Medical abortion with mifepristone and home administration of misoprostol up to 63 days' gestation

Abstract

Objective. To evaluate the acceptability and efficacy of medical abortion at home up to 63 days’ gestation without limits on travel distance to a registered institution. Design. Observational prospective study. Setting. Haukeland University Hospital between May 2006 and May 2009. Population. A total of 1018 women requesting abortion before 63 days’ gestation who chose medical termination with mifepristone and home administration of misoprostol. Methods. The women took 200 mg mifepristone under nurse supervision and self-administered 800 lg misoprostol vaginally 36–48 h later at home. All were contacted by phone for follow-up and assessment of bleeding, pain and acceptability. Main outcome measures. Evacuation rate, pain, bleeding, acceptability, influence of distance on treatment. Results. Median gestational age was 50 (range 35– 63) days and 70 (7.1%) of the women lived more than 60 min travel from the clinic. The rate of completed abortion was 93.6% and surgical evacuation was performed in 50 (4.9%) cases. Two women requested treatment on the day of misoprostol use. Moderate to strong pain was experienced by 68.4%, and 74.7% reported moderate to heavy bleeding. Parous women experienced less pain than nulliparous women (odds ratio 0.27; 95% confidence interval 0.19–0.34). In all, 95.1% of the women were satisfied with staying at home. Travel distance did not influence treatment outcome variables. Conclusions. In our experience, home administration of misoprostol is an effective and acceptable method for abortion up to 63 days of gestation and women should be eligible for this treatment option regardless of their travel distance from hospital.