Home self-administration of misoprostol for medical abortion up to 56 days' gestation

Abstract

Objective Studies from the USA have suggested the feasibility and acceptability of home medical abortion, however the issue has not been addressed in the UK. This study aimed to assess the feasibility, efficacy and acceptability of home self-administration of misoprostol for medical abortion up to 56 days' gestation. Methods Mifepristone 200 mg was given orally in hospital under nursing supervision. Women were provided with misoprostol tablets 600 µg and advised to take them sublingually 36-48 hours later. The main outcome measures were (1) feasibility, assessed through successful completion of abortion at home without the need for hospital admission, (2) efficacy, assessed through complete uterine evacuation without the need for further medical or surgical intervention and (3) women's acceptability of the procedure as assessed by questionnaire. Results A total of 49 women participated in this study. Of these, 48 women aborted at home while one opted to be admitted to hospital after receiving misoprostol at home. One woman underwent surgical evacuation 5 weeks following abortion for excessive bleeding and retained products of conception. A total of 43/44 (98%) women were satisfied with having the abortion at home. Conclusions This study suggests the feasibility and acceptability of home self-administration of misoprostol for medical abortion up to 56 days' gestation. These findings need to be assessed in the context of a randomised trial. Key message pointsq This study suggests the feasibility and acceptability of home self-administration of misoprostol for medical abortion up to 56 days' gestation.q These findings and the potential cost implications for health service provision, need to be assessed in the context of a randomised trial.

Self‐management of first trimester medical termination of pregnancy: a qualitative study of women's experiences

“…Research suggests that women self-managing first trimester TOP have varied experiences [2][3][4] but are no more likely to re-attend with complications than those treated in hospital. 5 Although a growing body of literature suggests that self-management is acceptable to women, 2,[6][7][8][9][10][11][12][13][14][15][16][17] there is a need to monitor and understand women's needs around this model of provision, to facilitate provision of the best possible support. Our research contributes to this understanding, by examining details of women's experiences of self-management ≤63 days, of which to date, relatively little is known.…”

Comparative effectiveness, safety and acceptability of medical abortion at home and in a clinic: a systematic review

“…Clinical trials from Canada, 7 Turkey 8,9 and the United States 10,11 report rates of complete abortion ranging from 91% to 98% for pregnancies up to 9 weeks when misoprostol is administered at home (Appendix A, available at: http://www.mariestopes.org/documents/Home-based%20 Medical-Abortion-Systematic-Review-Appendix.pdf ). Observational studies [12][13][14][15][16][17][18][19][20] have also shown that home-based medical abortion is well accepted and effective, with 86-98% of women reporting satisfaction with the method and complete abortion achieved in 87% to 98% of cases. However, none of these studies has compared home-based medical abortion with clinic-based protocols.…”

Setting up an outpatient service for early medical termination

“…6,12,17,18 This may reflect the small numbers of patients seen so far and our own learning curve. The uptake of telephone advice has amounted to a handful of calls and only one patient was admitted on the day of the misoprostol treatment.…”

“…Other investigators 12,15,16 have demedicalised medical termination by allowing the patient to self-treat with misoprostol at home rather than in hospital. Under the terms of the Abortion Act 1967, all treatment for abortion should be given in licensed premises.…”

“…[7][8][9][10][11] Some of the large abortion charities had already started outpatient treatment as an option for women in very early pregnancy; in one reported study from the UK women were able to self-administer misoprostol at home. 12 Whilst highly acceptable to women, this may lie outside the provisions of the Abortion Act 1967 since treatment was not being administered in licensed premises. As all misoprostol given as an abortifacient is outside the product licence but is widely accepted practice, action must be Tupper and Speed Andrews taken to redress this discrepancy to the benefit and desire of the pregnant women.…”