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Objective: To evaluate safety, feasibility, and acceptability of a telemedicine medical abortion service without pre‐treatment in‐person tests in Ukraine, Uzbekistan, and Azerbaijan. Methods: We conducted an open‐label, prospective, observational clinical study at five clinics in the three countries. Interested and eligible participants scheduled a telemedicine consultation with a study provider by phone or video. Medical abortion pills could be obtained by mail or courier or picked up at the study clinic or a pharmacy. Study providers contacted participants 1 week after mifepristone ingestion to assess abortion outcomes based on symptoms, and 3 weeks later to review the result of an at‐home, high‐sensitivity, urine pregnancy test. Participants were referred to in‐person visit based on symptoms, urine pregnancy test results, or initiative by the participant. Results: In all, 300 women participated in the study. Almost all participants received medical abortion medications the same day as their first contact with the study clinic, and the majority (n = 297, 99.0%) did not experience any problems receiving them. All except two women (0.67%) followed provider instructions on administration of medications. The majority of participants had a complete abortion without a procedure (Ukraine: n = 115, 95.8%; Uzbekistan: n = 127, 97.7%; Azerbaijan: n = 49, 98.0%), few had in‐person visits (Ukraine: n = 30, 25.0%; Uzbekistan: n = 3, 2.3%; Azerbaijan: n = 4, 8.0%), and most were very satisfied or satisfied with the service (Ukraine: n = 116, 96%; Uzbekistan: n = 128, 98%; Azerbaijan: n = 45, 90%). No serious adverse events occurred. Conclusion: Telemedicine medical abortion using the no‐test protocol is safe, feasible and acceptable for women in Ukraine, Uzbekistan, and Azerbaijan. Synopsis: Telemedicine medical abortion using a no‐test protocol is safe, feasible, and highly acceptable to women in Ukraine, Uzbekistan, and Azerbaijan. [ABSTRACT FROM AUTHOR]

Background Objectives Search Strategy Selection Criteria Data Collection and Analysis Main Results and Conclusions Prostaglandins (PGs) have emerged as key drugs in second trimester medical abortion (STMA) and are currently a cornerstone in obstetric practice. Nevertheless, the application of PGs, integral to labor and abortion procedures, is not risk‐free, and has been associated with several complications, particularly maternal fever and uterine rupture (UR).The main outcome of the present systematic review was to assess the safety of PGs use in STMA, particularly in scarred uterus (SC).The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guideline. We performed a comprehensive systematic review by searching multiple databases, including MEDLINE, EMBASE, Global Health, The Cochrane Library, Health Technology Assessment Database, and the research registers of Web of Science during the years 1990–2022.Only articles regarding cases of UR occurred after the use of PGs for STMA were included in the article. We excluded papers regarding UR during first trimester abortion induction of labor or pregnancy or unrelated to PGs use for STMA. Risk of bias was assessed employing a modified version of the “Newcastle‐Ottawa Scale” (NOS).A total of 178 studies were initially identified as potentially meeting the criteria for inclusion in the review. After full text evaluation, 110 other articles were excluded and 67 studies that suited the inclusion criteria were included. A total of 19 of the included studies were judged to have a high risk of bias. Given the heterogeneous nature of the findings, we opted for a narrative synthesis of the results.PGs appear to be an effective pharmacologic tool for STMA; however, their use is not entirely risk‐free. STMA requires well‐equipped obstetric centers with skilled clinicians and surgeons prepared for emergencies. Ultrasonographic scans should be routinely performed during STMA management, since a UR can also be silent during the induction of labor. Intrapartum transabdominal, transperineal, and transvaginal ultrasound may have the diagnostic potential to early recognize this obstetric emergency, to facilitate rapid medical and surgical treatment, improving the outcome. [ABSTRACT FROM AUTHOR]

Background: Abortion service as medical healthcare facility is an essential service a women needs. The objective of this study was to observe maternal outcome of supervised and unsupervised medical abortion in first trimester of pregnancy. Methods: A case control study was done with two groups of patients in their first trimester in a tertiary care hospital (SMGS) during a period of 1 year from July 2022 to July 2023.Case group includes 30 patients presenting to emergency department with history of unsupervised abortion pill intake. Control group consists of 30 patients presenting to OPD want abortion pill under supervision. The main outcome variables were comparison of success rate, complications like heavy bleeding, fever, shock, requirement of blood transfusion and interventions required in terms of medical management, surgical evacuations and Laparotomy. Results: In our study, the success rate achieved in terms of complete abortion was 76.7% in supervised group and 13.3% in unsupervised group. The complication rate was 23.3% in supervised group in contrast to 93.3% in the unsupervised group. 43.3% patients in unsupervised group required blood transfusion which was 10% in supervised group. 83.3% in the supervised group did not require intervention. In the unsupervised group 20% required medical management, 70% required surgical evacuations and 10 % had to undergo Laparotomy for ectopic pregnancy. Conclusion: In this study, we conclude that first trimester medical abortion under supervision is more effective and safe as compared to unsupervised medical abortion. Thus we recommend to curb the practice of over the counter sale of medical abortion pills. [ABSTRACT FROM AUTHOR]

Many studies show that supranational governance structures (SGS)—understood as international organizations or international treaties—contribute to the global diffusion of public policies. However, we still have a limited understanding of which properties of SGS hasten the number of policy adoptions. To advance this literature, we argue that SGS making legally binding and univocal claims are more likely to act as diffusion accelerators. We demonstrate the suitability of this argument through a case study of the global diffusion of mifepristone approvals, a single‐purpose medicine to terminate pregnancies that has revolutionized abortion services. The analysis supports our expectation. Links to the EU and the Maputo Protocol—the only two considered SGS that make binding claims with clear implications for this policy field—hasten mifepristone approvals. By contrast, ratification of four other treaties—that do not make binding and univocal claims—and exposure to World Health Organization guidelines on medical abortion does not hasten these approvals. [ABSTRACT FROM AUTHOR]

Abstract Background Recently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion. Methods A total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified. Results Relative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients.

Abstract Background Effective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy. Methods We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating “not satisfied” to 5, denoting “completely satisfied”), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed. Results The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine. Conclusions Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination.

To investigate the opinions of women residing in Turkey regarding abortion and its correlation with spirituality. A descriptive and cross-sectional study. The study included 487 women and data was collected between October and December 2023. The Descriptive Information Form, Stigmatizing Attitudes, Beliefs and Actions Scale (SABAS), and Spirituality Scale (SS) were used to evaluate the data and determine the correlation between them. Of the women surveyed, 78.6% reported no prior experience with curettage. The participants had low SABAS scores (26.95 ± 7.43) and high SS scores (22.50 ± 5.80). Age, education, employment status, religious affiliation, history of curettage, age at first childbirth, number of children, and number of siblings were all significantly correlated with SABAS and SS (p < 0.05). Additionally, a significant positive correlation was found between the participants' SABAS total score and all sub-factor scores, as well as their SS total scores. It was also determined that as women's stigmatization and negative attitudes towards curettage increased, their spiritual feelings increased as well (p < 0.05). A significant positive correlation was found between SS score and age and SABAS, and a negative correlation was found with the number of births (p < 0.05). It was found that women's stigmatizing attitudes towards abortion were influenced by their spiritual beliefs. To prevent women from being caught between the consequences of unwanted pregnancies and their spiritual beliefs, it is important to meet their needs for family planning and health counseling. [ABSTRACT FROM AUTHOR]

Background: Recently, the incidence of missed miscarriage has gradually increased, and medical abortion is a common method to terminate a pregnancy. In the process of medical abortion, massive vaginal bleeding takes place, leading to emergency surgical haemostasis. Emergency surgery may produce infection and organ damage. Our study aimed to investigate the high-risk factors for massive haemorrhage during a medical abortion. Methods: A total of 1062 missed miscarriage patients who underwent medical abortion participated in this retrospective study. According to the amount of bleeding, the patients were divided into a massive haemorrhage group and a control group. By comparing the general conditions of the two groups, such as fertility history, uterine surgery history, uterine fibroids, etc., the high-risk factors for massive haemorrhage during medical abortion were identified. Results: Relative to the control group, the massive haemorrhage group exhibited a higher proportion of patients with a previous artificial abortion (51.9% vs. 38.1%, P = 0.001). Additionally, the massive haemorrhage group had a lower percentage of first-time pregnant women (32.1% vs. 40.4%) and a higher proportion of women with shorter pregnancy intervals (44.9% vs. 33.1%, P = 0.03). Furthermore, there were notable differences between the two groups regarding maximum fibroid size, the duration of amenorrhea, and gestational week (P < 0.05). Conclusion: In this study, we determined that a history of artificial abortion and an amenorrhea duration of > 11 weeks represented high-risk factors for massive vaginal bleeding during medical abortion in missed miscarriage patients. [ABSTRACT FROM AUTHOR]

