Outcomes of very early medical and surgical abortion: Correlates of success and role of tissue evaluation
Awarded 2014
Large Research Grants
Maureen Baldwin, MD, MPH
Oregon Health & Science University

Objective: To compare outcomes of medical and surgical abortion at 42 days gestation by procedure type as well as compared to abortions performed at 43-48 days gestation. Methods: We conducted a multicenter cohort study to review outcomes of all cases of medical and surgical abortion <49 days gestation for 12 months at Planned Parenthood of the Columbia Willamette (Oregon) and for 6 months at Planned Parenthood of Orange and San Bernardino County (California) in 2014-2015. We identified incident cases by billing codes and performed chart review for ongoing pregnancy (growth after the expected abortion) and complications (hemorrhage, endometritis, ectopic pregnancy) up to 90 days post-abortion. Results: We reviewed all cases (n= 4321) during the study period at the two sites. Procedures <=42 days gestation comprised 1354/3176 (42.6%) medical abortions (MA) and 484/1148 (42.2%) surgical abortions (uterine aspirations, UA). Ongoing pregnancy was reported in 15 (1.1%) cases after MA and 6 (1.2%) cases after UA 42 days gestation (p=0.8) and 10 (0.6%) cases after MA and 1 (0.2%) case after UA between 43-48 days gestation (p=0.3). Ongoing pregnancy was higher at 42 days gestation compared to 43-48 days after UA (RR=8.22; 95%CI: 1.41, 48.07). Complications occurred in 19 (0.60%) cases after MA and 16 (1.4%) cases after UA (RR=2.33; 95% CI: 1.22, 4.43). Four subjects (0.09%) had ectopic pregnancy. Complications were not significantly different by procedure type 42 days gestation. Conclusion: Nearly three-quarters of early abortions are performed using medical abortion. Early abortion is safe and successful, regardless of procedure type.