Randomized comparison of efficacy and acceptability of medical versus surgical abortion

Abstract

Objective: To compare the clinical efficacy, patient acceptance, and provider resources needed to provide medical and surgical abortion in women with pregnancies up to 49 days gestation.Methods: Women with no pretreatment preference for method of abortion were randomized to medical abortion (group 1: methotrexate 50 mg orally, followed 5–6 days later by misoprostol 800 μg vaginally; the misoprostol dose was repeated if the abortion did not occur) or surgical abortion under local anesthesia using manual vacuum aspiration (group 2). The time spent by clinical staff for all interactions with participants were recorded prospectively.Results: Enrollment of 50 subjects took 24 months. Twenty-three of 25 women (92%, 95% CI 81, 100%) in group 1 and 24 of 25 women (96%, 95% CI 88%, 100%) in group 2 had complete abortions (P = 0.9). The complete abortion rate by study day 15 was 20 of 24 (83%, 95% CI 68, 98%), and 24 of 25 (96%, 95% CI 88%, 100%) for groups 1 and 2, respectively (P = 0.2). Only 63% of women randomized to medical abortion would choose that option again, compared with 92% of women who had a surgical abortion (P = 0.03). Surgical abortion is 3–13% more expensive to provide (from a personnel standpoint) than medical abortion using methotrexate and misoprostol.Conclusions: In women who did not have a preference between medical and surgical abortion, the side effect profile and patient acceptability of medical abortion are inferior to surgical abortion. Medical abortion, even with an increase in the number of office visits, seems to be slightly less costly than surgical abortion.