Patients' experiences with pain and bleeding in first-trimester abortion care.

Abstract

Background: Abortion care is safe and commonly needed. While pain and bleeding are expected, patients' experience of pain and bleeding at the time of abortion can affect patient satisfaction and the abortion experience. There is limited research characterizing factors associated with patient-reported severe pain and heavy bleeding with contemporary abortion methods.

Objective: To assess clinical predictors of patient-reported heavy bleeding and pain among first-trimester abortion patients.

Study design: We conducted a secondary analysis of a multicenter prospective cohort study of 644 participants undergoing medication or procedural abortion up to 11w6d. The primary outcome was participant-reported severe post-abortion pain; secondary outcomes included bleeding severity and discordance between expected and experienced pain and bleeding. We developed logistic regression models assessing clinical factors associated with severe pain, heavy bleeding, more than expected pain, and heavier than expected bleeding.

Results: Of 644 eligible participants, 516 (80%) responded, 347 (67%) of whom had medication abortion and 169 (33%) of whom had procedural abortion. One-fourth reported severe pain, 35.0% heavy bleeding, 31.6% more than expected pain, and 33.5% heavier than expected bleeding. Factors most strongly associated with participant-reported severe pain included medication abortion (OR=4.69 [95% C1: 2.56-8.58]), history of severe menstrual pain (OR=2.60 [95% CI: 1.38-4.89]), and screening positive for depression at baseline (OR=2.13 [95% CI: 1.18-3.85]). Independent risk factors for pain discordance included first abortion experience (aOR=2.03 [95% CI: 1.18-3.48]), nulliparity (aOR=2.21 [95% CI: 1.26-3.85]), history of a prior cesarean delivery (aOR= 2.06 [95% CI: 1.14-3.72]), and baseline depression (aOR=1.72 [95%CI: 1.05-2.82), adjusted for gravidity, abortion method, and location of care. Self-reported heavy bleeding was most strongly associated with medication abortion regimen (aOR=9.19 [95% CI: 5.09-16.61]) and screening positive for depression at baseline (aOR=2.15 [95% CI: 1.28-3.61]). Abortion method and gestational length were the only significant predictors of discordance between bleeding expectations and experience.

Conclusion: While most patients were prepared for the pain and bleeding experienced after abortion, the patient experience may be improved by anticipatory guidance that incorporates risk factors for severe pain and heavy bleeding.