Home abortion drug use effective, safe for most

Medication-induced home abortions are safe for women who are 50 to 63 days pregnant, a new study from Sweden shows.

Studies to date have only looked at home use of the procedure up to 49 days after conception, Dr. Helena Kopp Kallner of the Karolinska Institutet in Stockholm and her colleagues note in their report.

In medical abortion, a woman takes drugs to induce abortion, rather than undergoing surgery to remove the embryo. She will typically take two drugs: first, a dose of mifepristone (RU-486, known popularly as the "abortion pill"), followed by misoprostol (Cytotec) three to four days later.

In the United States women have been permitted to take misoprostol at home on their own since 2000, the researchers say, while most European countries require the drug to be administered in a clinic or hospital. However, home administration is an option in Sweden; in 2008, the researchers note, half of women at their clinic who had medical abortions chose to take misoprostol at home.

Kallner and colleagues offered the option of surgical or medical abortion for all women up to 63 days pregnant who sought treatment at their clinic between January 2004 and April 2007. As they report in Human Reproduction, nearly 3,000 women chose medical abortions, and 395 of these women opted for at-home use of misoprostol.

Among these women, 203 were less than 50 days pregnant and 192 were 50 to 63 days pregnant. Women took mifepristone orally at the clinic, and self-administered four misoprostol tablets vaginally 36 to 48 hours later. They were also instructed to take pain medications preventively, and more as needed.

For 199 of the women less than 50 days pregnant and 186 of the women at 50 to 63 days' gestation, use of the medications resulted in complete abortions; the remaining 10 women required surgery. About six out of 10 women in both groups needed extra pain medication.

Among the women in the earlier gestation group, 92 percent said they would opt for home administration again if they needed another abortion, and 87 percent of the women further along in their pregnancies said so.

Women who were further along in pregnancy reported more bleeding, but the difference between this group and the women who weren't so far on in their pregnancy could have been due to chance because of the small number of people in the study.

The researchers conclude that home misoprostol use is "safe and highly acceptable also to women with gestational length of 50-63 days as compared with shorter gestation."

SOURCE: Human Reproduction, online February 19, 2010.