Very early medication abortion ‘equally effective as delaying care’

Key takeaways:

• Very early initiation of medication abortion before confirmation via ultrasound was noninferior to standard care.
• There was a higher incidence of ongoing pregnancy after early medication abortion.

Medication abortion administered before a pregnancy can be confirmed via ultrasound is as effective as treatment that is delayed until a pregnancy is confirmed, researchers reported.

“In many settings, abortion providers delay treatment if the pregnancy location cannot be determined on ultrasound examination due to a fear that the pregnancy might be ectopic or that the treatment would not be effective in such an early gestation,” Karin Brandell, MD, an OB/GYN and doctoral student in the department of women’s and children’s health at Karolinska Institutet and Karolinska University Hospital in Stockholm, told Healio. “We show that the treatment is equally effective as delaying care. In addition, ectopic pregnancy in a low-risk population is rare (1%) and possible to diagnose regardless of whether abortion is initiated or delayed. These findings can increase access to abortion and reduce additional visits, in addition to other advantages of an early abortion such as shorter duration of bleeding, less pain and lower risk for postabortion infection.”

For the randomized controlled trial, researchers analyzed data from 1,504 women across 26 sites in nine countries who requested medication abortion at up to 42 days’ gestation with an unconfirmed intrauterine pregnancy on ultrasound examination. Researchers randomly assigned participants to immediate start of medication abortion (early start group; n = 754) or standard care (n = 750), meaning delayed treatment until the intrauterine pregnancy was confirmed. Primary outcome was complete abortion.

The findings were published in The New England Journal of Medicine.

In intention-to-treat analyses, a complete abortion occurred in 95.2% of participants in the early start group and in 95.3% of participants in the standard care group, for an absolute difference of –0.1 percentage points (95% CI, –2.4 to 2.1).

The reasons for failed abortion, defined as either ongoing pregnancy or surgical intervention for an incomplete abortion, differed between the early start and standard care groups.

The early start group had more ongoing pregnancies vs. standard care (3% vs. 0.1%; RR = 20.35; 95% CI, 2.74-150.87); however, there were more surgical interventions for women in the standard care group vs. the early start group (4.5% vs. 1.8%; RR = 0.41; 95% CI, 0.21-0.77).

Researchers observed ectopic pregnancies in 1.3% of women in the early start group and in 0.8% of pregnancies in the standard care group, with one rupture before diagnosis occurring in the early start group.

Rates of serious adverse events were similar in the early start and standard care groups (1.6% vs. 0.7%; P = .1), with most events being uncomplicated hospitalizations for treatment of an ectopic pregnancy or an incomplete abortion.

“It would be of value to evaluate if assessment of treatment outcome could be done earlier after the abortion than 7 days, especially for settings where medical abortion is restricted after 6 weeks, to be able to find the few ongoing pregnancies (around 3%) that we see after very early medication abortion,” Brandell told Healio. “In addition, it would be valuable to find medical treatments that would be effective and acceptable for both extrauterine pregnancies and early abortion.”

For more information:

Karin Brandell, MD, can be reached at karin.brandell@ki.se.