title: Safety, efficacy and acceptability of outpatient mifepristone-misoprostol medical abortion through 70 days since last menstrual period in public sector facilities in Mexico City.
abstract: Extensive evidence exists regarding the efficacy and acceptability of medical abortion through 63 days since last menstrual period (LMP). In Mexico City's Secretariat of Health (SSDF) outpatient facilities, mifepristone-misoprostol medical abortion is the first-line approach for abortion care in this pregnancy range. Recent research demonstrates continued high rates of complete abortion through 70 days LMP. To expand access to legal abortion services in Mexico City (where abortion is legal through 12 weeks LMP), this study sought to assess the efficacy and acceptability of the standard outpatient approach through 70 days in two SSDF points of service. One thousand and one women seeking pregnancy termination were enrolled and given 200 mg mifepristone followed by 800 μg misoprostol 24-48 hours later. Women were asked to return to the clinic one week later for evaluation. The great majority of women (93.3%; 95% CI: 91.6-94.8) had complete abortions. Women with pregnancies ≤ 8 weeks LMP had significantly higher success rates than women in the 9th or 10th weeks (94.9% vs. 90.5%; p = 0.01). The difference in success rates between the 9th and 10th weeks was not significant (90.0% vs. 91.2%; p = 0.71). The majority of women found the side effects (82.9%) and the use of misoprostol (84.4%) to be very acceptable or acceptable. This study provides additional evidence supporting an extended outpatient medical abortion regimen through 10 weeks LMP.
authors.affiliation: Coordinator of Reproductive Health, Secretariat of Health of Mexico City, Mexico City, Mexico.
authors.forename: Patricio
authors.initials: P
authors.lastname: Sanhueza Smith
authors.affiliation: Director, Gynuity Health Projects, New York, NY, USA.
authors.forename: Melanie
authors.initials: M
authors.lastname: Peña
authors.affiliation: Senior Program Associate, Gynuity Health Projects, New York, NY, USA. Electronic address: idzuba@gynuity.org.
authors.forename: Ilana G
authors.initials: IG
authors.lastname: Dzuba
authors.affiliation: Director of Legal Abortion Program, Hospital Materno Infantil Inguarán, Mexico City, Mexico.
authors.forename: María Laura
authors.initials: ML
authors.lastname: García Martinez
authors.affiliation: Director of Reproductive Health Clinic, Centro de Salud Beatriz Velasco de Alemán, Mexico City, Mexico.
authors.forename: Ana Gabriela
authors.initials: AG
authors.lastname: Aranguré Peraza
authors.affiliation: Independent consultant, Mexico City, Mexico.
authors.forename: Manuel
authors.initials: M
authors.lastname: Bousiéguez
authors.affiliation: Program Associate, Gynuity Health Projects, New York, NY, USA.
authors.forename: Tara
authors.initials: T
authors.lastname: Shochet
authors.affiliation: President, Gynuity Health Projects, New York, NY, USA.
authors.forename: Beverly
authors.initials: B
authors.lastname: Winikoff
mesh_terms: D000020:Abortifacient Agents, Nonsteroidal / Q000494:pharmacology*; D000021:Abortifacient Agents, Steroidal / Q000494:pharmacology*; D000028:Abortion, Induced / Q000379:methods* / Q000523:psychology; D000293:Adolescent; D000328:Adult; D004338:Drug Combinations; D005260:Female; D006801:Humans; D008800:Mexico; D008875:Middle Aged; D015735:Mifepristone / Q000494:pharmacology*; D016595:Misoprostol / Q000494:pharmacology*; D010045:Outpatients; D010342:Patient Acceptance of Health Care; D017060:Patient Satisfaction; D011247:Pregnancy; D011261:Pregnancy Trimester, First; D017150:Public Sector; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000020:Abortifacient Agents, Nonsteroidal; D000021:Abortifacient Agents, Steroidal; D004338:Drug Combinations; D016595:Misoprostol; D015735:Mifepristone
keywords: Mexico; medical abortion; mifepristone; misoprostol