Safety and effectiveness of medication and aspiration abortion before or during the sixth week of pregnancy: A retrospective multicenter study

Maureen K. Baldwin; Paula H. Bednarek; Jennefer Russo

doi:10.1016/j.contraception.2020.04.004

Safety and effectiveness of medication and aspiration abortion before or during the sixth week of pregnancy: A retrospective multicenter study

Obstetrics and Gynecology

Research output: Contribution to journal › Article › peer-review

11 Scopus citations

Abstract

Objective: To compare adverse outcomes of medication and aspiration abortion among those with intrauterine pregnancy <43 days gestation versus abortions performed at 43–48 days. Study design: We conducted a multicenter retrospective chart review study to review all medication and aspiration abortion of visualized pregnancy <49 days gestation at Planned Parenthood Columbia Willamette (Oregon) and Planned Parenthood of Orange and San Bernardino Counties (California) in 2014–2015. We identified incident cases by billing codes and performed chart review for adverse outcomes (ED visits, incomplete abortion), need for further interventions, or complications (hemorrhage, infection, and uterine perforation), captured up to 90 days post-abortion. Results: The 3930 abortions during the study period at the two sites included 2914 medication abortions and 1016 aspiration abortions, with 1470 medication abortions and 469 aspiration abortions at <43 days gestation. Composite adverse outcomes did not vary by gestation, for either medication abortion (75/1470; 5.1% for <43 days versus 94/1444; 6.5% at 43–48 days, p = 0.10) or aspiration (12/469; 2.6% for <43 days versus 16/547; 2.9% at 43–48 days, p = 0.72). Fewer incomplete abortions (ongoing pregnancy, symptomatic retained tissue, or retained gestational sac) occurred in the earlier gestational group (3.1% for <43 days versus 4.3% at 43–48 days, p = 0.04). Composite adverse outcomes were higher after medication versus aspiration abortion (169/2914; 5.8% versus 28/1016; 2.7%, p < 0.01). Conclusion: Medication and aspiration abortion performed either before or during the sixth week of ultrasound-confirmed intrauterine pregnancy have low rates of composite adverse outcomes, including complications or incomplete abortion. However, unplanned interventions are more common after medication compared to aspiration abortions. Implications: Very early medication and aspiration abortion are similarly safe and effective before or during the sixth week of ultrasound-confirmed pregnancy, though subsequent interventions are more likely after medication abortion. Patients with early pregnancy can safely initiate abortion with follow-up to ensure complete abortion.

Original language	English (US)
Pages (from-to)	13-17
Number of pages	5
Journal	Contraception
Volume	102
Issue number	1
DOIs	https://doi.org/10.1016/j.contraception.2020.04.004
State	Published - Jul 1 2020

Funding

The authors acknowledge the funding support of the Society of Family Planning Research Fund (SFPRF7-14). The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of Planned Parenthood Federation of America, Inc. We are grateful to patients and staff of the Planned Parenthood affiliates – Planned Parenthood of Orange and San Bernardino Counties and Planned Parenthood Columbia Willamette. Additionally, we would like to extend gratitude to the OHSU Women's Health Research Unit coordinators involved in chart review: Emily Boniface, Monica Dunn, Aubre Gilbert, and Chloe Souza. Disclosure of Potential Conflicts of Interests: This study was funded by the Society of Family Planning Research Fund (SFPRF7-14). REDCap through OHSU was utilized for this study and as such this research was supported by National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR0002369. The sponsor had no role in the study design, including collection, analysis or interpretation of data, writing the report, or the decision to submit the report for publication. Authors Russo and Bednarek are employed by Planned Parenthood as affiliate medical directors. Author Baldwin has a contract relationship with Planned Parenthood. The authors acknowledge the funding support of the Society of Family Planning Research Fund (SFPRF7-14). The findings and conclusions in this article are those of the authors and do not necessarily reflect the views of Planned Parenthood Federation of America, Inc. We are grateful to patients and staff of the Planned Parenthood affiliates – Planned Parenthood of Orange and San Bernardino Counties and Planned Parenthood Columbia Willamette. Additionally, we would like to extend gratitude to the OHSU Women’s Health Research Unit coordinators involved in chart review: Emily Boniface, Monica Dunn, Aubre Gilbert, and Chloe Souza. Disclosure of Potential Conflicts of Interests: This study was funded by the Society of Family Planning Research Fund (SFPRF7-14). REDCap through OHSU was utilized for this study and as such this research was supported by National Center for Advancing Translational Sciences of the National Institutes of Health under award number UL1TR0002369. The sponsor had no role in the study design, including collection, analysis or interpretation of data, writing the report, or the decision to submit the report for publication. Authors Russo and Bednarek are employed by Planned Parenthood as affiliate medical directors. Author Baldwin has a contract relationship with Planned Parenthood.

