European transnational survey related to medical abortion in the first trimester of pregnancy
Filipa Mendes Coutinho1, Teresa Bombas1 ,2, Paulo Moura1
1Serviço de Obstetrícia A, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal, 2On behalf of Expert Group on abortion, European Society of Contraception and Reproductive Health (ESC), Coimbra, Portugal
Background: Currently most European countries allow abortion upon women's request in the early weeks of pregnancy. Despite WHO's recommendations, the definitions and methods used in clinical practice are not well established. The knowledge of the different attitudes regarding abortion would be beneficial.
Methods: We conducted a survey via mail involving 20 centres from 19 countries in which abortion is legal, to understand the differences in clinical practice regarding medical abortion. We performed a statistical analysis assessing a number of variables, including: number of abortions per year; rate of medical abortion; availability of national guidelines; methods of follow-up; among others.
Results: Nineteen centres responded (95%) and most of these (84%) perform medical abortion. A large number do not use it as a first-line method. Thus, from an estimated 21,925 abortions registered in the past year, only 39% were performed by medical protocol. In spite of the lack of guidelines all the institutions use a combination of mifepristone and misoprostol to terminate pregnancy. The differences lie in the dosage used as well as the route of administration. Concerning follow-up, 52% of the institutions agree on a two week interval and almost 65% perform an hCG blood level as well as an ultrasound scan after this period. Similar percentages (63%) repeat medical treatment in case of ongoing pregnancy after a first cycle of medication and 68% in case of incomplete abortion. When asked if having more precise definitions for success of medical/surgical abortion would be beneficial, nearly 77% responded affirmatively.
Conclusions: In late years we have witnessed an increase in the number of medical abortions performed in European countries. Despite the WHO recommendations the access to abortion methods are quite different. The majority of the surveyed institutions agree this would be an important step towards improving management of the procedure.