Feasibility And Acceptability Of Medical Abortion

Background: A medical abortion is one that is brought about by taking medications which will end a pregnancy.The alternative is surgical abortion,which ends a pregnancy by emptying the uterus with vacuum aspiration.Mifepristone is taken together with misoprostol,to induce an abortion.Medical abortions can be provided as early as a pregnancy can be confirmed.In fact,the shorter the time that a woman has been pregnant,the better the medications will work.After taking the misoprostol,cramping and bleeding usually begin within a few hours,but sometimes it may take longer.The cramping and bleeding may be more than with a normal menstrual period.A woman considering medical abortion will need to be prepared for this.Objectives: The main objectives of the study were to investigate the acceptability and feasibility,to evaluate the success rate and to study safety and efficacy of medical abortion using a regimen of mifepristone 150 mg and misoprostol 600 ?g orally in women through ? 56 days estimated gestational age.Method: A total of 70 study populations were selected from outpatients department of obstetrics and gynecology at the Third Affiliated Hospital of Xinxiang Medical University.Women desiring medical abortion were eligible to participate if they were healthy and with pregnancies ? 56 days gestational age documented by ultrasound scan;be willing to have surgical abortion if medical abortion fails;be willing and able to sign an informed consent;be willing to comply with visit schedule.Participants were excluded from the study if following reasons noted like suspected ectopic pregnancy or undiagnosed adnexal mass;IUCD in place;chronic adrenal failure;concurrent long term corticosteroid therapy;history of allergy to mifepristone;history of asthma,glaucoma,sickle cell anemia;thrombophlebitis;liver disease;renal diseases;respiratory diseases;and women with inherited porphyria.On first visit participants were interviewed for screening checklist,mifepristone administration and regimen selection and also form-1&2 were filled up.Participants were prescribed tablet mifepristone 150 mg(25 mg×6)and misoprostol 600?g(200?g×3)in the clinic.They all were given the options to administer mifepristone either in clinic or if comfortable at home.They were advised to remain empty stomach 2 hours before and 2 hours after mifepristone ingestion.On day one,they were advised to administer mifepristone 50 mg at 8:00 am orally and then again administer tablet mifepristone 25 mg after 12 hours orally.For day two,they were given advised to administer mifepristone 25 mg at 8:00 am and then repeat the same dose after 12 hours.For day three participants were strictly advice to follow up in maternity ward of obstetrics and gynecology in empty stomach,and were interviewed and again form-2 was revised and completely filled up.They were advice to administer mifepristone 25 mg orally at 8:00 am and then 1 hour later administer misoprostol 600?g(200?g×3)at once orally.Participants were advised to stay in clinic around 4-5 hours during the medical abortion process.Women were told that they will probably experience nausea,vomiting,cramping abdominal pain and bleeding after taking misoprostol,so they would rather take misoprostol at a time someone is available to assist them if needed.All women were instructed to inform the clinic staff if they had heavy or persistent bleeding.After evaluating the current assessment of the abortion status;they were interviewed and form-3 was filled up and discharged from the clinic.All the participants were advised to follow up in one week in outpatients department.On one week follow up visit participants were again interviewed and form-4,5,8 & 9 were filled up.All the participants were being requested to have ultrasound scan for the assessment of their abortion status.Women with complete abortion were discharged whereas those with incomplete abortion or uncertain statuses were given the option of waiting for one more week or to undergo surgical intervention.For women electing to wait for one more week,an extended follow up visit was scheduled.Women for extended follow up visit were interviewed and form-4a was filled up.At the extended follow up visit the current assessment of the abortion status was assessed.If found complete,discharged from the study and if incomplete offered surgical back up.Also participants were given advice to make unscheduled visit if any heavy problem occurred like heavy bleeding,women request surgical termination etc.Effectiveness,success rate,feasibility,and acceptability of medical abortion using a regimen of mifepristone 150 mg and misoprostol 600?g orally were assessed.Results: 70 women were enrolled in the study.The average age of the study group was 26.57 years ranging from 18 to 42 years.The majority of the participants 58.57%(41/70)were bachelor level in education.The majority of women 68.57%(48/70)were primigravida.The average gestational age of the study group was 43.47 days ranging from 40 to 55 days.The efficacy rate was 94.29%(66/70)whereas 5.71%(4/70)were uncertain.Among 70 women,five women cited that they had previous abortion.These 5 women were asked to compare the medical abortion experience with their previous abortion;2/5 women said their experience with medical abortion were better when compared to previous medical abortions,2/5 said no different whereas 1/5 woman said don't know.After the satisfaction level compared to previous abortion of the participants were tested weather their age distribution influenced their level of satisfaction,it was found that their age distribution(p=0.004)shows a significant association..This would imply that their level of satisfaction compared to previous abortion is dependent on their age distribution.The most common reasons for selecting medical abortion were,more private & confidential;fear of surgery/manipulation;and safe,less risk of complication.The most commonly cited disadvantage was cramping abdominal pain 47.14%(33/70).When the disadvantages of medical abortion,described by the participants,were tested weather their age distribution influenced their occurrences during medical abortion process,it was found that their age distribution(p=0.043)shows a significant association.This would reflect that the early-aged adults(ages 15-24 years)experiences frequent sign and symptoms of medical abortion compared to the middle-aged adults(ages 25-34 years)and the advancing-aged adults(ages ?35 years).The vast majority of women(91.43%)were satisfied or very satisfied with the medical abortion method.95.71%(67/70)of women would choose the method again and 94.29%(66/70)of women would recommend the method to friends or relatives.There have been no such serious adverse events such as heavy bleeding requiring transfusion,anaphylactic reaction,septicemia,or death.Conclusion: A regimen of 150 mg of mifepristone orally followed by oral misoprostol 600 ?g for medical termination of pregnancy in women through ? 56 days estimated gestational age is an acceptable and feasible option since the success rate of medical abortion is 94.29%.Also the regimen is safe and effective since there have been no serious adverse events such as heavy bleeding requiring transfusion,anaphylactic reaction,septicemia,or death in the study.