Medical abortion efficacy at 8 and 9 weeks
Ana Rita Pinto, Inês Vaz, Alfredo Gouveia, Rute Magarinho, Paulo Sarmento (Portugal)
Centro Hospitalar do Porto – Unidade Maternidade Júlio Dinis, Portugal
Objective. Abortion by request is allowed in Portugal if carried out within the first 10 weeks since April 17 2007. It implicates a minimum of a 3-day introspection period and the availability of psychological counselling, as well as support from social services technicians and women are given the choice between medical and surgical procedures. This law is a response to illegal abortions and to the need of eradicating its practice, as they are often carried out without the required conditions and with high risks to the sexual and reproductive health of the women involved. Most studies carried out on this subject are related to medical abortions within the first 49 days. This study, however, aims at evaluating the efficacy of medical treatment in abortions after the first 7 weeks.
Design and Methods. Retrospective study reviewing 380 cases related to abortion by request between July 1 2007 and February 29 2008. The variables analysed were gestational age, treatment methods (medical vs. surgical), dosage administered, treatment efficacy, need of additional intervention as a follow up to protocol and the need for curettage as an aid to uterus emptying completion.
Results. From the 380 women who underwent abortion, the gestational age in 151 (39,7%) was over 49 days; 7 (4,6%) underwent surgical procedure and 144 (95,4%) medical procedure. Initially, 46 women were administered 200 mg of Mifepristone orally and 800 µg misoprostol orally 36 hours later. From October 1 2007 protocol was changed and in 98 (68,1%) women were administered 600 mg Mifepristone orally and 800 µg misoprostol orally 36 hours later. In the initial procedure, 69,6% (n=32) had a complete abortion although 4,3% (n=2) failed to appear for follow-up. 4 (8,7%) were evolutional pregnancies, 1 (2,2%) had a missed abortion and in 7 cases (15,2%) emptying was considered incomplete, 3 (6,5%) of which needed curettage to aid uterus emptying. In the following procedure, 61,2% (n=60) had a complete abortion although 7,1% (n=7) failed to appear for follow-up. 14 (14,3%) were evolutional pregnancies, 3 (3,1%) were missed abortions and in 14 (14,3) cases emptying was considered incomplete, 1 (1,0) of which needed curettage. Overall, medical treatment was administered to 144 women. Abortion was complete in 92 (63,9%) cases, 18 (12,5%) were evolutional gestations and 25 (17,4%) were incomplete abortions. Defining the presence of live embryo after medical cycle as medical abortion failure, it is calculated as 12,5%.
Conclusions. Medical abortion had an 87,5% efficacy rate for the absence of live embryo at the time of ultrasound control. In our service the efficacy rate in the same period of time of medical treatment for any gestational age was 91,9%. Although scientific evidence of efficacy of medical treatment relates mainly to pregnancies within the first 49 days, the authors conclude that its use in cases of higher gestational ages is highly efficient, thus contributing to a lower number of surgical abortions.