Funders	Funder number
Planned Parenthood of Orange and San Bernardino Counties and Planned Parenthood Columbia Willamette
Author National Institutes of Health National Institutes of Health National Institutes of Health National Institutes of Health The Bev Hartig Huntington's Disease Foundation National Institutes of Health	UL1TR0002369
National Center for Advancing Translational Sciences
Oregon State University/Oregon Health and Science University
Society of Family Planning	SFPRF7-14

Keywords

Abortion
Aspiration
Early abortion
Medication abortion
Surgical abortion

ASJC Scopus subject areas

Reproductive Medicine
Obstetrics and Gynecology

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10.1016/j.contraception.2020.04.004

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title = "Safety and effectiveness of medication and aspiration abortion before or during the sixth week of pregnancy: A retrospective multicenter study",

abstract = "Objective: To compare adverse outcomes of medication and aspiration abortion among those with intrauterine pregnancy <43 days gestation versus abortions performed at 43–48 days. Study design: We conducted a multicenter retrospective chart review study to review all medication and aspiration abortion of visualized pregnancy <49 days gestation at Planned Parenthood Columbia Willamette (Oregon) and Planned Parenthood of Orange and San Bernardino Counties (California) in 2014–2015. We identified incident cases by billing codes and performed chart review for adverse outcomes (ED visits, incomplete abortion), need for further interventions, or complications (hemorrhage, infection, and uterine perforation), captured up to 90 days post-abortion. Results: The 3930 abortions during the study period at the two sites included 2914 medication abortions and 1016 aspiration abortions, with 1470 medication abortions and 469 aspiration abortions at <43 days gestation. Composite adverse outcomes did not vary by gestation, for either medication abortion (75/1470; 5.1\% for <43 days versus 94/1444; 6.5\% at 43–48 days, p = 0.10) or aspiration (12/469; 2.6\% for <43 days versus 16/547; 2.9\% at 43–48 days, p = 0.72). Fewer incomplete abortions (ongoing pregnancy, symptomatic retained tissue, or retained gestational sac) occurred in the earlier gestational group (3.1\% for <43 days versus 4.3\% at 43–48 days, p = 0.04). Composite adverse outcomes were higher after medication versus aspiration abortion (169/2914; 5.8\% versus 28/1016; 2.7\%, p < 0.01). Conclusion: Medication and aspiration abortion performed either before or during the sixth week of ultrasound-confirmed intrauterine pregnancy have low rates of composite adverse outcomes, including complications or incomplete abortion. However, unplanned interventions are more common after medication compared to aspiration abortions. Implications: Very early medication and aspiration abortion are similarly safe and effective before or during the sixth week of ultrasound-confirmed pregnancy, though subsequent interventions are more likely after medication abortion. Patients with early pregnancy can safely initiate abortion with follow-up to ensure complete abortion.",

keywords = "Abortion, Aspiration, Early abortion, Medication abortion, Surgical abortion",

author = "Baldwin, \{Maureen K.\} and Bednarek, \{Paula H.\} and Jennefer Russo",

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T1 - Safety and effectiveness of medication and aspiration abortion before or during the sixth week of pregnancy

T2 - A retrospective multicenter study

AU - Baldwin, Maureen K.

AU - Bednarek, Paula H.

