Pain during medical abortion: a multicenter study in France

Saurel‐Cubizolles, Marie‐Josèphe; Opatowski, Marion; David, P.; Bardy, Françoise; Dunbavand, A

doi:10.1016/j.ejogrb.2015.09.025

Cited by 17 publications

(14 citation statements)

References 25 publications

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“…4,8,15 We found no difference in the pain intensity between teenagers and adult women, but the consumption of analgesics was higher among teenagers, The pain observed in the present study was more intense than that seen in most previous studies in medical abortion regimens containing various combinations of mifepristone and misoprostol. 5,8 Similarly, the onset of pain before misoprostol administration was more frequent (38.7%) than reported previously (11%). 27 As the most intense pain often occurs soon after misoprostol intake, there is a place for prophylactic pain medication to be used This must be kept in mind when comparing results of teenagers and adult women in our study.…”

Section: Discussionmentioning

confidence: 66%

“…3 Most patients undergoing medical abortion experience abdominal pain and, in every fourth woman, even severe pain. [3][4][5][6][7] Predictive factors for severe pain include young age, nulligravidity, advanced gestational age, anxiety and history of dysmenorrhea. [4][5][6]8,9 However, little is known on pain experience among teenage women undergoing medical abortion.…”

Section: Introductionmentioning

confidence: 99%

“…11,12 The overall need for analgesics during medical abortion in early pregnancy has been reported to vary between 68 and 91%, and 2-29% of women need additional narcotic analgesics. 5,7,13,14 Nonsteroidal anti-inflammatory drugs are widely used and they do not decrease the efficacy of medical abortion. 10,15,16 Ibuprofen and paracetamol both decrease the pain score during early medical abortion, ibuprofen being more effective.…”

Section: Introductionmentioning

confidence: 99%

“…Teenagers needed additional analgesics more often than adults (5 [3][4][5][6][7][8] vs 3 [2][3][4][5][6] times, P = .021); 38.0% of all teenagers (64.7% of the minors) received additional opiates compared with 7.9% in adult women. Severe pain (VAS ≥70) was associated with history of dysmenorrhea (adjusted odds ratio […”

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confidence: 99%

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Pain during medical abortion in early pregnancy in teenage and adult women

Kemppainen

Mentula

Palkama

et al. 2020

Acta Obstet Gynecol Scand

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Section: Discussionmentioning

confidence: 66%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

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Pain during medical abortion in early pregnancy in teenage and adult women

Kemppainen

Mentula

Palkama

et al. 2020

Acta Obstet Gynecol Scand

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“…A Cochrane Review included only one trial comparing low and high doses of mifepristone in case of medical abortion, and reported no significant difference in side-effects [20]. Furthermore, when considering other aspects of the expulsion of a pregnancy there is, maybe surprising, evidence that women receiving 600 mg mifepristone report a lower mean pain severity and even a lower prevalence of side-effects than the women receiving 200 mg mifepristone [33].…”

Section: Methods / Designmentioning

confidence: 99%

Mifepristone and misoprostol versus misoprostol alone for uterine evacuation after early pregnancy failure: study protocol for a randomized double blinded placebo-controlled comparison (Triple M Trial)

Berg¹,

Hamel²,

Snijders³

et al. 2019

BMC Pregnancy Childbirth

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BackgroundEarly pregnancy failure (EPF) is a common complication of pregnancy. If women do not abort spontaneously, they will undergo medical or surgical treatment in order to remove the products of conception from the uterus. Curettage, although highly effective, is associated with a risk of complications; medical treatment with misoprostol is a safe and less expensive alternative. Unfortunately, after 1 week of expectant management in case of EPF, medical treatment with misoprostol has a complete evacuation rate of approximately 50%. Misoprostol treatment results may be improved by pre-treatment with mifepristone; its effectiveness has already been proven for other indications of pregnancy termination.This study will test the hypothesis that, in EPF, the sequential combination of mifepristone with misoprostol is superior to the use of misoprostol alone in terms of complete evacuation (primary outcome), patient satisfaction, complications, side effects and costs (secondary outcomes).MethodsThe trial will be performed multi-centred, prospectively, two-armed, randomised, double-blinded and placebo-controlled. Women with confirmed EPF by ultrasonography (6–14 weeks), managed expectantly for at least 1 week, can be included and randomised to pre-treatment with oral mifepristone (600 mg) or oral placebo (identical in appearance). Randomisation will take place after receiving written consent to participate. In both arms pre-treatment will be followed by oral misoprostol, which will start 36–48 h later consisting of two doses 400 μg (4 hrs apart), repeated after 24 h if no tissue is lost. Four hundred sixty-four women will be randomised in a 1:1 ratio, stratified by centre.Ultrasonography 2 weeks after treatment will determine short term treatment effect. When the gestational sac is expulsed, expectant management is advised until 6 weeks after treatment when the definitive primary endpoint, complete or incomplete evacuation, will be determined. A sonographic endometrial thickness < 15 mm using only the allocated therapy by randomisation is considered as successful treatment. Secondary outcome measures (patient satisfaction, complications, side effects and costs) will be registered using a case report form, patient diary and validated questionnaires (Short Form 36, EuroQol-VAS, Client Satisfaction Questionnaire, iMTA Productivity Cost Questionnaire).DiscussionThis trial will answer the question if, in case of EPF, after at least 1 week of expectant management, sequential treatment with mifepristone and misoprostol is more effective than misoprostol alone to achieve complete evacuation of the products of conception.Trial registrationClinicaltrials.gov (d.d. 02-07-2017): NCT03212352.Trialregister.nl (d.d. 03-07-2017): NTR6550.EudraCT number (d.d. 07-08-2017): 2017–002694-19.File number Commisie Mensgebonden Onderzoek (d.d. 07-08-2017): NL 62449.091.17.

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