Abortion method change dropped infection rates

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After Planned Parenthood changed how it performed abortions in early 2006, the rate of serious infections fell markedly, according to a report in The New England Journal of Medicine for July 9.

Between 2001 and March 2006, the medical abortion protocol used by Planned Parenthood primarily involved two medications: oral mifepristone followed 24 to 48 hours later by vaginal misoprostol. In early 2006, the organization changed the protocol so that both drugs were given orally (the misoprostol was administered to the inside of the cheek), and patients were required to receive routine antibiotics or to undergo screening and treatment for chlamydia. Starting in July 2007, all patients were given routine antibiotics.

Doctors suspected that giving misoprostol vaginally could lead to infections. “Our findings demonstrated a reduction in serious infection when an oral route of misoprostol was used,” study co-author Mary Fjerstad, from Ipas, Chapel Hill, North Carolina, told Reuters Health.

She added that “it has long been assumed that, unlike surgical abortion, antibiotics have no role to play with medical abortion” because there are no instruments used.

With the change in procedure, serious infection rates fell 73%, from 0.93 to 0.25 per 1000 abortions. With routine antibiotic use for all patients, the rate dropped an additional 76% from 0.25 to 0.06 serious infections per 1000 abortions.

An “important take-home message is at this time, over half of all eligible women (with pregnancies of 9 weeks or less), choose medical abortion at Planned Parenthood. This study should reassure them and clinicians that a safe procedure is even safer with the changes in regimen described in the study,” Fjerstad said.

SOURCE: New England Journal of Medicine, July 9, 2009.

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