Purpose: This meta-analysis aimed to comprehensively assess the teratogenic risk to offspring associated with continuing pregnancy after administering mifepristone and/or misoprostol during gestation. Methods: We conducted a systematic search of multiple databases, including PubMed, Web of Science, Embase, Cochrane, CNKI, and CBM, from their inception to February 2024, with no language restrictions. We included cohort and case–control studies that analyzed the teratogenic effects of mifepristone and/or misoprostol on fetuses and newborns. Quality assessment was performed using the Newcastle–Ottawa Scale (NOS). The odds ratios (OR) from individual studies were combined using meta-analysis. Sensitivity testing and heterogeneity analysis were conducted. Results: A total of 13 studies were eligible for inclusion, comprising 5193 cases of congenital malformations and 12,232 controls. Conclusion: Our findings indicated that the use of misoprostol during early pregnancy increased the risk of congenital abnormalities in offspring (OR = 2.69; 95% CI: 1.57–4.62). However, the potential teratogenic effect of mifepristone during pregnancy cannot be ruled out. Additionally, the use of mifepristone and/or misoprostol has been linked to a higher risk of certain congenital anomalies, such as hydrocephalus (OR = 3.41; 95% CI: 1.17–9.97), Möbius syndrome (OR = 26.48; 95% CI: 11.30–62.01), and terminal transverse limb defects (OR = 10.75; 95% CI: 3.93–29.41). (PROSPERO, CRD42024522093, 03182024). [ABSTRACT FROM AUTHOR]

Background: Effective pain management during labor induction for pregnancy termination is essential. However, to date, no effective treatment has been identified. The primary aim of this study was to measure the analgesic efficacy of a sufentanil sublingual tablet system during pregnancy termination and patient satisfaction by comparing nulliparous and multiparous women. The secondary aims were to characterize the safety profile by reporting any side effects or adverse events and to determine the need for rescue therapy. Methods: We conducted an observational, retrospective, single-center study involving 48 women. The data retrieved for analysis included the total and hourly doses of sublingual sufentanil, evaluations of pain management satisfaction using a 5-point rating scale (ranging from 1, indicating "not satisfied" to 5, denoting "completely satisfied"), occurrence of side effects and adverse events, and the rate of rescue analgesic use. Categorical and numerical variables were compared between the two groups, and a correlation analysis was performed. Results: The median total dose of sufentanil required was 60 mcg. Nulliparous women required a higher dose of sufentanil compared with multiparous women (105 mcg vs. 45 mcg; P = 0.01). Additionally, they underwent a longer labor, indirectly measured by the time of device usage (625 min vs. 165 min; P = 0.05). Regarding satisfaction, 40 patients (83.4%) were satisfied or completely satisfied, whereas only 8 patients (16.6%) reported dissatisfaction. Multiparous women exhibited higher satisfaction levels than did nulliparous women (P = 0.03). No adverse events were reported, and the most common side effects were nausea and vomiting (31.2%). Four patients (12%) required acetaminophen due to insufficient analgesia, with only one patient necessitating a switch to intravenous morphine. Conclusions: Sublingual sufentanil was effective in both nulliparous and multiparous women with minimal side effects. Therefore, sublingual sufentanil can be considered a valid strategy for analgesia during labor induction for pregnancy termination. [ABSTRACT FROM AUTHOR]

Background: To what extent traditional Chinese medicine (TCM) combined with mifepristone and misoprostol is beneficial for improving the complete abortion rate and duration of vaginal bleeding has been a subject of debate in the field of medical abortion. Objective: To assess the evidence regarding the complete abortion rate and duration of vaginal bleeding of medical abortion assisted by different kinds of TCM. Search Strategy: We searched electronic databases such as PubMed, Web of Science and Cochrane Library database, China National Knowledge Internet, Wan fang Database, VIP Database, and China Biology Medicine disc from 2000 to February 15, 2023. Selection Criteria: The control group was medical abortion with mifepristone and misoprostol, and the experimental group was medical abortion assisted by TCM. Data Collection and Analysis: Major data extraction included sample size, age, medicine used for abortion, outcome measures. RevMan 5.3 and Stata 15.1 software were used to assess the literature quality and perform network meta‐analysis, respectively. Main Results: A total of 73 randomized controlled trials (RCTs) with 11 683 patients and nine kinds of TCM were included in this study. Compared with mifepristone and misoprostol, eight kinds of TCM had statistical significance in improving the complete abortion rate. The effect value of Sancao decoction was 5.86 (95% confidence interval [CI] 2.53–13.58). Seven kinds of TCM shortened the duration of vaginal bleeding. The effect value of comfrey and trichosanthin decoction was −8.75 (95% CI –10.86 to −6.64). Conclusions: This network meta‐analysis showed that Lenge Zhumo decoction and Sancao decoction could have a large beneficial effect on complete abortion rate in medical abortion during early pregnancy, and comfrey and trichosanthin decoction could be the best TCM for shortening the duration of vaginal bleeding. Synopsis: As a supplementary drug for medical abortion, traditional Chinese medicine can improve the rate of complete abortion and shorten the duration of vaginal bleeding. [ABSTRACT FROM AUTHOR]

BACKGROUND: In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and providers knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. METHODS: Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. RESULTS: Registration of abortion medicines-misoprostol or a combination of mifepristone and misoprostol-was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone-countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula-no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. CONCLUSION: Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.

Objective of the study: to explore the impact of medical abortion on infections, stress, and the vaginal microbiota, providing essential insights into the associated risks and the need for comprehensive care. Materials and methods. A total of 120 patients were examined, divided into groups: 50 women who underwent medical abortion, 50 women underwent surgical abortion and 20 women with no abortions as the control group. Additionally, the women were categorized based on stress levels into high stress group (29 women), medium stress group (54 women), and low stress group (17 women). Bacteriological studies were conducted to assess the species composition and quantitative composition of the vaginal microbiota in women post-abortion and with varying levels of stress. Results. The study found significant alterations in the vaginal microbiota of women post-abortion, differentiated by the type of abortion and stress levels. Women who underwent medical abortions exhibited higher levels of S. epidermidis, including strains with hemolytic properties, compared to those who had surgical abortions. The concentration of S. epidermidis in the medical abortion group was significantly higher than in healthy women, suggesting a potential link between medical abortion and increased susceptibility to opportunistic infections. Additionally, higher concentrations of E. coli, particularly hemolytic strains, were found in both abortion groups, with a slightly higher prevalence in the medical abortion group, highlighting an increased risk of post-abortion infections. The level of stress significantly affects the composition of the vaginal microbiota. Women experiencing high stress post-abortion showed a more pronounced dysbiosis compared to those with moderate or low stress levels. High-stress individuals had significantly elevated levels of pathogenic microorganisms, including S. aureus, S. agalactiae, and various Enterobacteriaceae, and a marked deficiency in protective Lactobacillus spp. The study also identified a higher incidence of mixed infections in high-stress women, often involving bacterial and viral pathogens such as G. vaginalis, C. trachomatis, U. urealyticum, and herpes simplex virus. Comparative analysis revealed that both types of abortion are associated with microbiota disruptions; however, medical abortions had a more substantial impact on certain pathogenic bacteria. For instance, the levels of Candida spp. were significantly higher in the medical abortion group compared to the surgical group, indicating a higher risk of fungal infections. Conversely, the concentration of Lactobacillus spp. was notably lower in women who underwent surgical abortions, suggesting a more severe impact on beneficial microbiota from surgical procedures. Conclusions. The findings underscore the importance of monitoring and managing the vaginal microbiota in women post-abortion, particularly those undergoing medical abortions and those experiencing high stress levels. Prophylactic and therapeutic measures, including the use of probiotics, should be considered to mitigate the risk of infections and restore the balance of protective bacteria.

