Abstract
BackgroundFrom 2001 to March 2006 Planned Parenthood health centers throughout the United States provided medical abortion by a regimen of oral mifepristone followed 24–48 h later by vaginal misoprostol. In response to concerns about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine antibiotic coverage for all medical abortions. MethodsWe performed a retrospective analysis of Planned Parenthood cases assessing the rates of mortality caused by infection following medical abortion during a time period when misoprostol was administered vaginally (2001 through March 2006), as compared with the rate from April 2006 to the end of 2012 after a change to buccal administration of misoprostol and after initiation of new infection-reduction strategies. ResultsThe mortality rate dropped significantly in the 81-month period after the joint change to (1) buccal misoprostol replacing vaginal misoprostol and (2) either sexually transmitted infection (STI) screening or routine preventative antibiotic coverage (15 month period) or universal routine preventative antibiotic coverage as part of the medical abortion (66-month period), from 1.37/100,000 to 0.00/100,000, P=.013 (difference=1.37/100,000, 95% CI 0.47–4.03 per 100,000). ConclusionThe infection-caused mortality rate following medical abortion declined by 100% following a change from vaginal to buccal administration of misoprostol combined with screen-and-treat or, far more commonly, routine antibiotic coverage. SignificanceDeaths from infection following medical abortion declined to zero after a change in the regimen.
Highlights
Planned Parenthood Federation of America is a federation of 71 independent local affiliates operating 738 health centers throughout the United States; 332 provide medical abortion
Antibiotics have been routinely administered at the time of surgical abortions since the publication of a meta-analysis demonstrating that their use resulted in a 42% reduction in post-abortion infection rates (RR=0.58, 95% CI 0.47-0.71).[1]
Between 2001 and late 2005, four women in the United States and one in Canada had died from a rare bacterial infection, Clostridium sordellii, following medical abortion with mifepristone and misoprostol;[6] an additional death occurred in the United States in early 2006 from Clostridium perfringens
Summary
Planned Parenthood Federation of America is a federation of 71 independent local affiliates operating 738 health centers throughout the United States; 332 provide medical abortion. Between 2001 and late 2005, four women in the United States and one in Canada had died from a rare bacterial infection, Clostridium sordellii, following medical abortion with mifepristone and misoprostol;[6] an additional death occurred in the United States in early 2006 from Clostridium perfringens. No such deaths had been reported in Europe, where medical abortion had been available longer and far more women had used it. In response to concerns about serious infections, in early 2006 Planned Parenthood changed the route of misoprostol administration to buccal and required either routine antibiotic coverage or universal screening and treatment for chlamydia; in July 2007, Planned Parenthood began requiring routine antibiotic coverage for all medical abortions
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