Comparison of medical abortion with surgical vacuum aspiration: women's preferences and acceptability of treatment

Abstract

Objectives: To assess women's preferences for, and the acceptability of, medical abortion and vacuum aspiration in the early first trimester.

Design: Patient centred, partially randomised trial. Medical abortion was performed with mifepristone 600 mg followed 48 hours later by gemeprost 1 mg vaginal pessary. Vacuum aspiration was performed under general anaesthesia.

Setting: Teaching hospital in Scotland.

Patients: 363 women undergoing legal induced abortion at less than nine weeks' gestation.

Main outcome measures: Women's preferences for method of abortion before abortion; acceptability judged two weeks after abortion by recording the method women would opt to undergo in future and by semantic differential rating technique.

Results: 73 (20%) women preferred to undergo medical abortion, and 95 (26%) vacuum aspiration; 195 (54%) were willing to undergo either method, and were allocated at random. Both procedures were highly acceptable to women with preferences. Gestation had a definite effect on acceptability in randomised women; at less than 50 days there were no differences, but between 50 and 63 days vacuum aspiration was significantly more acceptable.

Conclusions: Women who wish to use a particular method should be allowed their choice, regardless of gestation. Women of 50-63 days' gestation without preferences for a particular method are likely to find vacuum aspiration more acceptable. A patient centred, partially randomised trial design may be a useful tool in pragmatic research.

PIP: In Scotland, physicians compared women's preferences for and acceptability of medical abortion and vacuum aspiration in the early 1st trimester of pregnancy among 363 patients at the Maternity Hospital in Aberdeen. They measured acceptability 2 weeks after the abortion. The 4 groups included 73 women who chose a medical abortion (600 mg RU-486 followed 48 hours later by a vaginal pessary of 1 mg gemeprost), 95 women who chose vacuum aspiration, 99 women randomly allocated to medical abortion, and 96 women randomly allocated to vacuum aspiration. 23% had had a previous legal abortion. Almost all the women who had a preference for an abortion method accepted their chosen method (95% for medical abortion and 90% for vacuum aspiration). Just 4% from either group would choose another method if the need would arise in the future. Women randomized to medical abortion were significantly more likely to choose vacuum aspiration in the future than were those randomized to vacuum aspiration who would choose medical abortion in the future (22% vs. 2%; p .001). The only predictor of acceptability before the abortion among women randomly allocated to medical abortion was gestational age. Specifically, 95% of the women who considered medical abortion to be unacceptable underwent medical abortion at 50 or more days gestation. At gestations under 50 days, acceptability between the 2 randomly allocated groups was the same. The 2 groups did not differ in pain rating scores, indicating that preferences were likely to be more significant than pain. All 4 groups rated the quality of nursing care to be positive in 11 of the 12 bipolar adjectives. Women who preferred medical abortion rated treatment considerably higher on 4 scores (p .05). These 4 bipolar adjectives were relaxed-stressed, soft-hard, sympathetic-unsympathetic, and gentle-harsh.