This research addresses the intricate dimensions of reproductive healthcare by examining the complex interplay of medical, legal, and ethical considerations surrounding abortion. The Choice on Termination of Pregnancy Act (CTOP) of 1996 in South Africa aims to establish the circumstances and conditions under which a woman’s pregnancy may be terminated and addresses related matters. The Act specified that, for terminations during 0–12 weeks, safe medical procedures, primarily medication abortion, are predominant. In contrast, terminations during 13–20 weeks present additional complexities, requiring a combination of medical and surgical interventions.

Abstract Background In 2019, the World Health Organization identified improving access to safe abortion as an important priority toward improving sexual and reproductive health and rights and achieving Sustainable Development Goals. One strategy for addressing this priority is strengthening access to medicines for medical abortion. All 11 countries in the South-East Asia Region have some indications for legal abortion and permit post-abortion care. Therefore, strengthening access to medical abortion medicines is a reasonable strategy for improving access to safe abortion for the Region. Methodology We applied an adapted version of an existing World Health Organization landscape assessment protocol for the availability of medical abortion medicines at the country-level in the South-East Asia Region. We collected publicly available data on the existence of national health laws, policies, and standard treatment guidelines; inclusion of medical abortion medicines in the national essential medicines list; and marketing authorization status for medical abortion medicines for each country and verified by Ministries of health. The findings were once more presented, discussed and recommendations were formulated during regional technical consultation workshop. Each country teams participated in the process, and subsequently, the suggestions were validated by representatives from Ministries of Health.. Results Few countries in the Region currently have national policies and guidelines for comprehensive safe abortion. However, either mifepristone-misoprostol in combination or misoprostol alone (for other indications) is included in national essential medicines lists in all countries except Indonesia and Sri Lanka. Few countries earmark specific public funds for procuring and distributing medical abortion commodities. In countries where abortion is legal, the private sector and NGOs support access to medical abortion information and medicines. Several countries only allow registered medical practitioners or specialists to administer medical abortion. Conclusion Following this rapid participatory assessment and technical consultation workshop, the World Health Organization South-East Asia Regional Technical Advisory and Sexual and Reproductive Health and Rights technical committee recommended priority actions for policy and advocacy, service delivery, and monitoring and evaluation, and indicated areas for support.

Epidural analgesia alleviates pain during normal labour but women who undergo medical abortion procedures using epidural analgesia continue to express high pain levels. To understand this we assessed if patients undergoing medical abortions, treated with epidural analgesia, use their pain for psychological benefits. This study comprised 105 patients over 13 weeks of gestational age diagnosed with foetal abnormalities after selecting a medical abortion procedure using epidural analgesia. Three questionnaires were handed-out: 1) 'Need for Affect', assessed the motivation to react to emotions; 2) 'Pain-Levels' 3) PANA- 'Positive Affect' (PA), 'Negative Affect' (NA) assessed emotions pre-abortion and post-abortion. Patients with a strong Need for Affect and high Pain-Levels expressed a stronger PA post-abortion (b =.69, se =.11, β =.68, p <.001, 95%CI [.48,.90]). Patients with a strong NA pre-abortion and high Pain-Levels expressed a higher NA post-abortion (b =.48, se =.11, β =.53, p <.001, 95%CI [.26,.70]). Patients with a strong Need for Affect who express a strong PA pre-abortion intensify their pain to fulfill their Need for Affect, which then helps recovery. Patients with a strong NA pre-abortion and high Pain-Levels indicate a less favourable outcome. [ABSTRACT FROM AUTHOR]

Objective: To determine whether clinical outcomes among clients undergoing medical abortion after 12 weeks' gestation differ by provider cadre. Methods: Randomized controlled trial conducted among eligible clients seeking abortion between 13 and 20 weeks' gestation. Participants seeking in‐facility abortion were randomized to receive care from a mid‐level provider (nurse/midwife) or physician. The primary outcome was median time to expulsion with non‐inferiority margin of −1.5 h between provider groups. Quantile median regression models assessed non‐inferiority. Secondary outcomes included retained placenta, complications, and patient acceptability. Results: After randomization and eligibility assessment by the provider, 171 women participated in the study: 81 in the physician group and 90 in the mid‐level provider group. Their average age was 24 years, the mean gestational age was 16 weeks, and 65% were nulliparous in both groups. The median time to expulsion did not differ significantly, being 8.1 h for the mid‐level group and 6.6 h for the physician group. The adjusted median difference was 0.8 h (95% confidence interval [CI] –1.15 to 2.66), within the non‐inferiority margin. Retained placenta occurred similarly: 30.0% (n = 24) of the physician group and 20.5% (n = 18) of the mid‐level provider group (adjusted risk difference [ARD] 7.6%, 95% CI –2.81 to 18.06). Complications occurred in 7% of cases, including 5.0% (n = 4) of patients in the physician group and 8.9% (n = 8) in the mid‐level provider group (ARD –4.7%, 95% CI –12.43 to 3.12). Patient acceptability did not differ by group. Conclusions: Training mid‐level providers to provide abortion services after 12 weeks' gestation independently of physicians is feasible and may result in comparable clinical outcomes. Synopsis: Training mid‐level providers in abortion service provision after 12 weeks' gestation is feasible and results in comparable patient clinical outcomes to those achieved by physician‐led care. [ABSTRACT FROM AUTHOR]

Objective of the study: to explore the impact of medical abortion on infections, stress, and the vaginal microbiota, providing essential insights into the associated risks and the need for comprehensive care. Materials and methods. A total of 120 patients were examined, divided into groups: 50 women who underwent medical abortion, 50 women underwent surgical abortion and 20 women with no abortions as the control group. Additionally, the women were categorized based on stress levels into high stress group (29 women), medium stress group (54 women), and low stress group (17 women). Bacteriological studies were conducted to assess the species composition and quantitative composition of the vaginal microbiota in women post-abortion and with varying levels of stress. Results. The study found significant alterations in the vaginal microbiota of women post-abortion, differentiated by the type of abortion and stress levels. Women who underwent medical abortions exhibited higher levels of S. epidermidis, including strains with hemolytic properties, compared to those who had surgical abortions. The concentration of S. epidermidis in the medical abortion group was significantly higher than in healthy women, suggesting a potential link between medical abortion and increased susceptibility to opportunistic infections. Additionally, higher concentrations of E. coli, particularly hemolytic strains, were found in both abortion groups, with a slightly higher prevalence in the medical abortion group, highlighting an increased risk of post-abortion infections. The level of stress significantly affects the composition of the vaginal microbiota. Women experiencing high stress post-abortion showed a more pronounced dysbiosis compared to those with moderate or low stress levels. High-stress individuals had significantly elevated levels of pathogenic microorganisms, including S. aureus, S. agalactiae, and various Enterobacteriaceae, and a marked deficiency in protective Lactobacillus spp. The study also identified a higher incidence of mixed infections in high-stress women, often involving bacterial and viral pathogens such as G. vaginalis, C. trachomatis, U. urealyticum, and herpes simplex virus. Comparative analysis revealed that both types of abortion are associated with microbiota disruptions; however, medical abortions had a more substantial impact on certain pathogenic bacteria. For instance, the levels of Candida spp. were significantly higher in the medical abortion group compared to the surgical group, indicating a higher risk of fungal infections. Conversely, the concentration of Lactobacillus spp. was notably lower in women who underwent surgical abortions, suggesting a more severe impact on beneficial microbiota from surgical procedures. Conclusions. The findings underscore the importance of monitoring and managing the vaginal microbiota in women post-abortion, particularly those undergoing medical abortions and those experiencing high stress levels. Prophylactic and therapeutic measures, including the use of probiotics, should be considered to mitigate the risk of infections and restore the balance of protective bacteria. [ABSTRACT FROM AUTHOR]

