Population Council Research that makes a difference

Abstract

Rates of serious infection after changes in regimens for medical abortion 
Fjerstad,Mary; Trussell,James; Sivin,Irving; Lichtenberg,E.Steve; Cullins,Vanessa
New England Journal of Medicine 361(2): 145-151
Publication date: 2009


Background
From 2001 through March 2006, Planned Parenthoodhealth centers throughout the United States provided medicalabortion (abortion by means of medication) principally by aregimen of oral mifepristone followed 24 to 48 hours later byvaginal misoprostol. In response to concern about serious infections,in early 2006 Planned Parenthood changed the route of misoprostoladministration from vaginal to buccal and required either routineprovision of antibiotics or universal screening and treatmentfor chlamydia; in July 2007, Planned Parenthood began requiringroutine treatment with antibiotics for all medical abortions.

Methods
We performed a retrospective analysis assessing therates of serious infection after medical abortion during a timewhen misoprostol was administered vaginally (through March 2006),as compared with rates after a change to buccal administrationof misoprostol and after initiation of additional infection-reductionmeasures.

Results
Rates of serious infection dropped significantly afterthe joint change to buccal misoprostol from vaginal misoprostoland to either testing for sexually transmitted infection orroutine provision of antibiotics as part of the medical abortionregimen. The rate declined 73%, from 0.93 per 1000 abortionsto 0.25 per 1000 (absolute reduction, 0.67 per 1000; 95% confidenceinterval [CI], 0.44 to 0.94; P<0.001). The subsequent changeto routine provision of antibiotics led to a further significantreduction in the rate of serious infection - a 76% decline,from 0.25 per 1000 abortions to 0.06 per 1000 (absolute reduction,0.19 per 1000; 95% CI, 0.02 to 0.34; P=0.03).

Conclusions
The rate of serious infection after medical abortiondeclined by 93% after a change from vaginal to buccal administrationof misoprostol combined with routine administration of antibiotics.