Medical or Surgical Abortion

ABORTION PILL: MEDICAL OR SURGICAL ABORTION

'Information"

Learn About The Comparisons of Medical and Surgical Abortion.

Information On This Page:

MEDICAL ABORTION CANDIDATES

Some women are poor candidates for medical abortion.

A medical abortion is not a means to make abortion an easier decision for a woman uncertain about whether to continue the pregnancy. (1)

Women are poor candidates for medical abortion if they do not wish to participate in their abortion or take responsibility for their care, cannot return for follow-up visits, or cannot understand the instructions because of language or comprehension barriers. (1)

Due to the potential for medical abortion health risk complications, patients are required to commit to comprehensive follow-up care with their provider. This is especially important since the patient is expected to participate in the monitoring of her own abortion process. (1) (2)

MEDICAL OR SURGICAL ABORTION

Which procedure is more acceptable by women and has a greater level of satisfaction?

When comparing medical and surgical abortion, focus should therefore not only be on efficacy and complications, but also on acceptability and patient satisfaction. (3)

A Denmark study of over 1000 women revealed the following:

  • The abortion procedure experience was worse than expected by 27% of women choosing a medical procedure and by 7% choosing a surgical termination.
  • The frequency of severe side effects was higher in women having a medical than a surgical abortion.
  • At the 2 week follow-up, 75 % of women who had a medical procedure were still bleeding compared to 37% of women who had a surgical termination.
  • More women having a surgical than a medical procedure would opt for the same method again.
  • Failure after a medical procedure is experienced as worse than failure after a surgical procedure

The lower level of satisfaction with the medical procedure was significant for all women up to 63 days of gestation.

While the choice between procedures has a positive influence on satisfaction, severe side effects and increasing gestational age have a negative influence. (3)

First trimester abortion can be provided using either medical drug-induced abortion, up to nine weeks (See Alternative/Unapproved Regimens), or surgical techniques. (4)

Surgical abortion can be performed by aspiration (using an electric pump or a manual syringe) or by dilatation and curettage (sometimes called dilation and curettage or D&C). (4)

Dilatation and curettage (D&C) is an outdated surgical technique that should be replaced, whenever possible, by vacuum aspiration or medical (drug-induced) abortion which are better options. (4)

MEDICAL ABORTION COMPARED TO SURGICAL ABORTION

What are the differences between medical abortion and surgical abortion? (3) (4) (5) (6) (7) (8)

Feature

Medical Abortion Regimen

Vacuum Aspiration Procedure

Technique Used
  • Medical drug-induced abortion.
  • Uterine evacuation with drugs(Mifepristone & Misoprostol), a non-surgical method. Mifepristone initiates bleeding and misoprostol cause uterine contractions to expel the embryo and pregnancy tissue.
  • Uterine contents evacuated through a cannula attached to vacuum source (manual or electric). Gentle pressure is applied with a hand held plastic instrument.

Gestation limit of the technique
  • Can be used up to 9-10 weeks of pregnancy

Effectiveness Rate
  • 89-98% effective
  • More than 98-99% effective

Failure Rate
  • 1-2% failure

Time required for the procedure to complete the process
  • May take 9 -16 days with ranges up to 69 days
  • (See WARNINGS)
  • 5-15 minutes

Products of Conception (POC) check (embryo and pregnancy tissue)
  • POC may be expelled at home unless there is a failure requiring a surgical procedure to complete the process.
  • POC are examined and confirmed immediately

Procedure done by
  • Licensed Health Care Provider

Number of visits for the procedure
  • Require minimum 3 visits with FDA approved regimen.
  • Require 2 visits with alternative/unapproved regimens.
  • One visit

Follow up visit
  • Required to ensure completion and check for complications
  • (See WARNINGS)
  • Ideal, but not mandatory

Anaesthesia used
  • Oral pain control medication.
  • Narcotics for severe pain
  • (See Health Risks – SEVERE PAIN)
  • Local Anaesthesia & oral pain control medications