Background: In 2019, the World Health Organization identified improving access to safe abortion as an important priority toward improving sexual and reproductive health and rights and achieving Sustainable Development Goals. One strategy for addressing this priority is strengthening access to medicines for medical abortion. All 11 countries in the South-East Asia Region have some indications for legal abortion and permit post-abortion care. Therefore, strengthening access to medical abortion medicines is a reasonable strategy for improving access to safe abortion for the Region. Methodology: We applied an adapted version of an existing World Health Organization landscape assessment protocol for the availability of medical abortion medicines at the country-level in the South-East Asia Region. We collected publicly available data on the existence of national health laws, policies, and standard treatment guidelines; inclusion of medical abortion medicines in the national essential medicines list; and marketing authorization status for medical abortion medicines for each country and verified by Ministries of health. The findings were once more presented, discussed and recommendations were formulated during regional technical consultation workshop. Each country teams participated in the process, and subsequently, the suggestions were validated by representatives from Ministries of Health.. Results: Few countries in the Region currently have national policies and guidelines for comprehensive safe abortion. However, either mifepristone-misoprostol in combination or misoprostol alone (for other indications) is included in national essential medicines lists in all countries except Indonesia and Sri Lanka. Few countries earmark specific public funds for procuring and distributing medical abortion commodities. In countries where abortion is legal, the private sector and NGOs support access to medical abortion information and medicines. Several countries only allow registered medical practitioners or specialists to administer medical abortion. Conclusion: Following this rapid participatory assessment and technical consultation workshop, the World Health Organization South-East Asia Regional Technical Advisory and Sexual and Reproductive Health and Rights technical committee recommended priority actions for policy and advocacy, service delivery, and monitoring and evaluation, and indicated areas for support. [ABSTRACT FROM AUTHOR]

Objective: Previous studies have demonstrated quality concerns with misoprostol. Mifepristone, however, has not been extensively assessed for quality. Between 2020 and 2021, Concept Foundation and the International Planned Parenthood Federation conducted a study to determine the quality of these medical abortion drugs in low‐ and middle‐income countries (LMIC). Methods: The collection of batch samples of misoprostol and mifepristone was carried out by trained sampling agents in selected LMIC. Single drug packs and combipacks were sampled. A World Health Organization prequalified laboratory conducted testing method verifications and subsequent sample analysis. Tests included identification, assay, related substances, and content uniformity for misoprostol, and identification, assay, related substances, and dissolution for mifepristone. Results: Samples were collected from Burkina Faso, Cambodia, Democratic Republic of Congo, India, Kyrgyzstan, Moldova, Nepal, Nigeria, Pakistan, Uganda and Vietnam. Sixty‐four pooled batch samples were tested, consisting of 31 combipacks, 26 misoprostol‐only and seven mifepristone‐only products. Overall, 54.7% of samples were non‐compliant with one or more of the specifications, representing 51.6% of combipack products, 57.1% of misoprostol tablets analyzed and 23.7% of mifepristone tablets. One falsified misoprostol‐only product was found. Conclusion: The present study confirms that a significant problem still exists in relation to the quality of medical abortion drugs in LMIC. For misoprostol, our findings suggest that historical concerns around primary packaging may have been largely resolved but that manufacturing processes for both finished product and active pharmaceutical ingredient need to be improved. The present study also provides evidence of mifepristone quality issues. Synopsis: Over half of mifepristone, misoprostol, and combipack samples collected and tested did not meet one or more requirements. One product was falsified. [ABSTRACT FROM AUTHOR]

AIM: The study aims to examine the effective factors influencing the decision of families to whom medical abortion was recommended due to fetal anomalies. METHODS: The cross-sectional study was conducted at İstanbul University Hospital, Department of Gynecology and Obstetrics, High-Risk Pregnancies and Maternity Ward. The sample consisted of 233 pregnant women, to whom medical abortion was recommended due to the diagnosis of foetal anomaly collected inover a 1-year period. RESULTS: While 122 of the families decided to have medical abortions, 111 decided to give birth. The rate of deciding on medical abortion was the highest in families whose fetuses had a high expectation rate of lethal anomalies (p < .001). The most effective factor for the families who decided to give birth was their religious beliefs. The most effective factor for the families who decided to have a medical abortion was the information they received from health professionals. CONCLUSION: While the religious beliefs of the parents were effective in the decision to give birth, the information they received from the health professionals was effective in the decision to have a medical abortion. [ABSTRACT FROM AUTHOR]

At the start of the COVID-19 pandemic in Australia, as governments urged citizens to limit their movements and socially isolate as a protective strategy, the home became a place layered with new meanings. Feminists have long challenged characterisations of the home as a sanctuary. Such characterisations and feminist claims against them took on new complexity and significance during the pandemic. This article investigates access to abortion care in South Australia under COVID-19 restrictions, as a case study of the contest over the safety of the home. It examines the pre-existing legislative requirements placed on those in need of abortion that, in the context of the pandemic and newly available access to telehealth medicine, both illuminated and increased the exceptional status of abortion as a form of healthcare and complicated the gendered meanings of safety and home. [ABSTRACT FROM AUTHOR]

Objective: In 2018, the Department of Health and Social Care in England approved the use of misoprostol at home for early medical abortions, following administration of mifepristone at clinic. The objective of the present study was to assess the impact of the approval of home administration of misoprostol in England on access to medical abortion, assessed through proxy measures of the proportion of all abortions that were medical and gestational age. Methods: This study uses the clinical data from the British Pregnancy Advisory Service on abortions in England in years 2018–2019, containing demographic and procedure characteristics of patients. We conducted an interrupted time series analysis to establish the differences before and after the approval in access to medical abortion, measured by the proportion of all abortions that were medical, and gestational age. The analysis also examined whether these changes were equitable, with focus on area‐level deprivation. Results: The analysis of the data (145 529 abortions) suggested that there was an increase in the proportion of medical abortions and decrease in gestational age of abortions after the approval. Compared with the situation if former trends had continued, the actual proportion of early medical abortions was 4.2% higher in December 2019, and the mean gestational age 3.4 days lower. We found that the acceleration of existing trends in increase in proportion of medical abortions and decrease in gestational age were larger in the most deprived quintiles and in those reporting a disability, but not equal across ethnic groups, with Black and Black British women experiencing little change in trajectories post‐approval. Conclusion: The approval of home use of misoprostol as part of an early medical abortion regimen in England was associated with material and equitable improvements in abortion access. Pre‐approval trends toward greater uptake of medical abortion and declining gestational age were accelerated post‐approval and were greatest in the most deprived areas of England, but not across all racial/ethnic groups. The present findings strongly support the continuation or introduction of home management of medical abortions. Synopsis: Home use of misoprostol in medical abortions in England was associated with improvements in abortion access: higher proportion of medical abortions and lower gestational age. [ABSTRACT FROM AUTHOR]

In Argentina, Chile and Ecuador, abortion at later durations of pregnancy is legally restricted. Feminist collectives in these contexts support people through self-managed medical abortion outside the healthcare system. The model of in-person abortion accompaniment represents an opportunity to examine a self-care practice that challenges and reimagines abortion provision. We formed a collaborative partnership built on a commitment to shared power and decision-making between researchers and partners. We conducted 28 key informant interviews with accompaniers in Argentina, Chile and Ecuador in 2019 about their model of in-person abortion accompaniment at later durations of pregnancy. We iteratively coded transcripts using a thematic analysis approach. Accompaniers premised their work in a feminist activist framework that understands accompaniment as addressing inequalities and expanding rights, especially for the historically marginalised. Through a detailed description of the process of in-person accompaniment, we show that the model, including the logistical considerations and security mechanisms put in place to ensure favourable abortion outcomes, emphasises peer-to-peer provision of supportive physical and emotional care of the accompanied person. In this way, it represents supported self-care through which individuals are centred as the protagonists of their own abortion, while being accompanied by feminist peers. This model of supported self-care challenges the idea that "self-care" necessarily means "solo care", or care that happens alone. The model's focus on peer-to-peer transfer of knowledge, providing emotional support, and centring the accompanied person not only expands access to abortion, but represents person-centred practices that could be scaled and replicated across contexts.

