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Impact of self-administration of misoprostol for early medical abortion: a prospective observational cohort study
  1. Rebecca Elizabeth Finch1,
  2. Kevin McGeechan2,
  3. Anne Johnstone3,
  4. Sharon Cameron4,5
  1. 1 University of Edinburgh, Edinburgh, UK
  2. 2 School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Dean Terrace Centre, Edinburgh, UK
  4. 4 Department of Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
  5. 5 University of Edinburgh Division of Health Sciences, Edinburgh, UK
  1. Correspondence to Rebecca Elizabeth Finch, University of Edinburgh, Edinburgh EH16 4TJ, UK; s1407679{at}sms.ed.ac.uk

Abstract

Introduction In October 2017, Scotland legalised the home use of misoprostol for the purpose of early medical abortion (EMA). Women up to 9+6 weeks’ gestation can now self-administer the drug at home, 24–48 hours after receiving mifepristone in the clinic.

Objective To evaluate the impact of this change on the uptake and success rate of EMA, and on the provision of effective contraception on discharge.

Methods A prospective observational study was conducted to compare the outcomes of two cohorts of women in the 6 months before and 6 months after the introduction of home administration of misoprostol. The main outcome measures were uptake of EMA, success of EMA and provision of long-acting reversible contraception (LARC) to women undergoing EMA.

Results There was a statistically significant increase in the uptake of EMA from 698/1075 (64.9%) women in the first study period to 823/1146 (71.8%) in the second study period. There was no statistically significant difference in the success rate of EMA: 99.3% and 98.9% in clinic and home misoprostol cohorts, respectively. There was also no statistically significant difference in the proportion of women provided with LARC: 37.7% and 33.7% in clinic and home misoprostol cohorts, respectively.

Conclusions Self-administration of misoprostol at home increased uptake of EMA, with no effect on the high success rate that was previously seen with clinic administration of misoprostol. In addition, the reduced number of visits associated with home use of misoprostol has not affected the provision of effective contraception to women.

  • abortion
  • mifepristone
  • misoprostol
  • termination of pregnancy
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Footnotes

  • Contributors SC designed and supervised the study. REF collected and analysed the data, drafted the manuscript and designed the figures. AJ aided with data collection. KMcG advised on data analysis. SC helped work on the manuscript. All authors discussed and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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