Medical abortion or vacuum aspiration? Two year follow up of a patient preference trial

Abstract

Objective: To describe and compare health outcomes two years after medical abortion or vacuum aspiration in women recruited into a patient preference trial during 1990 to 1991.

Design: Women recruited to the original, partially randomised study were contacted for assessment using a structured interview.

Setting: Grampian region of Scotland, UK.

Participants: One hundred and forty women who had participated in a partially randomised study of first trimester abortion two years previously.

Intervention: Vacuum aspiration or medical abortion using mifepristone and gemeprost.

Main outcome measures: Long-term general, reproductive and psychological health; acceptability of procedure; perceived value of choice of method of termination.

Results: There were no significant differences between women who had undergone medical abortion or vacuum aspiration two years previously in general, reproductive or psychological health. Almost all women placed a high value on the provision of choice of method of termination. There was a significant difference in perception of long term procedure acceptability among women who had been randomised to a method of termination.

Conclusions: Women should have the opportunity to choose the method of termination. This opportunity will result in high levels of acceptability, particularly at gestations under 50 days of amenorrhoea.

PIP: In a comparative study conducted during 1990-91, 363 Scottish women with pregnancies of less than 64 days of gestation were given the option of selecting medical abortion with mifepristone/gemeprost or surgical vacuum aspiration abortion; those without a preference were randomly assigned to a method. There were no differences between groups in efficacy or medical complications at the 21-day postabortion follow-up. Medical abortion was associated with significantly more pain during the procedure, but not following hospital discharge, and its efficacy decreased with advancing gestation. At a median time interval of 26 months after the abortion, 140 women from the original cohort were reinterviewed to assess long-term acceptability. There were no significant differences between the medical and surgical abortion groups at long-term follow-up in their assessment of their current health status, the nature and incidence of subsequent morbidity requiring a doctor's care, consultations for psychiatric problems, or menstrual disorders. 9% of women who opted for surgical abortion and 11% who chose medical abortion indicated they would select a different method in the future. Vacuum aspiration remained significantly more acceptable than medical abortion among women who were randomly allocated to an abortion group. 97 women (69%) rated the opportunity to choose an abortion method as highly important, and 86-90% indicated a willingness to pay for the provision of such choice.