Scientific Paper Abstracts Originally Presented at the National Abortion Federation's Annual Meeting; April 23, 2007; Boston, Massachusetts

In This Article

Can Women Accurately Assess the Success of Medication Abortion Based on Symptoms Alone?

Alisa Goldberg, MD, MPH; Andrea Jackson; Jennifer Fortin, MPH; Garrett Fitzmaurice, ScD; Karen Lifford, MD

Introduction and Purpose/Objective(s): The primary purpose of this study was to evaluate whether women undergoing medical abortion can accurately assess the success of the abortion based on symptoms alone. If women can accurately self-assess the success of medication abortion, less intensive follow-up may be possible. Secondarily, we sought to identify predictors of medication abortion failure.

Data-Collection Methods: Given the high efficacy of medication abortion with mifepristone and misoprostol, most clinical trials and prospective cohort studies have relatively few failures. To compare a large number of medication abortion failures to successes, we conducted a case-control study at the three Planned Parenthood League of Massachusetts (PPLM) clinical sites. All women were 63 days' gestation or less, received 200 mg mifepristone followed by 800 mcg of vaginal misoprostol 6-72 hours later, and returned for follow up. Primary cases were defined as women who completed the medical abortion regimen and required uterine evacuation for a retained gestational sac or ongoing pregnancy. Controls were defined as women who completed the medical regimen and successfully expulsed the pregnancy as confirmed by ultrasound without the need for suction curettage. We identified 188 women who had a medication abortion and a subsequent suction curettage within 3 months at PPLM between January 1, 2004 and December 31, 2005. These charts were reviewed and cases where the suction curettage was for a second pregnancy were excluded. Controls were matched to cases by clinical site and procedure date.

Summary of Results: We had a total of 53 primary cases with ongoing pregnancy or retained gestational sac and an equal number of controls (N=106). Compared to controls, cases were more likely to be under 6 weeks gestation or between 8 and 9 weeks gestation (p=0.01). Primary cases were more likely to doubt that they had expulsed the prenancy as compared to their controls (OR 4.0, 95%CI 1.3-13.5). Cases were also far more likely to have ongoing pregnancy symptoms (OR 7.9, 95%CI 2.5-29.0) and to report the absence of bleeding or presence of only light bleeding within 48 hours after taking misoprostol (OR 10.1, 95%CI 2.1-94.1) compared to controls. As joint predictors of medication abortion failure, having either ongoing pregnancy symptoms, minimal bleeding or doubting explulsion had occurred identified 36 of 53 cases (68%) correctly with ongoing pregnancy or retained sac and misidentified 12 of 53 controls (23%). There was no difference between cases and controls with regard to age, parity, body mass index or the interval between administration of mifepristone and misoprostol.

Conclusions: A combination of the patient's assessment of expulsion, ongoing pregnancy symptoms and bleeding patterns within 48 hours of administration of misoprostol can help assess the success of medical abortion, however approximately one third of women with a retained pregnancy would not be identified by symptoms alone.

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