Abstract
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 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.
Nonphysician 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.
Nonphysician 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.
Keywords
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Article info
Publication history
Published online: January 10, 2019
Accepted:
December 31,
2018
Received in revised form:
December 28,
2018
Received:
August 22,
2018
Footnotes
☆Staff time to conduct these analyses was funded by the David and Lucile Packard Foundation and an anonymous donor. The authors declare no conflicts of interest.
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