Background: The use of medical abortion increases among unplanned pregnant women. The primary objective of this study is to assess the outcomes of using a combination of Mifepristone followed by sublingual Misoprostol for the termination of pregnancy up to 63 gestational days. The secondary objectives were identifying significant factors that contribute to an increased rate of incomplete abortions resulting in surgical intervention and evaluating the safety of this medical procedure. Methods: This retrospective cohort study was conducted at Siriraj Hospital, a tertiary care center in Thailand, from July 2021 to December 2023. Women were given 200 mg of oral Mifepristone at the clinic, followed by self-administration of 800 μg of sublingual Misoprostol at home 36–48 hours later. A follow-up visit was scheduled approximately 14 days later to confirm the outcome of the procedure. Demographic and medical data were collected from medical records and subsequently analyzed. The primary outcome was defined as the success of the procedure, indicated by complete abortion without the need for surgical intervention. Secondary outcomes included assessing side effects and complications following medication administration, as well as identifying factors associated with an increased rate of incomplete abortions. Results: The final analysis included follow-up data from 205 women. Medical abortion was successful in 70.7% (145 out of 205) of cases, with no ongoing pregancies recorded. No serious side effects or complications were detected. Diarrhea and chills were the most commonly observed side effects. The study found that women with a history of previous abortions and those experiencing significantly heavier bleeding after the procedure were at a higher risk of incomplete abortion, requiring surgical aspiration. Conclusions: The regimen of oral Mifepristone followed by sublingual Misoprostol for medical termination of pregnancy is effective and safe through 63 days of gestation. A history of previous abortion and experiencing heavier bleeding after the procedure were identified as risk factors for incomplete abortion.

ObjectiveTo develop a minimum data set, known as a core outcome set, for future abortion randomized controlled trials.Study designWe extracted outcomes from quantitative and qualitative systematic reviews of abortion studies to assess using a modified Delphi method. Via email, we invited researchers, clinicians, patients, and healthcare organization representatives with expertise in abortion to rate the importance of the outcomes on a 9-point Likert scale. After 2 rounds, we used descriptive analyses to determine which outcomes met the predefined consensus criteria. We finalized the core outcome set during a series of consensus development meetings.ResultsWe entered 42 outcomes, organized in 15 domains, into the Delphi survey. Two-hundred eighteen of 251 invitees (87%) provided responses (203 complete responses) for round 1 and 118 of 218 (42%) completed round2. Sixteen experts participated in the development meetings. The final outcome set includes 15 outcomes: 10 outcomes apply to all abortion trials (successful abortion, ongoing pregnancy, death, hemorrhage, uterine infection, hospitalization, surgical intervention, pain, gastrointestinal symptoms, and patients' experience of abortion); 2 outcomes apply to only surgical abortion trials (uterine perforation and cervical injury), one applies only to medical abortion trials (uterine rupture); and 2 apply to trials evaluating abortions with anesthesia (over-sedation/respiratory depression and local anesthetic systemic toxicity).ConclusionUsing robust consensus science methods we have developed a core outcome set for future abortion research.ImplicationsStandardized outcomes in abortion research could decrease heterogeneity among trials and improve the quality of systematic reviews and clinical guidelines. Researchers should select, collect, and report these core outcomes in future abortion trials. Journal editors should advocate for core outcome set reporting.

Abstract Background In Kenya and Uganda, unsafe abortions are a leading cause of maternal mortality. The new WHO policy guidelines on the safe termination of pregnancies up to 9 weeks lack information on women’s experiences with self-administered medical abortion (MA), impeding the development of interventions to increase MA use. This study aimed to comprehend women’s experiences with MA in Kenyan and Ugandan pharmacies. Methods A cross-sectional mixed-methods survey utilized data from medical registers in 71 purposefully identified pharmacies and clinics dispensing MA drugs between September and October 2021. Forty women who were MA users participated in focus group discussions. The main outcome variables were: sources of MA information, costs of MA services, complications from MA, pain management, follow-up rates, and use of post-MA contraception. Quantitative data were analyzed using Stata 15, while qualitative thematic analysis was conducted using Dedoose qualitative analysis software. Results 73.6% of 2,366 women got an MA, both in Kenya (79%) and Uganda (21%). Most (59.1%) were walk-in clients. Kenya had significantly more women referred for MA (49.9%) than Uganda (10.1%) (p 0.05). Friends and family members were the main sources of MA information. The median cost of MA was USD 18 (IQR 10–60.5) in Kenya and USD 4.2 (IQR 2–12) in Uganda. Most MA clients received pain management (89.6%), were followed up (81%), and received post-MA contraception (97.6%). Qualitative results indicated a lack of medicines, high costs of MA, complications, stigma, and inadequate training of providers as barriers to MA use. Conclusions and recommendations Communities are a valuable information resource for MA, but only if they have access to the right information. A relatively weak health referral system in Uganda highlights the importance of pharmacies and clinicians collaborating to support clients’ abortion needs and contraceptive use after medical abortion (MA). Low client follow-up rates show how important it is to make sure pharmacy technicians know how to give MA correctly. Finally, it is crucial to strengthen the supply chain for MA products in order to eliminate cost barriers to access.

Abstract Background The recently amended Thai abortion law allows pregnant women to undergo abortions up to the gestational age of 12 weeks. Medical abortion is significant because it has revolutionized access to safe abortion care—abortion medicine can now be safely and effectively administered outside of a healthcare facility to women in early pregnancy. This contribution supports the pharmacists’ role in interprofessional safe abortion teamwork. Adequate knowledge of the current laws regarding safe abortion services will increase pharmacists’ competence in providing services. However, safe abortions as a subject have not been formally incorporated into the curriculum for Thai pharmacy students. Therefore, this study aimed to evaluate the knowledge, attitude, and intended practice of fifth-year pharmacy students at Chulalongkorn University. Methods A cross-sectional study was conducted using an electronic self-administered questionnaire adapted from previously published studies to evaluate participants’ knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. The invitations were sent to all fifth-year pharmacy students at Chulalongkorn University. Results Among all invitations sent, 104/150 (69.3%) participants responded to the survey. Only a third of the participants (31.7%) had good knowledge scores. Based on five questions regarding the gestational age limit for legal abortion, most participants (52.7%) answered questions incorrectly. Although more than half of the participants (52.5%) disagreed with two pro-choice statements, an overwhelming majority (87.5%) agreed that abortion was a woman’s right. Safe abortion services were mostly agreed upon with serious fetal defects (91.9%), non-HIV maternal health conditions (82.2%), and sexual assaults (77.4%). A positive attitude toward abortion affects the intention to perform an abortion under socioeconomic conditions. Conclusion Most participants lacked knowledge on the amended abortion law, especially on the gestational limits of abortion. Participants with favorable attitudes toward abortion tended to be more liberal regarding safe abortion services.

Background: Follow‐up after early medical abortion (EMA) in Australia often entails tracking serum human chorionic gonadotropin levels or performing ultrasonography in‐clinic. In other countries, methods of follow‐up such as using a low‐sensitivity urine pregnancy test (LSUPT), telephone evaluation and a questionnaire have been demonstrated to be safe and acceptable. Aims: To evaluate the safety and efficacy of telephone follow‐up after EMA using an LSUPT and questionnaire. Materials and Methods: A prospective observational cohort study of patients undergoing telephone follow‐up after EMA using an LSUPT and questionnaire was conducted from March 26 to July 31, 2020. Outcomes of patients who returned to clinic because of a positive LSUPT were evaluated and adverse event rates were calculated. Routinely collected adverse event information was used to compare complication rates during the evaluation period with that prior to introduction of the LSUPT. Results: During the study period, 2223 patients underwent the new protocol. One hundred and ninety‐seven patients had a positive LSUPT at their telephone follow‐up. One hundred and thirty‐two had an incomplete abortion, 11 had a continuing pregnancy, 53 had a complete abortion and one left the clinic before full assessment. Conclusions: Introduction of telephone follow‐up with an at‐home LSUPT reduced the number of patients requiring unnecessary clinic appointments, with over 90% of patients completing their follow‐up at home. Complication rates during the study period were found to be at least comparable with previously identified organisational adverse events. [ABSTRACT FROM AUTHOR]

