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

Failure rates for both abortion methods were extremely low (Table 3). Only one surgical patient (1%) required a backup intervention. Among medical patients, there were 10 failures (for a rate of 4%): six user choice, one provider choice and three true drug failures.*

Diligent efforts were made to minimize loss to follow-up. All women who did not report for a scheduled appointment were sent up to three reminder letters. Only after providers made home visits in an effort to trace these patients were the women designated as lost to follow-up. In total, nine surgical patients (7%) and three medical abortion patients (1%) were lost to followup. All available data from these 12 women are included in our analysis.

Side effects-nausea, vomiting, cramping, pain, diarrhea and bleeding-were far more common among the medical abortion clients than among the women who chose surgery (Table 3). However, although we have included cramping and bleeding as side effects, they may be symptoms of a medical abortion; indeed, if they do not occur, the woman is unlikely to have a successful medical abortion.

Furthermore, medical abortion patients were observed on more occasions (at least three visits vs. at least two) and for a longer period of time (17 vs. 15 days) than were surgical abortion patients. More important, even for medical clients, none of the observed side effects represented a serious medical risk.

Side effects of medical abortion varied at different stages of the procedure (Table 4). Women were more likely to report nausea and vomiting after taking mifepristone than later in the abortion process, but this may reflect symptoms of pregnancy. (Indeed, upon enrollment in the study, 43% of all women reported nausea-42% who chose medical abortion and 46% who opted for surgical-and 6% reported vomiting.) Cramping and abdominal pain increased sharply during the four-hour observation period immediately after administration of misoprostol, but subsided later. Profuse bleeding, although never experienced by more than 5% of the medical abortion clients, was also most likely during these four hours.

Among the most serious risks of abortion, regardless of the method used, is excessive blood loss during and following the procedure. On average, the women in both groups experienced minimal blood loss (Table 5). Only 2% of women who had medical abortions and 1% of their counterparts who had surgical procedures experienced a reduction in their hemoglobin levels of greater than 2 g per deciliter (which is considered clinically meaningful blood loss), and none required a transfusion (not shown).

Analysis of participants' diaries showed that medical abortion clients reported more blood loss than did surgical abortion patients. The mean number of days of bleeding (i.e., heavy, normal or light) was significantly greater for women who had medical abortions than for those who had surgical abortions.* For both groups, however, heavy bleeding accounted for only a small number of total bleeding days.