Risk of cervical and uterine injury
  • Generally, no risk of injury to cervix and uterus if no instrumentation is required.
  • Failed abortion will usually require a surgical procedure.
  • Possible complications if misoprostol is used over 8 weeks gestation.
  • (See Misoprostol BOXED WARNINGS)
  • Possible, but rare

Post – procedure bleeding
  • Usually heavy.
  • Bleeding can last an average 9-16 days.
  • Women can bleed up to 30 days or more.
  • (See BLEEDING & HEMORRHAGE)
  • Minimal, light bleeding usually 1-7 days

Post – procedure pain

  • Intense and prolonged pain is possible (See SEVERE PAIN)

  • Very short period of pain

Hospital/clinic stay

  • Few hours on each visit

  • Few hours

Risk of fetal malformation if pregnancy continues

  • None

Cost involved
  • Can cost more if FDA approved regimen is used.
  • Alternative/unapproved regimens use 1/3 the dosage of mifepristone and eliminate one office follow-up visit to reduce the cost.

  • Cost effective as lesser resources required

Acceptability to women
  • Takes Longer to Complete
  • Higher Failure Rates
  • Intense, Prolonged Pain
  • Woman is very involved in monitoring her own procedure
  • More waiting and uncertainty to see if the procedure was successful
  • If unsuccessful a surgical procedure will be required
  • Can only be used to 7 weeks with FDA approved regimen, up to 9 weeks alternative/unapproved regimen
  • Higher risk of infection than surgical procedure
  • More Bleeding, Cramping, Nausea, Diarrhea and other adverse side effects
  • Lower satisfaction due to higher incidence of adverse side effects
  • Quicker to Complete
  • Higher Success Rate
  • Less Painful
  • Woman awake during procedure
  • Noiseless procedure with manual vacuum aspiration
  • Small risk of uterine or cervical injury
  • Provider controlled
  • Woman can be less involved
  • Can be used past 9 weeks pregnancy
  • Higher Satisfaction with surgical procedure

MEDICAL ABORTION  & SURGICAL ABORTION – HEALTH RISKS

What are the health risks comparisons of medical abortion to surgical abortion?

Surgical abortion up to 9 weeks of gestation has been the method of choice for elective pregnancy termination since the 1960s. (9)

Medical abortion has become an alternative method for first trimester pregnancy terminations with the availability of mifepristone (progesterone receptor agonist) and misoprostol (prostaglandin). (9)

Termination of pregnancy is one of the most common gynecologic procedures. (10)

In the United States, nearly 50% of pregnancies are unintended, and 22% of all pregnancies (excluding miscarriages) end in termination. (11)

With the dramatic change of abortion practices in recent years since the introduction of medical abortion, the safety of medically induced abortion is of great public health interest. (10)

A 2009 European study reported the incidence and risk factors of adverse events of 22,368 women who had medical abortion compared to 20,251 women who had surgical abortion at a gestational age of 63 days or less. The risk of the three major complications (hemorrhage, infection, and incomplete abortion) and surgical (re)evacuation were analyzed. (10)

The European study compared medical and surgical abortion in regard to the incidence and risk factors of immediate (i.e., within 42 days after termination of pregnancy) adverse events and complications in a large nationwide cohort. (10)

The overall risk of major complications was higher in medical abortion compared to surgical abortion: (10)

  • Bleeding (hemorrhage) risk was almost eight times higher in medical abortion (15.6% compared with 2.1%)
  • Incomplete abortion risk was over five times higher in medical abortion (6.7% compared with 1.6%)
  • Infection risk was similar in both procedures of abortion (1.7% compared with 1.7%)
  • Repeat abortion (surgical intervention) risk was 3.5 times higher in medical abortion (5.9% compared to 1.8%)
  • Surgical intervention risk due to hemorrhage, infection, incomplete abortion was five times higher in medical abortion (9.6% compared with 1.9%)

Overall risk of major complications was over four times higher in medical abortion (20.0% compared with 5.6% ) than surgical abortion. (10)

Because medical abortion is being used increasingly in several countries, it is likely to result in an elevated incidence of overall morbidity related to termination of pregnancy. (10)

REFERENCES

1. Creinin, Mitchell D. Current Medical Abortion Care,Current Women's Health Reports, 3(6): 461-9. NCBI, PubMed. [Online] December 3, 2003. [Cited: September 8, 2011.] http://www.ncbi.nlm.nih.gov/pubmed/14613667. PMID: 14613667.

