Comparison of unscheduled re-attendance and contraception at discharge, among women having the final stage of early medical abortion at home and those remaining in hospital

Abstract

Introduction Throughout Great Britain, increasing numbers of women having an early medical abortion are choosing to go home soon after administration of misoprostol, to expel the pregnancy at home (early medical discharge, EMD), rather than remain upon the hospital premises (day case). However, data are lacking on how this impacts upon an abortion service in terms of unscheduled re-attendance rates and contraception provision at discharge. Methods A retrospective audit was carried out of women undergoing medical abortion (up to 64 days' gestation) over 9 months at a National Health Service hospital in Scotland, to determine (1) unscheduled re-attendance rates within 6 weeks of the procedure for an abortion-related complication and (2) method of contraception provided at discharge. Results Over the audit period 1128 women had an early medical abortion of whom 590 (52%) chose EMD. There was no signifi cant difference in unscheduled re-attendance rates between EMD (n=23, 4%) and day case groups (n=20, 4%). There was no signifi cant difference in the proportion of women in each group who left hospital with an effective method of contraception (n=362, 61% and n=355, 60% for EMD and day case groups, respectively). Conclusions Women undergoing early medical abortion who choose to expel the pregnancy at home are no more likely to re-attend hospital with a post-abortal complication and are just as likely to receive effective contraception than those who remain on hospital premises.

Shifting abortion care from a hospital to a community sexual and reproductive health care setting

“…Clearly the success of medical abortion is not dependent on the skill of the provider; however, one could hypothesise that if one setting provided superior advice or clinical expertise then that might impact upon the recognition of complications or the rate of intervention. The same low rate of women attending each site with a suspected complication (<3%) is reassuring and is no higher than previously reported among women after EMA 10. However, there was a higher telephone contact rate for the SRH setting.…”

Acceptability and feasibility of phone follow-up with a semiquantitative urine pregnancy test after medical abortion in Moldova and Uzbekistan

“…If medical abortion is chosen, frequent non-compliance with the follow-up visit schedule can be expected. Studies have reported that 20-50% of women did not return for the follow-up visit [5,[9][10][11].…”

Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study

“…Until October 2017, women in Scotland who wished to have an EMA were required to make an additional visit to the clinic to obtain misoprostol, the second of the drugs given for medical abortion. This was commonly self-administered by women in the clinic,5–7 after which they went home to abort the pregnancy. Women found these extra visits inconvenient and reported distressing bleeding or pain on their journey home due to the onset of action of misoprostol 8 9.…”