175:diagnosis
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000900:Anti-Bacterial Agents; D016595:Misoprostol
keywords: Buccal misopristol; Clostridia; Doxycycline; Medical abortion; Mortality