PREGNANT people who took the first dose of misoprostol at home had an increased chance of completing their care in hospital within 9 hours when having an abortion after 12 weeks. A medical abortion involves taking two pills: mifepristone and misoprostol. Mifepristone is commonly administered at a clinic for abortions after 12 weeks, with the first dose of misoprostol being administered one or two days later. Subsequent additional doses are administered every few hours until the abortion is complete. The present research hypothesised that administering the first dose of misoprostol at home, rather than in the hospital, could increase the rate of day-care procedures, where the abortion is completed in less than 9 hours. It could also reduce the length of inpatient stay and improve patient satisfaction.
This was a multicentre, open label, randomised controlled trial conducted at six hospitals in Sweden. The trial included pregnant people aged 18 and older, between 85 to 153 days of gestation. Participants were randomised in a 1:1 ratio to receive mifepristone in-clinic, followed by either home or hospital administration of the first dose of misoprostol. The primary outcome measured was the proportion of abortions completed as day-care procedures. The intention-to-treat analysis included all participants with known primary outcomes, and safety analyses included all treated individuals.
A total of 457 participants were randomised between January 2019 and December 2022. In the intention-to-treat population, 220 participants were assigned to the home group and 215 to the hospital group. The day-care abortion rate was significantly higher in the home group, with 71% (156/220) completing the procedure as day-care patients, compared to 46% (99/215) in the hospital group. The difference was statistically significant (95% CI, 15.4–34.3; p<0.0001). In the safety analysis, 22% (97/444) of participants experienced an adverse event, and 2% (7/444) aborted after taking only mifepristone.
The research team therefore conclude that administering the first dose of misoprostol at home significantly increases the proportion of day-care procedures in medical abortions after 12 gestational weeks. This method could offer a safe and effective alternative to in-clinic protocols, potentially reducing the need for prolonged hospital stays.
Abigail Craig | EMJ
Reference
Rydelius J et al. First dose of misoprostol administration at home or in hospital for medical abortion between 12-22 gestational weeks in Sweden (PRIMA): a multicentre, open-label, randomised controlled trial. Lancet. 2024;404(10455):864-73.
