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Early medical abortion using low-dose mifepristone followed by buccal misoprostol: a large Australian observational study

Philip Goldstone, Jill Michelson and Eve Williamson
Med J Aust 2012; 197 (5): 282-286. || doi: 10.5694/mja12.10297

Summary

Objective: To describe the use of mifepristone in combination with buccal misoprostol in women undergoing an early medical abortion (EMA) in Australia.

Design, setting and participants: Retrospective, observational study of 13 345 EMAs (gestational age ≤ 63 days) conducted at 15 Marie Stopes International Australia clinics between 1 September 2009 and 31 August 2011.

Intervention: Oral mifepristone 200 mg, administered at the clinic, followed 24–48 hours later by buccal misoprostol 800 µg, self-administered at home.

Main outcome measure: Failure rate (proportion of women with an incomplete abortion requiring surgical aspiration or a continuing pregnancy).

Results: Pregnancy termination follow-up information was available for 83.4% (11 155/13 376) of EMAs. From the patient demographic database, the EMA failure rate was 3.5% (465/13 345). Of these, most (382; 2.9% of total) were incomplete abortions requiring surgical aspiration, and 83 (0.6% of total) were continuing pregnancies. Haemorrhage (16; 0.1%) and known or suspected infection (25; 0.2%) were infrequent. One woman, who did not seek follow-up despite signs of infection, died from sepsis (< 0.01%). In 6755 EMAs with clinic follow-up from April 2010 to August 2011, 6381 women participated in a survey. Most reported medium or heavy bleeding and moderate or severe pain/cramps; most also reported that bleeding, pain/cramps and their overall experience were as expected or better than expected.

Conclusions: Mifepristone, with buccal misoprostol self-administered at home, for EMA up to 63 days of gestation had a low failure rate, was well accepted, and provided an effective treatment option with a favourable safety profile for women seeking an abortion in Australia.

  • Philip Goldstone1
  • Jill Michelson2
  • Eve Williamson1

  • Marie Stopes International Australia, Melbourne, VIC.


Acknowledgements: 

This study was sponsored by Marie Stopes International Australia, a not-for-profit, non-governmental organisation. The sponsor did not impose any impediment, directly or indirectly, on the publication of our results. We acknowledge the independent medical writing assistance of Justine Southby and Julie Ely of ProScribe Medical Communications, funded from an unrestricted financial grant from MSIA. We also acknowledge the contributions to the study from the Marie Stopes Study Group: Ivana Borsky, Harry Cohen, Nicole Gastaldin, Janelle Hall, Katerina Lagios, Gary Lubransky, Alex MacPherson, Kevin Pedemont, Andrew Perry, Rebecca Quake, Charles Russell-Smith, Robin Tideman, and Ying Zhou.

Competing interests:

Philip Goldstone is an employee of, and Jill Michelson and Eve Williamson are consultants to, Marie Stopes International Australia.

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