The abortion access landscape for patients has changed dramatically in the wake of the US Supreme Court Dobbs v. Jackson Women's Health Organization decision in June of 2022. In response, the Division of Midwifery at Baystate Medical Center in Springfield, Massachusetts, began a medication abortion service for both established patients and those who may seek care from out of state. This service increases access to abortion care now while also providing the clinical experience needed for student nurse‐midwives to become future abortion providers. This article outlines the steps taken to implement a medication abortion service and ways it can be adopted by other midwifery practices. Strategies to address possible clinical, administrative, and logistical challenges are addressed. Finally, this article is a call to action because midwives are well qualified to provide high quality, safe, and comprehensive medication abortion within the midwifery model of care. [ABSTRACT FROM AUTHOR]

Medical abortion is a common medical procedure that women choose to terminate an unwanted pregnancy, but it often brings post‐abortion complications. Danggui (Angelica sinensis Radix)–Yimucao (Leonuri Herba), as a herbal pair (DY) in clinical prescriptions of traditional Chinese medicine, is often used in the treatment of gynecological diseases and has the traditional functions of tonifying the blood, promoting blood circulation, removing blood stasis and regulating menstruation. In this study, serum lipidomics were adopted to dissect the mechanism of DY in promoting recovery after medical abortion. A total of 152 differential metabolites were screened by lipidomics. All metabolites were imported into MetaboAnalyst for analysis, and finally key metabolic pathways such as glycerophospholipid metabolism, linoleic acid metabolism and pentose and glucuronate interconversions were enriched. Our results indicated that metabolic disorders in abortion mice were alleviated by DY through glycerophospholipid metabolism, while prostaglandin and leukotriene metabolites might be the key targets of DY to promote post‐abortion recovery. [ABSTRACT FROM AUTHOR]

To explore women's perception of the need for an ultrasound scan before medical abortion provided by telemedicine services. We have analysed women's requests for medical abortion through the website from the 1st of January 2019 to the 5th of October 2020. Before receiving abortion drugs for self-managed medical abortion, women received online counselling and were asked to complete an online survey on pre-abortion ultrasound scan and the reasons for having or not having one. The initial dataset included 62641 entries from 207 countries. Each entry corresponded to a person's request for medical abortion. Women reported only one or multiple reasons for not having a pre-abortion ultrasound scan. Among 59648 women requesting a medical abortion, 45653 (76,54%) did not have any pre-abortion ultrasound scan and specified a reason for that. The countries with the highest rates of women not having a pre-abortion ultrasound scan were Thailand, Poland, Northern Ireland, Mexico, South Korea, Japan, Chile, Indonesia, Germany, and Brazil. The main reasons for not having a pre-abortion ultrasound scan were being confident regarding pregnancy length; and thus, no need for a scan stated by 10910/34390 women (31.7%), lack of resources stated by 10589/34390 women (30.8%), and privacy issues stated by 6472/34390 women (18.8%). Most women opting for medical abortion through telemedicine did not undergo a pre-abortion ultrasound scan. The main reason stated was that women did not find it necessary, lack of resources and privacy issues Women requesting medical abortion through telemedicine were asked about their views and experiences regarding pre-abortion ultrasound scan. Of 59648 women included in the study, 76% did not have a scan. The main reason stated was that women did not find it necessary, lack of resources and privacy issues. [ABSTRACT FROM AUTHOR]

Abstract Background In recent years a growing number of manufacturers and medical abortion products have entered country markets and health systems, with varying degrees of quality and accessibility. An interplay of factors including pharmaceutical regulations, abortion laws, government policies and service delivery guidelines and provider’s knowledge and practices influence the availability of medical abortion medicines. We assessed the availability of medical abortion in eight countries to increase understanding among policymakers of the need to improve availability and affordability of quality-assured medical abortion products at regional and national levels. Methods Using a national assessment protocol and an availability framework, we assessed the availability of medical abortion medicines in Bangladesh, Liberia, Malawi, Nepal, Nigeria, Rwanda, Sierra Leone and South Africa between September 2019 and January 2020. Results Registration of abortion medicines—misoprostol or a combination of mifepristone and misoprostol—was established in all countries assessed, except Rwanda. Mifepristone and misoprostol regimen for medical abortion was identified on the national essential medicines list/standard treatment guidelines for South Africa as well as in specific abortion care service and delivery guidelines for Bangladesh, Nepal, Nigeria, and Rwanda. In Liberia, Malawi, and Sierra Leone—countries with highly restrictive abortion laws and no abortion service delivery guidelines or training curricula—no government-supported training on medical abortion for public sector providers had occurred. Instead, training on medical abortion was either limited in scope to select private sector providers and pharmacists or prohibited. Community awareness activities on medical abortion have been limited in scope across the countries assessed and where abortion is broadly legal, most women do not know that it is an option. Conclusion Understanding the factors that influence the availability of medical abortion medicines is important to support policymakers improve availability of these medicines. The landscape assessments documented that medical abortion commodities can be uniquely impacted by the laws, policies, values, and degree of restrictions placed on service delivery programs. Results of the assessments can guide actions to improve access.

Idun Røseth,1,2 Anne Marit Lyberg,2 Eva Sommerseth,2 Berit Margethe Sandvik,2 Bente Dahl2 1Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway; 2Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Borre, NorwayCorrespondence: Idun Røseth, Department of Child and Adolescent Psychiatry, Telemark Hospital Trust, P.O Box 2900 Kjørbekk, Skien, 3710, Norway, Tel +47 41200462, Email idun.roseth@sthf.noIntroduction: Medical abortion has rapidly become the dominant abortion method in western countries. Pain is a known adverse effect; however, few studies have explored women’s subjective experience of medical abortion pain.Purpose: To explore Norwegian women’s experiences of pain when performing a medical abortion at home.Material and Methods: We recruited 24 women through an advertisement on Facebook and conducted semi-structured, face-to-face interviews. The interviews were transcribed verbatim and the data were analyzed using a phenomenological hermeneutical method.Results: Our findings consisted of two main themes: 1) Being in pain or becoming pain, and 2) Being caught off guard and struggling to cope. Participants described undergoing severe pain, comparable to giving birth, during the medical abortion. Unprepared for the type and intensity of the pain, they felt anxious and insecure. Pain is physical, but it also has important psychological, social, and existential dimensions. Our culture (in)forms our thoughts and feelings about our pain, affecting our ability to endure suffering. The participants’ experiences of abortion pain prompt timely questions concerning gendered socio-cultural and existential meanings connected to pain, specifically in relation to female reproductive functions.Conclusion: Women need realistic information about the type and intensity of abortion pain, as well as evidence-based pain medication. Psychological factors may affect the experience of abortion pain and should therefore be taken into account in abortion care.Keywords: gender, medical abortion, pain, phenomenological hermeneutical study, women’s sexuality, women’s reproductive functions

Background: Missed miscarriage patients with residual tissue in the uterine cavity after medical abortion can be treated by surgery and expectant therapy. Because surgery may cause damage to the endometrium, expectant treatment is preferred clinically. However, the individual probability of expulsion of residual tissue from the uterus remains unelucidated. The present study used logistic regression analysis and nomogram to create a scoring system for quantitatively evaluating the individual probability of residual tissue expulsion in patients with missed miscarriage. Methods: A cohort of 126 patients with missed miscarriage who had residual tissue after medical abortion were included in the trial after receiving their informed consent. Of these patients, 102 and 24 patients had successful and failed expectant treatment, respectively. Results: Logistic regression analysis showed that gravidity, residual tissue size, and residual tissue with blood supply significantly affected the probability of expulsion of residual tissue after medical abortion. A special nomogram was constructed for predicting the probability of successful expulsion. At the maximum Youden index of 0.696, the area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.849; this corresponded to a score of 77.78 and probability of residual tissue expulsion of 71%. Conclusion: A scoring system was established based on a nomogram. The success rate of residual tissue expulsion from the uterine cavity was significantly improved at the total score of 77.78 points after assigning influence weights to each influencing factor and an AUC of 0.849.