AU - Russo, Jennefer

PY - 2020/7/1

Y1 - 2020/7/1

N2 - Objective: To compare adverse outcomes of medication and aspiration abortion among those with intrauterine pregnancy <43 days gestation versus abortions performed at 43–48 days. Study design: We conducted a multicenter retrospective chart review study to review all medication and aspiration abortion of visualized pregnancy <49 days gestation at Planned Parenthood Columbia Willamette (Oregon) and Planned Parenthood of Orange and San Bernardino Counties (California) in 2014–2015. We identified incident cases by billing codes and performed chart review for adverse outcomes (ED visits, incomplete abortion), need for further interventions, or complications (hemorrhage, infection, and uterine perforation), captured up to 90 days post-abortion. Results: The 3930 abortions during the study period at the two sites included 2914 medication abortions and 1016 aspiration abortions, with 1470 medication abortions and 469 aspiration abortions at <43 days gestation. Composite adverse outcomes did not vary by gestation, for either medication abortion (75/1470; 5.1% for <43 days versus 94/1444; 6.5% at 43–48 days, p = 0.10) or aspiration (12/469; 2.6% for <43 days versus 16/547; 2.9% at 43–48 days, p = 0.72). Fewer incomplete abortions (ongoing pregnancy, symptomatic retained tissue, or retained gestational sac) occurred in the earlier gestational group (3.1% for <43 days versus 4.3% at 43–48 days, p = 0.04). Composite adverse outcomes were higher after medication versus aspiration abortion (169/2914; 5.8% versus 28/1016; 2.7%, p < 0.01). Conclusion: Medication and aspiration abortion performed either before or during the sixth week of ultrasound-confirmed intrauterine pregnancy have low rates of composite adverse outcomes, including complications or incomplete abortion. However, unplanned interventions are more common after medication compared to aspiration abortions. Implications: Very early medication and aspiration abortion are similarly safe and effective before or during the sixth week of ultrasound-confirmed pregnancy, though subsequent interventions are more likely after medication abortion. Patients with early pregnancy can safely initiate abortion with follow-up to ensure complete abortion.

AB - Objective: To compare adverse outcomes of medication and aspiration abortion among those with intrauterine pregnancy <43 days gestation versus abortions performed at 43–48 days. Study design: We conducted a multicenter retrospective chart review study to review all medication and aspiration abortion of visualized pregnancy <49 days gestation at Planned Parenthood Columbia Willamette (Oregon) and Planned Parenthood of Orange and San Bernardino Counties (California) in 2014–2015. We identified incident cases by billing codes and performed chart review for adverse outcomes (ED visits, incomplete abortion), need for further interventions, or complications (hemorrhage, infection, and uterine perforation), captured up to 90 days post-abortion. Results: The 3930 abortions during the study period at the two sites included 2914 medication abortions and 1016 aspiration abortions, with 1470 medication abortions and 469 aspiration abortions at <43 days gestation. Composite adverse outcomes did not vary by gestation, for either medication abortion (75/1470; 5.1% for <43 days versus 94/1444; 6.5% at 43–48 days, p = 0.10) or aspiration (12/469; 2.6% for <43 days versus 16/547; 2.9% at 43–48 days, p = 0.72). Fewer incomplete abortions (ongoing pregnancy, symptomatic retained tissue, or retained gestational sac) occurred in the earlier gestational group (3.1% for <43 days versus 4.3% at 43–48 days, p = 0.04). Composite adverse outcomes were higher after medication versus aspiration abortion (169/2914; 5.8% versus 28/1016; 2.7%, p < 0.01). Conclusion: Medication and aspiration abortion performed either before or during the sixth week of ultrasound-confirmed intrauterine pregnancy have low rates of composite adverse outcomes, including complications or incomplete abortion. However, unplanned interventions are more common after medication compared to aspiration abortions. Implications: Very early medication and aspiration abortion are similarly safe and effective before or during the sixth week of ultrasound-confirmed pregnancy, though subsequent interventions are more likely after medication abortion. Patients with early pregnancy can safely initiate abortion with follow-up to ensure complete abortion.

KW - Abortion

KW - Aspiration

KW - Early abortion

KW - Medication abortion

KW - Surgical abortion

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Safety and effectiveness of medication and aspiration abortion before or during the sixth week of pregnancy: A retrospective multicenter study

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