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Being at home is as safe as at the hospital when a medical abortion after twelve weeks of pregnancy is initiated. When starting at home, day patient care is usually sufficient, and women are satisfied with the treatment, a study shows.
In the case of medical abortion up to and including the tenth week of pregnancy, the procedure used is a so-called home abortion. At ten to twelve weeks, day patient care is most commonly used, while medical abortion after twelve weeks of pregnancy may have a longer course requiring an overnight stay in hospital.
The current study, published in The Lancet and led by researchers at the University of Gothenburg and Karolinska Institutet, included 457 women in Sweden who were planning to have a medical abortion after 12 weeks of pregnancy. The aim was to investigate the need for hospitalization if treatment was started at home.
About half of the participants were randomly assigned to take the first dose of the abortion medicine misoprostol at home in the morning, two hours before admission to the gynecological hospital ward. Others were randomized to follow the usual healthcare routine and take the first dose after arrival on the ward.
Benefits in the home group
The researchers measured how many people suffered a complication or needed surgical intervention in connection with the abortion. Participants' pain was assessed repeatedly during treatment, and specific satisfaction surveys were also conducted.
The results show that 71% of those who initiated their abortion at home could be treated as day patients, compared to 46% of those who started in hospital, which is a statistically significant result.
The incidence of severe complications during and after the abortion was low, and the proportion of participants requiring surgical intervention was 6.4% in the home group and 8.5% in the hospital group, confirming previous research in this area.
The majority of study participants were very satisfied with the treatment; 86% in the home group and 81% in the hospital group. However, significantly more people in the home group, 78%, preferred the treatment they were randomized to, compared to 49% in the hospital group.
Economy and autonomy
The researchers assess that a higher proportion of patients would only need day patient care for a medical abortion after 12 weeks of pregnancy if they were offered to take the first dose of misoprostol at home. A change that can bring several benefits.
Johanna Rydelius is a PhD student in obstetrics and gynecology at Sahlgrenska Academy at the University of Gothenburg, a Gynecologist at Sahlgrenska University Hospital and one of the researchers behind the study:
“Providing day patient care for this group of patients could allow countries with limited access to inpatient treatment to expand their abortion care. Day patient care is also potentially less costly for both the healthcare system and the individual patient. Being able to start their own medical treatment at home also promotes patient autonomy,” she says.
The study included Danderyd Hospital, Karolinska University Hospital, Sahlgrenska University Hospital, Södersjukhuset and Örebro University Hospital. The Principal Investigator was Kristina Gemzell Danielsson, Professor at Karolinska Institutet and Gynecologist at Karolinska University Hospital. The treatments in the study were conducted in 2019-2022.
Johanna Rydelius, tel. +46 707 14 93 60, e-mail johanna.rydelius@vgregion.se
A Randomized Trial of First dose of Misoprostol Administration at Home or in Hospital for Medical Abortion between 12-22 gestational weeks - The PRIMA (PRIMing At home) Trial, DOI: 10.1016/S0140-6736(24)01079-1
Johanna Rydelius
photo: University of Gothenburg
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