AbstractThe COVID-19 pandemic impacted comprehensive abortion care provision. To maintain access to services while keeping individuals safe from infection, many organisations adapted their programmes. We conducted a programme evaluation to examine service adaptations implemented in Bolivia, Mali, Nepal, and the occupied Palestinian territory. Our programme evaluation used a case study approach to explore four programme adaptations through 14 group and individual interviews among 16 service providers, facility managers and representatives from supporting organisations. Data collection took place between October 2021 and January 2022. We identified adaptations to comprehensive abortion care services in relation to provision, health information systems and counselling, and referrals. Four overarching strategies emerged: (1) the use of digital technologies, (2) home and community outreach, (3) health worker optimisation, and (4) further consideration of groups in vulnerable situations. In Bolivia, the use of a messaging application increased access to confidential gender-based violence support and comprehensive abortion care. In Mali, the adoption of digital approaches created timely and complete data reporting and trained members of the community served as “interlocutors” between the communities and providers. In Nepal, an interim law expanded medical abortion provision to pharmacies, and home visits complemented facility-based services. In the occupied Palestinian territory, the use of a hotline and social media expanded access to quick and reliable information, counselling, referrals, and post-abortion care. Adaptations to comprehensive abortion care service delivery to mitigate disruptions to services during the COVID-19 pandemic may continue to benefit service quality of care, access to care, routine monitoring, as well as inclusivity and communication in the longer term.

AbstractThe non-governmental organisation Profamilia developed and implemented medical abortion through telemedicine in response to the Covid-19 pandemic. This service is now integrated as an alternative to in-person care and available to abortion-seekers across Colombia. Previous research has emphasised bottlenecks in abortion provision, but less is known about implementation processes and experiences. We assessed the feasibility and acceptability of telemedicine for medical abortion from the perspectives of key informants involved in the implementation in Colombia. We conducted 15 in-depth interviews with healthcare professionals, coordinators and support staff implementing telemedicine for medical abortion in the early phase of implementation, between March and October 2021. We analysed the data using the framework method and applied the normalisation process theory in our analysis and interpretation of findings. Our findings show that strong leadership, organisational efforts on pre-implementation training, monitoring and evaluation, and collaboration between diversely skilled and experienced providers are essential for successful implementation. Participants were generally positive towards the use of telemedicine for medical abortion; concerns related to effectiveness, safety and safeguarding existed mainly among providers with less clinical experience. We identified contextual barriers, such as social opposition, regulatory barriers, providers’ unavailability, and poor phone and internet connections in rural areas, which impacted the feasibility of the intervention negatively. In conclusion, to ensure stakeholders' buy-in and for the service to reach all abortion seekers in need, future implementation endeavours must address concerns about safety and effectiveness, and tackle identified contexual barriers.Plain Language SummaryIn telemedicine for medical abortion, all or some components of abortion care, such as initial consultations, home delivery of abortion medication, and post-abortion follow up are provided with the use of telecommunications. Telemedicine for medical abortion has been shown to be a safe and effective form of service delivery.In this study, we interviewed 15 healthcare providers and staff involved in the implementation of a telemedicine service for medical abortion in Colombia to determine whether they deemed the service to be acceptable and feasible. We found that collaboration between providers of different backgrounds and levels of experience, appropriate training and strong leadership were key factors for successfully implementing the service. However, some healthcare providers, especially those with less clinical experience, were concerned that telemedicine for medical abortion may not be safe and may risk the health and well-being of abortion-seekers. Further, social opposition to abortion, unclear regulation and limited access to technology were identified as barriers that need to be addressed to ensure the service reaches all abortion-seekers in need.In conclusion, despite contextual barriers and some provider’s concerns about medical safety, telemedicine for medical abortion was viewed as a positive and feasible form of service delivery in Colombia.

AbstractPatient choice of medical or surgical abortion is a standard of quality abortion care, but the choice of surgical abortion is constrained in England and Wales, particularly since the COVID-19 pandemic and introduction of telemedicine. This qualitative study explored the perspectives of abortion service providers, managers, and funders on the need to offer a choice of methods within early gestation abortion services in England and Wales. Twenty-seven key informant interviews were conducted between August and November 2021, and framework analysis methods were used. Participants presented arguments both for and against offering method choice. Most participants felt that it was important to maintain choice, although they recognised that medical abortion suits most patients, that both methods are very safe and acceptable, and that the priority for abortion services is to maintain timely access to respectful care. Their arguments related to practicalities around patient needs, the risk of reinforcing inequalities in access to patient-centred care, potential impacts on patients and providers, comparisons to other services, costs, and moral issues. Participants argued that constraining choice has a greater impact on those who are less able to advocate for themselves and there were concerns that patients may feel stigmatised or isolated when unable to choose their preferred method. In conclusion, although medical abortion suits most patients, this study highlights arguments for maintaining the option of surgical abortion in the era of telemedicine. More nuanced discussion of the potential benefits and impacts of self-management of medical abortion is needed.

AbstractIn 2018, Ipas Bolivia launched an abortion self-care (ASC) community intervention with the goal of increasing access to supportive, well-informed abortion support provided by community agents (CAs). Between September 2019 and July 2020, Ipas conducted a mixed-methods evaluation to assess the reach, outcomes, and acceptability of the intervention. We used logbook data maintained by CAs to capture demographic characteristics and ASC outcomes of people supported. We also conducted in-depth interviews with 25 women who had received support and 22 CAs who had provided support. 530 people accessed ASC support through the intervention, most of whom were young, single, educated women accessing abortion in the first trimester. Among the 302 people who self-managed their abortions, 99% reported having a successful abortion. No women reported adverse events. All women interviewed expressed satisfaction with the support provided by the CA and, in particular, with the information, lack of judgement, and respect they felt from CAs. CAs spoke highly about their experience and viewed their participation as a way to increase people’s ability to exercise their reproductive rights. Obstacles included experiences of stigma, fears of legal repercussions, and difficulties dispelling misconceptions around abortion. Legal restrictions and abortion stigma continue to complicate access to safe abortion, and findings from this evaluation highlight important avenues for the effectiveness and expansion of ASC interventions, including legal support to people who have abortions and those who provide abortion support, building capacity of people as informed buyers, and ensuring that interventions reach rural and other often under-served people.

Introduction: Misoprostol is widely used for medication abortion and postpartum hemorrhage. However, it has been associated with the adverse effect of fever, which can pose challenges in management and potentially contribute to unnecessary antibiotic use. The incidence of misoprostol-induced fever in the context of medical abortion has not been extensively studied. Methods: This retrospective cohort study aimed to determine the incidence of fever following misoprostol administration at a tertiary care hospital in Saudi Arabia. The study included female patients who received misoprostol for pregnancy termination or management of missed or incomplete abortion between January 2017 and December 2019. Data on demographics, misoprostol dosage and route, fever characteristics, outcome of abortion, and antibiotic use were collected. Statistical analysis was preformed using appropriate tests. Results: A total of 213 patients were included in the study. The incidence of fever post-misoprostol administration was 8%. Patients who developed fever had a higher gestational age and received higher doses of misoprostol. However, no significant associations were found between other patient variables and fever incidence. Antibiotic therapy was administered to a almost half of the patients who developed fever post-misoprostol but was determined to be unnecessary in all cases. Conclusion: This study contributes to the understanding of misoprostol-induced fever in the context of medical abortion. Further research is needed to explore strategies for reducing unnecessary antibiotic use in this population. [ABSTRACT FROM AUTHOR]

Background: In Kenya and Uganda, unsafe abortions are a leading cause of maternal mortality. The new WHO policy guidelines on the safe termination of pregnancies up to 9 weeks lack information on women's experiences with self-administered medical abortion (MA), impeding the development of interventions to increase MA use. This study aimed to comprehend women's experiences with MA in Kenyan and Ugandan pharmacies. Methods: A cross-sectional mixed-methods survey utilized data from medical registers in 71 purposefully identified pharmacies and clinics dispensing MA drugs between September and October 2021. Forty women who were MA users participated in focus group discussions. The main outcome variables were: sources of MA information, costs of MA services, complications from MA, pain management, follow-up rates, and use of post-MA contraception. Quantitative data were analyzed using Stata 15, while qualitative thematic analysis was conducted using Dedoose qualitative analysis software. Results: 73.6% of 2,366 women got an MA, both in Kenya (79%) and Uganda (21%). Most (59.1%) were walk-in clients. Kenya had significantly more women referred for MA (49.9%) than Uganda (10.1%) (p 0.05). Friends and family members were the main sources of MA information. The median cost of MA was USD 18 (IQR 10–60.5) in Kenya and USD 4.2 (IQR 2–12) in Uganda. Most MA clients received pain management (89.6%), were followed up (81%), and received post-MA contraception (97.6%). Qualitative results indicated a lack of medicines, high costs of MA, complications, stigma, and inadequate training of providers as barriers to MA use. Conclusions and recommendations: Communities are a valuable information resource for MA, but only if they have access to the right information. A relatively weak health referral system in Uganda highlights the importance of pharmacies and clinicians collaborating to support clients' abortion needs and contraceptive use after medical abortion (MA). Low client follow-up rates show how important it is to make sure pharmacy technicians know how to give MA correctly. Finally, it is crucial to strengthen the supply chain for MA products in order to eliminate cost barriers to access. [ABSTRACT FROM AUTHOR]

