Objective: To assess the impact of the introduction of new medical methods on the provision of therapeutic abortions at the Royal Infirmary Edinburgh.
Design: A review of the total number of abortions performed by medical and surgical means between 1989 and 1995 (inclusive); a prospective survey of the terminations of pregnancy (< or = 9 weeks of gestation) performed over the six-month period of January to June 1994; and a questionnaire of the reasons why women chosen a particular method.
Setting: Large teaching hospital in Scotland.
Subjects: One thousand and seven women seeking early pregnancy termination between January and June 1994.
Main outcome measures: Proportion of pregnancies terminated by medical means; comparison of complete abortion rate, incidence of complications and morbidity following both medical and surgical methods (< or = 9 weeks of gestation); reasons for preference of the method of abortion.
Results: Since 1991 there has been a progressive increase in the number of medical abortions performed at the Royal Infirmary of Edinburgh, and by 1994 the majority of women (57%) seeking abortion at < or = 9 weeks chose a medical method. Women who chose medical abortion had more years at full-time education and were less likely to smoke (P < 0.04). Both medical and surgical methods were highly effective (> 96% complete abortion) with a low incidence of complications and morbidity. However, women who had chosen the medical method were less likely to receive antibiotics for suspected endometritis than their surgical counterparts (chi 2, P = 0.0001).
Conclusions: If this trend towards medical methods in Edinburgh is repeated elsewhere, it will inevitably have an impact on gynaecological services by releasing staff and operating time for other purposes.
PIP: Data on 329 medical (drug-induced) abortions were compared with data on 215 vacuum aspiration abortions to determine the impact of new medical methods on therapeutic abortions. Medical abortions were performed at less than 9 weeks' gestation, while vacuum aspirations were performed at less than 12 weeks' gestation. All abortions were performed at the Royal Infirmary of Edinburgh, Scotland, during January-June 1994. The medical abortion method included 200 mg oral mifepristone and 0.5 mg gemeprost (vaginal pessary) or 600 mcg oral misoprostol 36-48 hours after administration of mifepristone. Since 1991, in terms of early pregnancy termination, the number of medical abortions has increased and the number of vacuum aspirations has decreased at the Royal Infirmary. Women who chose the medical method of pregnancy termination were more likely than those who chose vacuum aspiration not to smoke (60% vs. 51%), to have completed at least 19 years of formal education (18.5% vs. 13%), and to have had a previous induced abortion (32.5% vs. 24%) (p 0.04). Complete abortion rates were similar (96.4% for medical abortion and 97.9% for surgical abortion). Complications were rare for both methods. Women who had undergone vacuum aspiration were more likely to receive antibiotics for suspected endometritis than those who opted for medical abortion (9.6% vs. 1.2%; p = 0.0001). Postabortion bleeding was more likely to be perceived as heavier than normal menses in the medical abortion group than in the surgical abortion group (66% vs. 11%; p = 0.001). The two most important sources of information on abortion methods were medical staff (87%) and the information sheet (40%). The reduced demand for vacuum aspirations has released operating room time for other gynecological procedures. If the trend continues in Edinburgh and elsewhere, it will influence the provision of abortion services nationwide.