Medical Abortion in Family Practice: A Case Series

Abstract

Background: We wanted to determine the outcomes of medical abortions in four family practice centers.Methods: This study was a retrospective case series of consecutive medical abortions in four community health centers between November 2000 and April 2002. We defined a successful medical abortion as one that required no further intervention after the administration of the medications mifepristone and misoprostol. The subset of abortions in patients who had suction procedures were called failures.Results: In this series of 236 abortions, only 1 woman had a viable pregnancy after taking the medication as directed, and she had an elective suction procedure to terminate the pregnancy. None of the patients under the complete care of family physicians received suction procedures for other indications. Two patients underwent suction procedures at other institutions for unknown indications. Eight were lost to follow-up. One did not adhere to the protocol and so was excluded from the data analysis. The failure rate of the protocol for patients cared for by the family physicians at follow-up was 0.4%.

Practice Bulletin No. 143

“…Initial reports showed that mifepristone and misoprostol can be integrated into clinical practice with low rates of patients lost to follow-up (77,78). The introduction of medical abortion into widespread clinical practice has required continued emphasis on follow-up because failure rates for medical abortion are higher than those for surgical techniques, and misoprostol is potentially teratogenic.…”

Early Abortion in Family Medicine: Clinical Outcomes

“…[6][7][8][9] These factors have led to initiatives to bring fi rst-trimester abortion training into family medicine settings. [10][11][12][13][14][15] There has been little research assessing early abortion outcomes in family medicine, and studies have been of inadequate size to measure dif-ferences in outcomes from specialized abortion sites. 12 Concern has been raised over the effectiveness and safety of providing these procedures in family medicine settings 16,17 ; these sites could have unacceptably high rates of complications or have complications that go beyond the ability of that site to manage.…”

“…[10][11][12][13][14][15] There has been little research assessing early abortion outcomes in family medicine, and studies have been of inadequate size to measure dif-ferences in outcomes from specialized abortion sites. 12 Concern has been raised over the effectiveness and safety of providing these procedures in family medicine settings 16,17 ; these sites could have unacceptably high rates of complications or have complications that go beyond the ability of that site to manage. 18,19 Abortion care settings with less-experienced physicians have in some studies had higher rates of complications than those with only fully trained physicians.…”

Update on Medication Abortion

“…Although most women experienced at least one ultrasound, rates of provision of routine ultrasound decreased as the study period progressed and providers became more experienced with medication abortion. Table 2 lists clinical factors that mandated ultrasound in pre‐ and post‐abortion visits 31 …”