Options for early therapeutic abortion - A comparative review

Vacuum aspiration, either manual or electric, has for many years been the most commonly used method for termination of an early pregnancy. More recently, new medical methods have been developed which for many women are attractive alternatives to the surgical procedure. The compounds mainly used are prostaglandin analogues, methotrexate, and mifepristone in combination with a suitable prostaglandin analogue. However, only the last method has been registered for routine clinical use. The treatment schedule mainly used is mifepristone 200 to 600mg followed 36 to 48 hours later by oral misoprostol 0.4 to 0.6mg in pregnancies up to 49 days and vaginal gemeprost 1.0mg or misoprostol 0.8mg if the treatment period is extended to 63 days of amenorrhoea. The ability to compare medical and surgical methods is limited by the fact that there are few randomised studies and the definitions of successful outcome (complete abortion), adverse effects and complications vary from one study to the other. Experience with the method used is also important for the outcome. However, it seems adequate to state that the medical method is equally, or almost equally, as effective as vacuum aspiration. Duration of bleeding and amount of blood loss is greater following medical abortion. Also the frequency of uterine pain, vomiting and diarrhoea is higher following medical abortion than following vacuum aspiration. On the other hand, the frequency of major complications such as excessive bleeding, blood transfusion and pelvic infection does not seem to differ between the two procedures. Surgical complications, for example, uterine perforation and cervical tears, are obviously not a risk associated with medical abortion. Both methods are equally well accepted provided the woman is allowed to choose. It is not possible to state which method is best. Medical termination of early pregnancy will not replace, but is an alternative to, vacuum aspiration and ideally both methods should be available to give the woman a choice.