Abstract
Background From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the United States provided medical abortions principally by a regimen of oral mifepristone, followed 24–48 h later by vaginal misoprostol. In late March 2006, analyses of serious uterine infections following medical abortions led Planned Parenthood to change the route of misoprostol administration and to employ additional measures to minimize subsequent serious uterine infections. In August 2006, we conducted an extensive audit of medical abortions with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen. Objectives We sought to evaluate the effectiveness of the buccal medical abortion regimen and to examine correlates of its success during routine service delivery. Methods In 2006, audits were conducted in 10 large urban service points to estimate the success rates of the buccal regimen. Success was defined as medical abortion without vacuum aspiration. These audits also permitted estimates of success rates with oral misoprostol following mifepristone in a subset in which 98% of the subjects stemmed from two sites. Results The effectiveness of the buccal misoprostol–mifepristone regimen was 98.3% for women with gestational ages below 60 days. The oral misoprostol–mifepristone regimen, used by 278 women with a gestational age below 50 days, had a success rate of 96.8%. Conclusion In conjunction with 200 mg of mifepristone, use of 800 mcg of buccal misoprostol up to 59 days of gestation is as effective as the use of 800 mcg of vaginal misoprostol up to 63 days of gestation.
Highlights
From January 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the U.S provided medical abortion principally by a regimen of 200 mg oral mifepristone followed 24–48 h later by 800 mcg of misoprostol administered vaginally, at home, by the woman herself
Data consistently informed us that medical abortion with mifepristone and vaginal misoprostol had a rate of ongoing pregnancy of about 0.5% and that an additional 1% of patients had uterine evacuation for various reasons including problematic bleeding, persistent gestational sac, clinician judgment or patient request
There was conjecture, but no evidence, that the vaginal route of misoprostol contributed to the incidence of rare but serious infection among women having medical abortion
Summary
From January 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the U.S provided medical abortion principally by a regimen of 200 mg oral mifepristone followed 24–48 h later by 800 mcg of misoprostol administered vaginally, at home, by the woman herself. An in-depth retrospective chart audit was conducted in 2003 of 11,290 clients in which the overall success rate of medical abortion with mifepristone and vaginal misoprostol through 63 days since the start of the last menstrual period was 98.5%. Healthcare organizations providing medical abortion have been interested in alternatives to vaginal administration of misoprostol for several reasons. From 2001 to March 2006, Planned Parenthood Federation of America (Planned Parenthood) health centers throughout the U.S provided medical abortion principally by a regimen of oral mifepristone followed 24–48 h later by vaginal misoprostol. We conducted an extensive audit in August 2006 of medical abortion with the new buccal misoprostol regimen so that patients could be given accurate information about the success rate of the new regimen
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