At-home misoprostol increases rate of day-care procedures and patient satisfaction in late medical abortion

1. 71% of home group patients and 46% of hospital group patients completed abortion as a day-care procedure.

2. Majority of adverse events were mild-to-moderate with no fatalities reported.

Evidence Rating Level: 1 (Excellent)

Study Rundown: Medical abortion after three months has traditionally required hospital admission. Studies suggest that administering the first dose of misoprostol at home could increase the rate of day-care procedures, reduce hospital stays, and improve patient satisfaction. This randomized controlled trial aimed to compare home versus hospital misoprostol administration in pregnant women undergoing abortion. The primary outcome was the proportion of day-care procedures, defined as abortions completed within nine hours, while a key secondary outcome was patient safety. According to study results, home misoprostol administration increased the proportion of day-care procedures compared to hospital administration. Although this study was well done, it was limited by an inability to mask participants and healthcare providers due to the nature of the intervention.

Click to read the study in The Lancet

Relevant Reading: A Comparison of Medical Management with Misoprostol and Surgical Management for Early Pregnancy Failure

In-depth [randomized controlled trial]: Between Jan 8, 2019, and Dec 21, 2022, 871 patients were assessed for eligibility across 6 hospitals in Sweden. Included were patients ≥ 18 years old undergoing medical abortion between 85-153 days of pregnancy. Altogether, 457 patients (220 in the home group and 215 in the hospital group) were included in the final analysis. Significantly more abortions were completed as day-care procedures in home group than in hospital group (71% vs. 46%, 95% confidence interval [CI] 15.4-34.3, p<0.0001). 22% (97 of 444) patients experienced an adverse event, with 2% aborting after mifepristone only. There were no differences in adverse events between groups. Findings from this study suggest that home administration of misoprostol increases the rate of day-care procedures in medical abortion after 12 gestational weeks, providing a safe and effective alternative to in-clinic protocols.

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