Safety, efficacy and acceptability of mifepristone-misoprostol medical abortion in Vietnam

International Family Planning Perspectives, Mar 1999 by Ngoc, Nguyen Thi Nhu, Winikoff, Beverly, Clark, Shelley, Ellertson, Charlotte, Et al

Results

Sample Characteristics

The sample consisted of 393 women-221 in Hanoi and 172 in Ho Chi Minh City. Overall, 260 women chose medical abortion and 133 opted for a surgical procedure (Table 1).^

Women who selected the medical method were slightly younger than those who decided on surgical abortion (26.4 vs. 27.9 years) and had had more years of schooling (11.6 vs. 10.6). Both groups sought to terminate their pregnancies quite early, but the mean gestational age was somewhat lower among women who chose the medical method (5.9 weeks) than among those who opted for surgery (6.1 weeks). Women undergoing medical abortion were less likely than those having surgical procedures to be married (73% vs. 84%) and to have been using a contraceptive (38% vs. 59%). The differences in age and length of gestation, however, were no longer statistically significant once we controlled for study site (not shown).

Method Choice and Adherence to Protocol Upon enrollment in the study, women were asked to name up to three reasons for their method selection. Among women who selected the medical method, 59% did so to avoid pain (Table 2). Substantial proportions also chose the medical method to avoid surgery or anesthesia (43%), or because they believed that it was the safer option (40%) or that it would be less traumatic (30%).

In contrast, women choosing surgical abortion did so mainly because they perceived it to be simpler and faster (68%) or more effective (64%) than medical abortion. As with the medical patients, safety concems loomed large in the minds of surgical patients (47%). Large proportions of women also decided to undergo surgery because it entailed fewer visits (28%) or was convenient (26%). Fear of side effects was not a major concern to women in either group when they selected their method.

Only three medical abortion patients did not complete the protocol. One woman, feeling worried and fatigued, went to another clinic before taking misoprostol and obtained a surgical abortion. Another woman did not return to the clinic in time to receive misoprostol and had a surgical intervention. The third woman requested a surgical abortion at another clinic after taking misoprostol because she had experienced only spotting and not heavy bleeding. All three are included in the analysis.

Efficacy and Safety

Since medical abortion clients selected their method to avoid surgery, we considered any of these women who underwent a surgical procedure for any reason to represent a treatment failure.l2 All surgical abortion patients who had more than one surgical procedure were also deemed to represent treatment failures.

Three types of failures can occur among medical patients: user choice, provider choice (or error) and true drug failures. User choice failure occurs when a woman asks for surgical intervention prior to the end of the study or is unable or chooses not to take the complete medical treatment. Provider choice failure occurs when a provider performs or recommends medically unwarranted surgical interventions (either out of impatience or in reaction to a concern with no clear medical basis). True drug failure occurs when an adverse event requires surgical intervention during the study period or when an abortion is not complete by the end of the study.