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. 2023 Apr;12(2):563-574.
doi: 10.1007/s40122-023-00477-2. Epub 2023 Feb 25.

Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings

Aubert Agostini  1 , Laura Miquel  2 , Hélène Herman-Demars  3 , Sandrine Frantz  4 , Marie Sicot  5 ; for RYMMA investigator group
Collaborators, Affiliations

Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings

Aubert Agostini et al. Pain Ther. 2023 Apr.

Abstract

Introduction: Women frequently report pain associated with medical termination of pregnancy (MToP), and its management can differ largely between centres. This study aimed at evaluating in real-life settings pain related to MToP and its management in France.

Methods: This was a non-interventional prospective, longitudinal study run in 23 centres between 2015 and 2016 that included 893 pregnant women. Pain was reported by women prior any curative analgesic intake (CAI) through a five-level Likert scale (absence, mild, moderated, severe, extreme). Modalities of analgesic prophylaxis prescription (APP) and intake (API) and CAI were collected. Risk factors were investigated using ordinal logistic regression (for pain) or logistic regression (for CAI) with stepwise selection of variables.

Results: APP was prescribed to 657 (73.7%) women irrespective of the gestational age, among whom 386 (73.7%) took the treatment. Out of 740 women who documented their pain symptoms prior to any CAI, few declared no pain (n = 94, 12.7%) or intense pain (n = 88, 11.9%). The majority reported mild or moderate pain (n = 558, 75.4%). On multivariate analysis adjusted on gestational age, increasing initial [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.47] or total dose (OR 1.15, 95% CI 1.05-1.26) of misoprostol taken were independent factors associated with risk of more pain. When adjusting for gestational age, initial dose of misoprostol (OR 1.69, 95% CI 1.45-2.66) and pain experienced (OR 3.58, 95% CI 2.82-4.55) were significantly associated with higher risk of CAI while API (OR 0.52, 95% CI 0.36; 0.75) was negatively associated.

Conclusions: Most of the women received an APP, but not all used it. API and gestational age were not related to different risks of more pain following MToP, whereas history of at least one child showed a negative association. Higher doses of misoprostol were strongly associated with both pain and CAI. API was associated with a decreased risk of CAI.

Keywords: Medical termination of pregnancy; Mifepristone; Misoprostol; Pain management.

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References

    1. Vilain A, Fresson J, Rey S. Interruptions volontaires de grossesse: la baisse des taux de recours se poursuit chez les plus jeunes en 2021. DREES (Direction de la recherche, des études, de l'évaluation et des stratistiques). 2022;1241. https://drees.solidarites-sante.gouv.fr/publications-communique-de-press.... Accessed 17 Nov 2022.
    1. HAS. Interruption volontaire de grossesse par méthode médicamenteuse. Haute Autorité de Santé; 2010. https://www.has-sante.fr/upload/docs/application/pdf/2011-04/ivg_2001_-_.... Accessed 13 Jan 2023.
    1. Mifepristone Marketing Authorization - 06 September 2007. http://agence-prd.ansm.sante.fr/php/ecodex/extrait.php?specid=62681445. Accessed 13 Jan 2023.
    1. HAS. Interruption volontaire de grossesse par méthode médicamenteuse - Mise à jour. Haute Autorité de Santé; 2021. https://www.has-sante.fr/jcms/p_3223429/fr/interruption-volontaire-de-gr.... Accessed 13 Jan 2023.
    1. ANSM. Decision of 21/02/2022 - Compassionate prescription framework for misoprostol in the management of voluntary medical termination of pregnancy at the 8th and 9th week of amenorrhea. 2022. https://ansm.sante.fr/actualites/decision-du-21-02-2022-cadre-de-prescri.... Accessed 13 Jan 2023.

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