Abstract
Background
From 2001 to March 2006 Planned Parenthood health centers throughout the United States
provided medical abortion by a regimen of oral mifepristone followed 24–48 h later
by vaginal misoprostol. In response to concerns about serious infections, in early
2006 Planned Parenthood changed the route of misoprostol administration to buccal
and required either routine antibiotic coverage or universal screening and treatment
for chlamydia; in July 2007, Planned Parenthood began requiring routine antibiotic
coverage for all medical abortions.
Methods
We performed a retrospective analysis of Planned Parenthood cases assessing the rates
of mortality caused by infection following medical abortion during a time period when
misoprostol was administered vaginally (2001 through March 2006), as compared with
the rate from April 2006 to the end of 2012 after a change to buccal administration
of misoprostol and after initiation of new infection-reduction strategies.
Results
The mortality rate dropped significantly in the 81-month period after the joint change
to (1) buccal misoprostol replacing vaginal misoprostol and (2) either sexually transmitted
infection (STI) screening or routine preventative antibiotic coverage (15 month period)
or universal routine preventative antibiotic coverage as part of the medical abortion
(66-month period), from 1.37/100,000 to 0.00/100,000, P=.013 (difference=1.37/100,000, 95% CI 0.47–4.03 per 100,000).
Conclusion
The infection-caused mortality rate following medical abortion declined by 100% following
a change from vaginal to buccal administration of misoprostol combined with screen-and-treat
or, far more commonly, routine antibiotic coverage.
Significance
Deaths from infection following medical abortion declined to zero after a change in
the regimen.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to ContraceptionAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis.Obstet Gynecol. 1996; 87: 884-890
- Early pregnancy termination with mifepristone and misoprostol in the United States.N Engl J Med. 1998; 338: 1241-1247
- Mifepristone and misoprostol for early medical abortion: 18 months experience in the United States.Contraception. 2003; 67: 463-465
- Infection after medical abortion: a review of the literature.Contraception. 2004; 70: 183-190
- Safety of mifepristone abortions in clinical use.Contraception. 2005; 72: 175-178
- Fatal toxic shock syndrome associated with Clostridium sordellii after medical abortion.N Engl J Med. 2005; 353: 2352-2360
- Letter to the editor on deaths associated with medication abortion.Contraception. 2005; 72: 319
http://www.cdc.gov/hai/organisms/csordellii.html. Accessed November 15, 2013.
- Sexually Transmitted Disease Surveillance 2006 Supplement, Gonococcal Isolate Surveillance Project (GISP) Annual Report 2006.U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, Atlanta, GA2008
- Two distinct oral routes of misoprostol in mifepristone medical abortion: a randomized controlled trial.Obstet Gynecol. 2008; 112: 1303-1310
- Rates of serious infection after changes in regimens for medical abortion.N Engl J Med. 2009; 361: 145-151
- Pregnancy-related mortality in the United States, 1998 to 2005.Obstet Gynecol. 2010; 116: 1302-1309
- Effectiveness of medical abortion with mifepristone and buccal misoprostol through 59 gestational days.Contraception. 2009; 80: 282-286
- Significant adverse events and outcomes after medical abortion.Obstet Gynecol. 2013; 121: 166-171
Article info
Publication history
Published online: December 12, 2013
Accepted:
November 24,
2013
Received in revised form:
November 19,
2013
Received:
September 25,
2013
Footnotes
☆Funding: This work was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant for Infrastructure for Population Research at Princeton University, Grant R24HD047879 (JT).
☆☆Disclaimer: The findings and conclusions in this presentation are those of the authors and do not necessarily represent the views of Planned Parenthood Federation of America.
★Disclosures: The authors report no financial conflicts of interest.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
