Abstract
Objectives
Few studies have investigated the features associated with pain levels during abortion.
We aimed to investigate the risk factors for experiencing pain during medication abortion,
focusing on women's psychological distress and anxiety levels.
Study design
We carried out this observational study at two centers in Bologna, Italy. We included
women aged 18 years or more with a viable intrauterine pregnancy of up to 63 days
of amenorrhea, who chose medication abortion. Women received 600 mg of Mifepristone
orally and after 48 hours 400 mcg of buccal misoprostol, repeated after 3 hours according
to local and regional medication abortion guidelines, as well as prophylactic analgesia.
We evaluated the clinical characteristics which may represent risk factors for severe
pain (Visual Analogue Scale ≥ 70) through a multivariate model.
Results
Two hundred forty-two patients were included in our analysis; 92 (38.0%) reported
severe pain during medication abortion. Women with higher baseline anxiety levels
(General Health Questionnaire 12 score ≥ 6 and General Anxiety Disorder 7 score ≥
10) had a higher probability of experiencing pain with a Visual Analogue Scale ≥70
(OR = 3.33, 95% CI 1.43–7.76), as well as those who reported dysmenorrhea in the past
year (OR = 6.30, 95% CI 2.66–14.91). Previous vaginal deliveries were inversely correlated
with pain intensity (OR 0.26, 95% CI 0.14 – 0.50).
Conclusions
Increased baseline anxiety levels, dysmenorrhea and no previous vaginal deliveries
are associated with severe pain in women undergoing medication abortion.
Implications
The identification of women at risk for severe pain based on clinical and historical
factors as well as the definition of an adequate analgesic regimen may help to improve
women's care and pain management during medication abortion.
Keywords
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Article info
Publication history
Published online: December 02, 2022
Accepted:
November 21,
2022
Received in revised form:
November 20,
2022
Received:
July 11,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Elsevier Inc. All rights reserved.
