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

At their final visit, women were asked to describe the best and worst aspects of their abortion method (Table 7, page 14). Each was permitted up to three answers. For medical abortion, the features most frequently cited by patients were that the method is less painful than surgical abortion (35%), is safer (30%), does not involve surgery (20%) and is effective (14%). The emphasis on less pain is not surprising, given that surgical abortion is delivered with minimal anesthesia in Vietnam.

Prolonged heavy bleeding was most commonly reported as the worst feature of medical abortion (mentioned by 39% of women). A substantial proportion of medical clients (17%) also reported that the method involved too many visits and too lengthy a follow-up. Some 30% of women who had medical abortions, however, were unable to offer any negative features of the method.

Women who chose surgical abortion clearly appreciated the method's effectiveness (46%), as well as the ease and simplicity of the procedure (23%). Yet 23% were unable to name any good characteristics of the method. Although surgical abortion clients reported far less pain during the study than did medical clients, 57% considered pain the method's worst feature. Surgical clients also included fear of surgery and mental stress among the worst features of their method.

Discussion

Our findings suggest that mifepristonemisoprostol medical abortion is a safe, effective and desirable alternative to surgical abortion in Vietnam. The method's success rate in our study (96%) is the highest documented in a developing country"3 and is comparable to the rate found in developed countries.14 Moreover, while the medical abortion failure rate in our study exceeds that of the surgical method, many Vietnamese women apparently are willing to accept an increased risk of failure, since most said they would choose medical abortion again and would recommend it to their friends.

Three women whose pregnancies had not yet terminated as of their exit visits were advised to return for additional follow-up rather than receive surgical intervention. Two had had complete abortions by the time they returned and thus required no backup procedure, while the third eventually received sharp curettage to complete her abortion. This experience confirms that the method's failure rate is largely a function of the protocol employed and suggests that the date of the follow-up visit can be successfully delayed beyond the current standard of two weeks, which has been adopted from the surgical regimen.

Side effects were more common among medical abortion clients than among surgical clients, but they did not jeopardize the safety of the medical regimen and were tolerable for the vast majority of women who chose that method. However, women who had medical abortions reported bleeding more and longer than they had expected and more frequently than women who obtained surgical procedures. Since women's expectations may significantly affect their comfort and satisfaction with a method, medical abortion patients must receive appropriate advance information to prepare them for the method's potential side effects.