2. National Abortion Federation. Patient Counseling in Medical Abortion. Early Options, A Provider's Guide to Medical Abortion. [Online] 2010. [Cited: September 8, 2011.] http://www.prochoice.org/education/cme/online_cme/m1patient.asp.

3. Rorbye, Christina, Norgaard, Mogens and Nilas, Lisbeth. Medical versus surgical abortion: comparing satisfaction and potential confounders in a partly randomized study, Human Reproduction, 20(3):834-8. Epub 2004 Dec 23. NCBI, PubMed. [Online] March 2005. [Cited: September 26, 2011.] http://www.ncbi.nlm.nih.gov/pubmed/15618257.

4. IPPF, Vekemans, Marcel. First trimester abortion guidelines and protocols. Surgical and medical procedures. International Planned Parenthood Federation. [Online] September 2008. [Cited: May 25, 2011.]www.ippf.org/system/files/abortion_guidelines_and_protocol_english.pdf

5. Abuabara, K; Blum, J; Bracken, H; Gynuity Health Projects. Providing Medical Abortion in Low-resource Settings: An Introductory Guidebook, 2nd Edition. Gynuity Health Projects. [Online] December 2009. [Cited: June 24, 2011.] http://gynuity.org/resources/info/medical-abortion-guidebook/.

6. IPAS India. Refresher course for medical abortion services, Reference manual, REFMA-IND-E09. IPAS. [Online] March 15, 2009. [Cited: January 17, 2011.] http://www.ipas.org/en/Resources/Ipas%20Publications/Refresher-course-for-medical-abortion-services-Reference-manual.aspx

7. U.S.Department of Health & Human Services. Drugs@FDA, Label and Approval History, Mifepristone Labeling Revision. FDA, U.S. Food and Drug Administration. [Online] April 27, 2009. [Cited: July 16, 2011.] http://www.accessdata.fda.gov/drugsatfda_docs/label/2009/020687s015lbl.pdf.

8. Department of Health & Human Services, CDC, FDA, NIH. Emerging Clostridial Disease Workshop, May 11, 2006, James McGregor, pages 15-17. U.S. Department of Health & Human Services, U.S. Food and Drug Adminstration. [Online] June 22, 2006. [Cited: June 28, 2011.] http://www.fda.gov/downloads/AboutFDA/CentersOffices/CDER/UCM183030.pdf.

9. Wedisinghe, Lilantha and Elsandabesee, Deya. Flexible mifepristone and misoprostol administration interval for first-trimester medical termination, Contraception, 81(4):269-74. NCBI, PubMed. [Online] April 2010. [Cited: September 20, 2011.] http://www.ncbi.nlm.nih.gov/pubmed/20227541.

10. Niinimäki, Maarit, et al., et al. Immediate Complications After Medical Compared With Surgical Termination of Pregnancy, Obstetrics & Gynecology, 114(4):795-804. NCBI, PubMed. [Online] October 2009. [Cited: September 20, 2011.] http://www.ncbi.nlm.nih.gov/pubmed/19888037. PMID: 19888037.

11. Jones, Rachel K, et al., et al. Abortion in the United States: Incidence and Access to Services, 2005. Guttmacher Institute, Perspectives on Sexual and Reproductive Health. [Online] March 2008. [Cited: September 15, 2011.] http://www.guttmacher.org/pubs/journals/4000608.html. DOI:10.1363/4000608.

12. Greene, Michael F. Fatal Infections Associated with Mifepristone-Induced Abortion, N Engl J Med, 353(22):2317-8. NCBI, PubMed. [Online] December 1, 2005. [Cited: September 13, 2011.] http://www.ncbi.nlm.nih.gov/pubmed/16319378. PMID: 16319378.

 

Page Last Updated: 7/25/2012

Comments on this entry are closed.