Early medical abortion before missed menses: a prospective observational study of outcomes of abortion at less than 30 days from last menstrual period.
Elizabeth April Wheate, John Joseph Reynolds-Wright, Sharon T Cameron
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引用次数: 0
Abstract
Introduction: High-sensitivity urine pregnancy tests can detect pregnancy before missed menses. The widespread availability of these tests, alongside improvements in abortion access in many settings, may mean more women present for abortion at a very early stage of pregnancy. We aimed to examine the outcome of early medical abortion (EMA) in pregnancies less than 30 days from last menstrual period (LMP).
Methods: This study analysed prospectively collected data on patients at less than 30 days from LMP seeking abortion at a single service in Edinburgh, UK between March 2020 and December 2023. We determined the effectiveness, outcomes of the pregnancy (complete abortion, ongoing pregnancy, incomplete abortion) and serious complications among those seeking EMA at this gestation.
Results: Of 13 565 patients seeking abortion, 78 (0.6%) presented with a self-reported positive home pregnancy test and less than 30 days from LMP. Some 63/78 patients (81%) proceeded to EMA with mifepristone followed by misoprostol. Of this group, 31/63 (49%) had a pre-abortion ultrasound. Complete abortion occurred in 58/63 (92%, 95% CI 82% to 97%), 4/63 (6%) had an ongoing pregnancy and 1 (1%) had a surgical evacuation for incomplete abortion. There were no serious complications.
Conclusions: Only a very small percentage of patients present for abortion before a missed period. Nevertheless, EMA at this stage is safe and effective. There may be a higher rate of ongoing pregnancy, and so those patients wishing to proceed to EMA should be advised of the importance of confirming success in line with local protocols.
导读:高灵敏度尿妊娠试验可在月经未来前发现妊娠。这些检查的广泛提供,以及在许多情况下堕胎机会的改善,可能意味着更多的妇女在怀孕早期就进行堕胎。我们的目的是检查早期药物流产(EMA)在妊娠少于30天的最后一次月经(LMP)的结果。方法:本研究前瞻性地分析了2020年3月至2023年12月期间在英国爱丁堡单一服务中寻求流产的LMP患者小于30天的数据。我们确定了在妊娠期寻求EMA的患者的有效性、妊娠结局(完全流产、持续妊娠、不完全流产)和严重并发症。结果:在13 565例寻求流产的患者中,78例(0.6%)自我报告家庭妊娠试验阳性,且距LMP不到30天。约63/78例患者(81%)在米非司酮治疗后再使用米索前列醇治疗。其中,31/63(49%)有流产前超声检查。完全流产发生在58/63 (92%,95% CI 82%至97%),4/63(6%)持续妊娠,1(1%)因不完全流产手术撤离。没有严重的并发症。结论:只有非常小比例的患者在月经未来前进行流产。然而,现阶段的EMA是安全有效的。可能会有更高的持续妊娠率,因此那些希望进行EMA的患者应该被告知确认符合当地协议的成功的重要性。
期刊介绍:
BMJ Sexual & Reproductive Health is a multiprofessional journal that promotes sexual and reproductive health and wellbeing, and best contraceptive practice, worldwide. It publishes research, debate and comment to inform policy and practice, and recognises the importance of professional-patient partnership.