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Early medical abortion: best practice now lawful in Scotland and Wales but not available to women in England
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  • Published on:
    Second doctor signature on HSA forms
    • Humphrey Birley, GUM Consultant The Cordell Centre, Aneurin Bevan Health Board, Royal Gwent Hospital, Newport

    The move to single visit medical abortion[1] will be a great improvement in convenience to clients. The requirement of two doctors to sign the HSA form results in many attending and sometimes waiting for hours purely to obtain a signed form. This inconvenience could easily be removed by distant signing of such forms. In a service such as ours with an electronic patient record, readily accessed at a remove, the requirement for such attendance seems especially egregious.

    Reference
    1 Lord J, Regan L, Kasliwal A, et al. Early medical abortion: best practice now lawful in Scotland and Wales but not available to women in England. BMJ Sex Reprod Health 2018;44:155–8.

    Conflict of Interest:
    None declared.
  • Published on:
    Comment on ‘Early medical abortion: best practice now lawful in Scotland and Wales but not available to women in England’
    • Keith Hindell, Former Vice-Chairman of Pregnancy Advisory Service None

    Jonathan Lord, Lesley Regan and colleagues make a strong case for allowing home use of misoprostol in early medical abortion. Indeed it has been obvious for some years ever since the WHO reviewed research trials in various countries. Isn't this really the time to make both abortifacients, mifepristone and misoprostol, available off prescription?

    They are safe, reliable and easy to use. Complications requiring further medical attention after self-administration are only marginally more common than when supervised by medical staff. Dire results are rare. Is this the time to recognise that the present, medically supervised, regulated system has been outflanked by pharmaceutical technology?

    In fact abortion has become so easy that many women obviously prefer it to contraception. In 2017 approximately 74 000 abortions in England & Wales (39% of the total) were for women who had had at least one before. Whether or not repeated abortion by medical means in early pregnancy is undesirable or even harmful does not seem to have been established.

    Pills over the counter would be a popular innovation because it would enable a pregnant woman to achieve a termination more quickly and with greater privacy than now. She would, for example, not need to run the gauntlet of abortion protesters outside clinics.

    Of course there are snags and difficulties. It could not be done without a change in the laws which currently forbid self-induction of abortion and r...

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    Conflict of Interest:
    None declared.
  • Published on:
    Home use of misoprostol: is it really safe and appreciated?

    Regarding the Scottish decision on home abortion of 26th October 2017, Lord J, Regan L, Kasliwal A, et al. claim that "Home use of misoprostol in Scotland is relatively new. The larger abortion services in Scotland report widescale uptake of home use of misoprostol among women and that it is highly appreciated with no negative impact on services." The Scottish “abortion services” consulted are not named and the reference for the bold claim that home use of misoprostol is “highly appreciated” is “S Cameron [co-author], personal communication 2018”. Such statements do not inspire confidence.

    In response to some other claims made in the article: women having better control over timing in practice will mean less precision in timing, since medical supervision is supposed to guarantee ‘correct’ time between drugs and a ‘correct’ route of administration, whether sublingual, buccal or vaginal. If these are departed from, the effectiveness goes down, and the complications go up. This is well-known.

    As regards travel and onset of bleeding, the Creinin paper [1] referred to by the authors had a bleeding onset median time of 2 hours for the standard (misoprostol taken 24 hours after mifepristone), and 3.7 hours when mifepristone and misoprostol were taken together. Others state that the onset of bleeding with the standard regimen was after 2 hours and meant light to moderate spotting at 4 hours after misoprostol [2]. Depending on the travel time, there m...

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    Conflict of Interest:
    None declared.