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Very early medical abortion: treatment with mifepristone and misoprostol before ultrasonographic visualisation of an intrauterine pregnancy
  1. Natalie Qian Ru Tai1,
  2. John Joseph Reynolds-Wright2,3,
  3. Sharon Cameron2,3
  1. 1 Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
  2. 2 Chalmers Centre for Sexual and Reproductive Health, NHS Lothian, Edinburgh, UK
  3. 3 MRC Centre for Reproductive Health, The University of Edinburgh, Edinburgh, UK
  1. Correspondence to Natalie Qian Ru Tai, The University of Edinburgh Edinburgh Medical School, Edinburgh EH16 4SB, UK; N.Q.R.Tai{at}


Introduction Abortion providers may be reluctant to commence abortion before ultrasound evidence of intrauterine pregnancy (IUP) due to concerns of missed ectopic pregnancy. In 2017, very early medical abortion (VEMA) was introduced at an abortion service in Edinburgh, UK. Following ultrasound, patients without confirmed IUP, and without symptoms or risk factors for ectopic pregnancy, could commence treatment immediately after baseline serum-human chorionic gonadotrophin (hCG) measurement, and return for follow-up serum-hCG a week later to determine treatment success (≥80% decline from baseline). This study aimed to compare clinical outcomes between two pathways: (1) VEMA; and (2) standard-of-care delayed treatment where treatment is only commenced on IUP confirmation by serial serum-hCG monitoring and/or repeat ultrasound.

Methods A retrospective database review was conducted of VEMA eligible patients from July 2017 to December 2021. Study groups were determined by patient preference. Records were searched for abortion outcomes, duration of care, number of appointments (clinic visits, ultrasounds, serum-hCG) and clinical data entries.

Results Of 181 patients included, 77 (43%) chose VEMA and 104 (57%) chose delayed treatment. 11/181 (6.1%) were lost to follow-up. Cohort ectopic prevalence was 4.4% and was not statistically different between groups (2.6% vs 5.8%, VEMA vs delayed group, respectively, p=0.305), as with complete abortion rates (93.3% vs 97.6%, p=0.256). All VEMA group ectopics were detected on the seventh day (from initial visit) while time-to-diagnosis for delayed group ectopics ranged from 7 days to 3 weeks. VEMA patients had significantly reduced duration of care (12 vs 21 days, p<0.001), number of visits (2 vs 3, p<0.001), ultrasounds (1 vs 2, p<0.001) and data entries (6 vs 9, p<0.001).

Conclusions VEMA is safe, effective and reduces the duration of care, number of appointments and clinical administrative time. It should be offered to medically eligible patients.

  • Mifepristone
  • Patient Safety
  • Reproductive Health
  • Health Services Research
  • family planning services
  • abortion, induced

Data availability statement

No data are available. Due to the sensitive nature of abortion data, no further patient data are available to be shared.

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Data availability statement

No data are available. Due to the sensitive nature of abortion data, no further patient data are available to be shared.

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  • Contributors SC, JJR-W and NQRT designed the study, analysed the data and drafted the manuscript. SC is the guarantor for this manuscript. All authors reviewed the final manuscript before submission.

  • Funding This study did not receive any specific funding. This research was conducted in part by staff at the MRC Centre for Reproductive Health which is supported by grant number MR/N022556/1.

  • Competing interests JJR-W has received an education grant from Gedeon Richter.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.