A comparison of medical abortion (using mifepristone and gemeprost) with surgical vacuum aspiration: efficacy and early medical sequelae.

ABSTRACT

PIP: In Aberdeen, Scotland, researchers compared the efficacy rate of medical abortion with that of vacuum aspiration and examined their complications and the nature and incidence of short-term sequelae. All 363 pregnant women had amenorrhea for less than 63 days. The medical abortion procedure consisted of administration of 600 mg mifepristone followed by 1 mg gemeprost (vaginal pessary) 48 hours later. Women who underwent medical abortion at less than 50 days gestation were less likely to experience pain than those who underwent medical abortion between 50 and 63 days gestation (mean pain related index [PRI] scores, 20.5 vs. 25.5, p = 0.04 and analgesia during inpatient treatment, 43% vs. 63%; p = 0.02). Medical abortion was less effective at 50-63 days gestation than at less than 50 days gestation (complete abortion, 98% vs. 92.6%). 90% of women requiring curettage after medical abortion were at 50-63 days gestation. Gestation affected neither pain nor efficacy rates of vacuum aspiration, however. At follow-up 16 days after the procedure, the significant differences in the medical sequelae of the 2 procedures during and immediately after abortion disappeared. The short-lived sequelae did not greatly affect recovery times. For example, even though women who underwent vacuum aspiration required more time off work than those who underwent medical abortion (2.5 vs. 1.2 days; p = 0.007), the return of normal daily activities was essentially the same for both groups (0.6-1.3 vs. 0.8-1.5 days). These results suggest that at gestations of less than 50 days, the 2 procedures are equally effective and have similar 0-21 day complication rates. On the other hand, at 50-63 days gestation, medical abortion becomes more unpleasant and its efficacy begins to diminish. In conclusion, at higher gestations, women who do not prefer one method over another will probably find vacuum aspiration more acceptable than medical abortion.