SECOND TRIMESTER MA AS A DAY SERVICE
Could second-trimester medical abortion be offered as a day service? Assessing the feasibility of a 1-day outpatient procedure using pooled data from six clinical studies
by T Shochet, M Dragoman, J Blum, D Abbas, K Louie, I Platais, T Tsereteli, B Winikoff
Contraception 10 January 2019, E-pub ahead of print
Objectives: Current service delivery models for second-trimester medical abortion typically include routine inpatient admission and overnight stays. To assess the feasibility of a day-service model, we evaluated outpatient administration of abortion medications and analyzed the proportion of clients who could avoid an overnight stay. We also examined additional key elements of medical abortion care to evaluate the practicality of this model.
Study design: We pooled data from six clinical studies of second-trimester medical abortion conducted by Gynuity Health Projects over the past 10 years. We include 868 individuals receiving mifepristone–misoprostol abortion between 13 and 22 weeks’ gestation.
Results: At 8 h post misoprostol initiation, 309/521 (59.3%) participants at 13-18 weeks’ gestation had a successful abortion; by 10 h, 382/521 (73.3%) were successful. Taking the mifepristone at home lowered neither the efficacy of the method nor satisfaction with the experience. Non-physician providers played a significant role in the provision of care. Needed interventions were relatively rare; serious complications were very rare.
Conclusions: Our findings support the provision of second-trimester medical abortion in a day-clinic setting, especially at ≤18 weeks’ gestation. Such a model could increase access to quality care in many settings.
Implications: Second-trimester medical abortion can safely and effectively be offered as a day service. Non-physician providers are well suited to provide the majority of care. Developing guidelines for a 1-day model could increase access to quality care in many settings worldwide.