Publication:

Is it time to move up? Feasibility of medical abortion between 9-13 weeks of gestation

Background Medical termination of pregnancy act helps to reduce incidence of illegal abortion its dreaded complication like maternal mortality to analyze the safety, efficacy and acceptability of medical regimen in 9-13 weeks of pregnancy.

Methods A prospective study was carried out for a period of two and half years. All patients between 9-13 weeks of pregnancy seeking medical termination of pregnancy were given either medical regimen or surgical abortion depending on patients’ preference. Medical regimen consisted of 200 mg of mifepristone followed by 600 mcg of misoprostol after 48 hours. If required 2nd and 3rd dose of misoprostol was repeated. Surgical abortion was done under sedation after cervical priming with misoprostol.

Results Out of 353 cases of medical termination of pregnancy, 92 cases (26.1%) were between 9-13 weeks of pregnancy. Two cases were excluded as surgical abortion was indicated in them. Out of 90 cases, only 30 cases (33.3%) were willing to participate in randomized controlled trial if needed. Out of 90 cases, 50 (55.6%) preferred surgical abortion, while 40 (44.4%) cases preferred medical abortion. Out of 40 cases of medical abortion, 5% cases required surgical curettage, while 3.8% cases required repeat curettage in surgical group. Minor complication rate was comparable in both groups except for prolonged bleeding, which was significantly higher in medical abortion group. Major complication in the surgical group was uterine perforation (1.9%). After completion of procedure, both group satisfied with same procedure, 92% in medical abortion group and 89% in surgical abortion group.

Conclusions Medical abortion is a safe and effective alternative to surgical abortion between 9-13 weeks of gestation.  It should be included routinely at these gestations, thus increasing women's choice. However randomized controlled trial for medical versus surgical abortion between 9-13 weeks will be difficult to initiate.