Efficacy and Safety of a Regimen for Medical Abortion up to 63 Days of Gestation: A Retrospective Study in Northern Greece

Background and Objectives: First trimester medical abortion with the combination of mifepristone and misoprostol is highly effective. The aim of this study was to assess the efficacy and safety of a modified medical abortion protocol, offering a structured outpatient approach up to 9 weeks (63 days) of gestation. This study may contribute to existing evidence by evaluating a slightly altered regimen and its real-world effectiveness in clinical practice. Material and Methods: This was a retrospective cohort study conducted at the Third Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Greece, during a two-year period (2022-2024). Women aged 18 years or older with an intrauterine pregnancy <= 63 days confirmed by transvaginal ultrasound were included. Exclusion criteria included ectopic pregnancy, contraindications to study medications, or loss to follow-up. Mifepristone (200 mg) was administered orally on Day 1, and misoprostol (800 mcg) was administered vaginally on Day 3. Serial follow-up visits on Days 8, 15, and 21 were scheduled according to the success of each cycle. Results: In total, 130 women were included in the study. A high success rate of 96.9% (95% CI: 92.3-99.2%) was observed. Success was most frequently observed on Day 8 (60.8%). Success rates were 100% for the age group of 18 to 25 years, approximately 96% for both the groups of 26-35 and 36-45 years, and around 50% for those aged >45 years. With regards to gestational age, success rates were 97.5% for <= 7 weeks (49 days) and 95.9% for >7 weeks (p = 0.63). Side effects were reported by 13.2% of participants (95% CI: 7.8-20.1%) and mainly involved the gastrointestinal system. Pain intensity was reported as moderate; analgesics were used by 75.4% of patients. The satisfaction rate for the medical abortion process was 95.4% (95% CI: 90.2-98.3%). Conclusions: Early-first-trimester medical abortion on an outpatient basis is a feasible, patient-friendly method with high efficacy, exhibiting limited side effects and a high satisfaction rate.