Three years on: a review of medical terminations of pregnancy performed in a sexual health service

Abstract

Access to abortion services is often limited in parts of regional Australia, including north Queensland. Since March 2006, the Cairns Sexual Health Service (CSHS) has provided medical termination of pregnancy (MToP) services for women up to 9 weeks gestation, using a regimen of methotrexate and misoprostol. We conducted a retrospective chart audit of all women undergoing an MToP at the CSHS between 1 March 2006 and 31 March 2009. In total, 147 medical terminations in 136 women were performed during this 3-year period. At the time of first presentation, the mean age was 27 years, 77 (57%) of the 136 women were of less than 7 weeks gestation and 86 (63%) had not had a previous termination. A successful medical termination of pregnancy was achieved in 69 of 85 (81%, 95% confidence interval (CI): 72, 88) women at less than 7 weeks gestation and in 43 of 62 (69%, 95% CI: 57, 80) women with gestation between 7 and 9 weeks. Provision of medical termination of pregnancy through sexual health services is one strategy to address access inequity in regional areas. Demand for this service in Cairns continues to rise; however, since late August 2009 MToP in Queensland is no longer available pending legal reform.

Medical abortion: the Australian experience

“…All currently practised medical methods of abortion include the use of some form of synthetic prostaglandin, sometimes alone, but more often with the antiprogesterone mifepristone (formerly known as RU486). In some parts of the world, usually because mifepristone is not available, methotrexate has been used with or without prostaglandins [7][8][9].…”

“…The AP legislation was first used for the importation of mifepristone into Australia in 2006 by two specialist gynecologists in Cairns (QLD) [9,16,17,20]. At that time, although the TGA was very professional in its processing of applications, the procedures involved were time-consuming.…”

“…Induced abortion using methotrexate/misoprostol was practiced in the USA up until the introduction there of mifepristone/misoprostol regimens in 2000 [4,7]. There is wide experience of the drug combination reported in the world literature, and the consensus is that it is safe and effective, although less effective than the mifepristone/miso prostol combination, particularly at gestations of 49-63 days [4,7,9]. Like misoprostol, methotrexate is licensed in Australia only for purposes other than abortion, and its use for abortion would therefore be 'off-label.'…”

“…Although use of the drug is increasing in Australia it is still not universally available. First-trimester medical abortion using methotrexate plus misoprostol has also been practised to some extent in Australia [8,9].…”

Methotrexate Induces Apoptosis of Postpartum Placental Cytotrophoblasts

“…Methotrexate (MTX) has been extensively used in the treatment of obstetric disorders such as unruptured ectopic pregnancies [Suzuki et al, 2012], medical abortions [Downing et al, 2010], cesarean scar pregnancies [Riaz et al, 2015], and gestational trophoblastic neoplasias [Savage et al, 2015]. The efficacy of MTX against highly proliferating trophoblasts is well acknowledged.…”