Background: The recently amended Thai abortion law allows pregnant women to undergo abortions up to the gestational age of 12 weeks. Medical abortion is significant because it has revolutionized access to safe abortion care—abortion medicine can now be safely and effectively administered outside of a healthcare facility to women in early pregnancy. This contribution supports the pharmacists' role in interprofessional safe abortion teamwork. Adequate knowledge of the current laws regarding safe abortion services will increase pharmacists' competence in providing services. However, safe abortions as a subject have not been formally incorporated into the curriculum for Thai pharmacy students. Therefore, this study aimed to evaluate the knowledge, attitude, and intended practice of fifth-year pharmacy students at Chulalongkorn University. Methods: A cross-sectional study was conducted using an electronic self-administered questionnaire adapted from previously published studies to evaluate participants' knowledge of the recently amended Thai abortion law, attitude toward abortion, and intended practices. The invitations were sent to all fifth-year pharmacy students at Chulalongkorn University. Results: Among all invitations sent, 104/150 (69.3%) participants responded to the survey. Only a third of the participants (31.7%) had good knowledge scores. Based on five questions regarding the gestational age limit for legal abortion, most participants (52.7%) answered questions incorrectly. Although more than half of the participants (52.5%) disagreed with two pro-choice statements, an overwhelming majority (87.5%) agreed that abortion was a woman's right. Safe abortion services were mostly agreed upon with serious fetal defects (91.9%), non-HIV maternal health conditions (82.2%), and sexual assaults (77.4%). A positive attitude toward abortion affects the intention to perform an abortion under socioeconomic conditions. Conclusion: Most participants lacked knowledge on the amended abortion law, especially on the gestational limits of abortion. Participants with favorable attitudes toward abortion tended to be more liberal regarding safe abortion services. [ABSTRACT FROM AUTHOR]

Background and Objective: The need to perform an abortion in the first three months of pregnancy with an effective and safe drug therapy is more important than other methods. The purpose of this study is to compare the effects of letrozole and misoprostol versus misoprostol alone on abortion. Methods: In this clinical trial, 114 candidates for legal abortion in the first trimester of pregnancy were randomly assigned to three groups of 38 people receiving sublingual misoprostol alone with placebo (same amount of letrozole), misoprostol with letrozole 10 mg daily for 3 days and the third group was given misoprostol along with letrozole with a daily dose of 5 mg for 3 days. In addition to the demographic and obstetrical information of the patients, the primary outcome including complete and incomplete abortion, misoprostol dosage and side effects were compared in patients of three groups. Findings: The mean gestational age of the patients was 73.1±9.2 days. A total of 84 (73.7%) patients had complete abortion, including 28 patients (73.7%) in the letrozole 5 mg group, 32 patients (84.2%) in the letrozole 10 mg group, and 24 patients (63.2%) were in the placebo group. In the letrozole 10 mg group, with a statistically significant difference, the rate of complete abortion was higher in them than in the placebo group (84.2 vs. 63.2%, p=0.037). 20 patients in the letrozole 5 mg group, 16 in the letrozole 10 mg group, and all patients in the placebo group received misoprostol, and the difference between the two groups of letrozole 10 mg and placebo was significant in terms of misoprostol intake (p=0.001). The most common side effect in patients of all three groups was nausea and vomiting, which did not have a statistically significant difference between all three groups. Conclusion: The findings of the present study showed that letrozole 10 mg along with misoprostol is effective in patients who need legal abortion in the first trimester.

Aims: To assess clinical outcomes and complications in women with ≥1 prior caesarean delivery (CS) during mid‐pregnancy medical abortion with misoprostol following mifepristone priming. Materials and Methods: Retrospective analysis of abortions at 13–28 weeks gestation using sequential mifepristone and misoprostol at a single centre from 1/2008–12/2018. Procedural outcomes were compared between cases with no prior CS, one prior and ≥2 prior CS. Results: There were 1399 consecutive women who underwent a medical abortion, with 304 (21.7%) having ≥1 prior lower segment CS (241 one, 49 two, 12 three, one four) and one a prior classical CS. Median gestation was 19 weeks (interquartile range (IQR) 17–21) among nulliparas, multiparas with no prior CS and multiparas with prior CS, P = 0.505. Compared with nulliparas (median procedural duration 10.8 h, IQR 7.5–16.5; adjusted hazards ratio (aHR) = 1.20 95%CI 1.04–1.40, P = 0.015), multiparas with prior CS had a shorter procedural duration (9.5 h, IQR 6.5–13.5) while multiparas with no CS had the shortest duration (7.0 h, IQR 5.0–9.8; aHR = 2.28 95%CI 2.01–2.58, P < 0.001). Complications were more frequent with prior CS: estimated blood loss (medians: 100 cc no CS vs 150 cc ≥1 CS, P = 0.002), blood loss >1000 cc (3.6% no CS vs 7.2% ≥1 CS; odds ratio (OR) = 2.11 95%CI 1.23–3.62, P = 0.007) and placental retention (17.3% no CS vs 25.3% ≥1 CS; adjusted OR = 1.44 95%CI 1.05–1.99, P = 0.024). Uterine rupture occurred in 4/304 women with ≥1 prior CS (1.3%). Conclusions: Mifepristone‐misoprostol abortion in women with prior CS is generally safe but associated with an increased risk of procedural complications. Lowering of the misoprostol dosage with prior CS may reduce uterine rupture, although this hypothesis requires ongoing research. [ABSTRACT FROM AUTHOR]

Introduction: The administration of mifepristone, followed by misoprostol, is widely used for medical abortion. Many studies have demonstrated home abortion to be safe in pregnancies up to 63 days of gestation, and recent data support its safety when extended to more advanced pregnancies. We studied the efficacy and acceptability of home use of misoprostol up to 70 days of gestation in a Swedish setting and compared the outcomes between pregnancies with a gestational age of up to 63 days and pregnancies with gestational age 64–70 days. Material and methods: This prospective cohort study was performed between November 2014 and November 2021 at Södersjukhuset and Karolinska University Hospital, Stockholm, and some patients were also recruited from Sahlgrenska University Hospital, Göteborg and Helsingborg Hospital. The primary outcome was the rate of complete abortions and was defined as complete abortion without any need for surgical or medical intervention and assessed by clinical assessment, pregnancy test and/or vaginal ultrasound. Secondary objectives were assessed by daily self‐reporting in a diary and included pain, bleeding, side effects and women's satisfaction and perception of home use of misoprostol. A comparison of categorical variables was made with Fisher's exact test. The significance level was set to a p‐value ≤0.05. The study was registered at Clinicaltrials.gov on July 14, 2014 (NCT02191774). Results: During the study period we enrolled 273 women opting for medical abortion with home use of misoprostol. In the early group, up to 63 days of gestation, 112 women were included with a mean gestational length of 45 days and in the late group, 64–70 days of gestation, 161 women with a mean gestations length of 66.3 days were included. Complete abortion occurred in 95% (95% CI 89–98) of women in the early group and in 96% (95% CI 92–99) in the late group. No differences were found regarding side effects and acceptability was similarly high in both groups. Conclusions: Our results show high efficacy and acceptability of medical abortion when misoprostol is administered at home up to 70 days of gestation. This supports previous findings about maintained safety when misoprostol is administered at home even past a very early pregnancy. [ABSTRACT FROM AUTHOR]