Acceptability, efficacy and safety of medical abortion in a Romanian private practice clinic
ESC Congress Library. Blidaru I. May 4, 2016; 126837; A-010
Assoc. Prof. Iolanda E. Blidaru
Assoc. Prof. Iolanda E. Blidaru
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Abstract
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Introduction. Abortion on demand is legally approved in Romania until up to 14 weeks of amenorrhea. It may be provided only by obstetrician-gynecologists, both in public hospitals and in private outpatient offices. Medical abortion, using mifepristone and misoprostol, is approved in Romania since 01.02.2009. This study aims to evaluate the acceptability, efficacy, and safety of early medical abortion, performed in a private outpatient clinic in the North East of Romania.

Design and methods. Two endovaginal ultrasound exams were performed. The first assessed the intrauterine gestation and dated the pregnancy; the second confirmed the ovular sac expulsion after the procedure. Medical abortion, with mifepristone 200mg followed by misoprostol 400µg/800µg after 48 hours, was proposed for pregnancies aged between 5 weeks and 63 days of amenorrhea.

Results. 1350 first-trimester induced abortions were performed during 52 months in a private clinic in Iasi, Romania. Of these, 320 patients (23.7%), aged 16 – 46, were suitable and accepted the medical abortion method, but only 292 (91.25%) completed the procedure. Two patients vomited the mifepristone and asked for termination by suction curettage; 25 patients (7.8%) expulsed the ovular sac before taking the misoprostol dose; and one patient didn’t return for the misoprostol dose. From this last group, 269 (92%) expulsed the ovular sac during the first week; 23 patients were submitted to conventional suction termination, because expulsion of the ovular sac did not produce during the next seven days in 22 cases; and because one patient had important bleeding during the expulsion. At the end of the treatment phase, the patients evaluated the procedure. Common complaints related to the procedure were: pelvic pain (75%; n=219), chills without fever (71.91%; n=210), nausea without vomiting (8.56%; n=25), and severe vomiting in one patient. Accompanying bleeding was evaluated as moderate by most patients (88.7%; n=259). 13 patients presented persistent bleeding for 2-3 weeks after expulsion, requiring curettage.

Conclusions. Medical abortion was shown to be an acceptable, efficient, and safe procedure. However, it does not currently represent the first option for our patients, because they consider it expensive, they are not informed about, and many are not able to complete the procedure. It may become a preferred method for early termination of pregnancy in Romania, if women would become more aware of its advantages. They also should be convinced it cannot replace the need for contraception.

 

 

Key words: medical abortion, family planning, abortion on demand

 

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