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To determine factors predicting severe pain among patients having mifepristone-misoprostol medication abortion at ≤9 weeks’ gestation.
A randomized, placebo-controlled trial in Vietnam, Nepal, and South Africa assessed pain levels with use of prophylactic tramadol, ibuprofen/metoclopramide, or placebo. This is a secondary analysis to identify predictors of severe pain. Primary outcome was maximum pain score (scale 0–10) within eight hours of taking misoprostol, analyzed as a dichotomized variable.
556 patients enrolled between June 2016 and October 2017 were included; 283 (50.9%) had maximum pain score of 8 (49.1%). In multivariable analysis, controlling for study center and prophylactic treatment arm, history of prior vaginal delivery (OR, 0.37; 95% CI, 0.24–0.55) was associated with reduced odds of severe pain while higher gestational duration (OR, 1.05; 95% CI, 1.01–1.09), higher pain score for menstrual cramps (OR, 1.16; 95% CI, 1.07–1.26), and higher anticipated pain score (OR, 1.11; 95% CI, 1.00–1.24) were associated with increased odds of severe pain. Sociodemographic variables including marital status, education, employment, food insecurity, housing instability, and history of anxiety or depression were not associated with severe pain.
In addition to known risk factors such as parity and gestational duration, this analysis identified new predictors of having severe pain with medication abortion. Patients seeking medication abortion should be counseled about the factors that may increase their risk of having severe pain as well as given options for prophylactic pain management to help them better prepare for and manage their abortion experience.
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