A total of 363 women undergoing legal abortion at < 63 days of amenorrhoea were allocated by a patient-centered, partially randomized study design to undergo medical abortion (using mifepristone 600 mg followed 48 h later by gemeprost 1 mg vaginal pessary) or vacuum aspiration (performed under general anaesthesia). The aim of the study was to compare the efficacy and complications of the two procedures. Main outcome measures included efficacy rates, medical complications within 21 days of abortion and unplanned family doctor consultation rates within 8 weeks following abortion. Sequelae such as pain, vaginal bleeding and recovery time were assessed by the change in haemoglobin level, the time taken to return to work or normal activity and the analgesic use. Results were gestation-related; at 50 days of amenorrhoea there was little to choose between the two procedures. At 50-63 days of amenorrhoea medical abortion becomes more painful and less effective, whereas vacuum aspiration retains high tolerance and efficacy. Women who are unsure which method to use are likely to find vacuum aspiration more acceptable at longer gestations.
PIP: In Aberdeen, Scotland, researchers compared the efficacy rate of medical abortion with that of vacuum aspiration and examined their complications and the nature and incidence of short-term sequelae. All 363 pregnant women had amenorrhea for less than 63 days. The medical abortion procedure consisted of administration of 600 mg mifepristone followed by 1 mg gemeprost (vaginal pessary) 48 hours later. Women who underwent medical abortion at less than 50 days gestation were less likely to experience pain than those who underwent medical abortion between 50 and 63 days gestation (mean pain related index [PRI] scores, 20.5 vs. 25.5, p = 0.04 and analgesia during inpatient treatment, 43% vs. 63%; p = 0.02). Medical abortion was less effective at 50-63 days gestation than at less than 50 days gestation (complete abortion, 98% vs. 92.6%). 90% of women requiring curettage after medical abortion were at 50-63 days gestation. Gestation affected neither pain nor efficacy rates of vacuum aspiration, however. At follow-up 16 days after the procedure, the significant differences in the medical sequelae of the 2 procedures during and immediately after abortion disappeared. The short-lived sequelae did not greatly affect recovery times. For example, even though women who underwent vacuum aspiration required more time off work than those who underwent medical abortion (2.5 vs. 1.2 days; p = 0.007), the return of normal daily activities was essentially the same for both groups (0.6-1.3 vs. 0.8-1.5 days). These results suggest that at gestations of less than 50 days, the 2 procedures are equally effective and have similar 0-21 day complication rates. On the other hand, at 50-63 days gestation, medical abortion becomes more unpleasant and its efficacy begins to diminish. In conclusion, at higher gestations, women who do not prefer one method over another will probably find vacuum aspiration more acceptable than medical abortion.