Clinical Question

Is same-day initiation of medication abortion safe and effective for early pregnancy of unknown location?

Bottom Line

The retrospective cohort study suggests that the same-day start of medication abortion is a reasonable option for more rapid pregnancy termination and exclusion of ectopic pregnancy for patients who had their last menstrual period within 42 days and initial ultrasonography results showing no gestational sac. Patients with major risk factors for or symptoms suggesting ectopic pregnancy were not eligible for same-day medication abortion. A larger randomized controlled trial is necessary to verify the relative effectiveness and safety of same-day initiation of medication abortion vs. delaying it until the diagnosis of intrauterine pregnancy. (Level of Evidence = 2b)

Synopsis

The study is a retrospective cohort of 452 patients with a positive pregnancy test result seeking medication abortion within 42 days of their last menstrual period. Initial ultrasonography showed no gestational sac (intrauterine or ectopic). Those with major risk factors for ectopic pregnancy (e.g., intrauterine device in situ, prior tubal surgery, prior ectopic pregnancy) were not eligible for same-day treatment and were excluded from the study. Of the study cohort, 55 (12%) had initial hCG testing and received same-day start of medication abortion at the discretion of the treating clinician using mifepristone, 200 mg orally, followed by misoprostol, 800 mcg orally within 48 hours, and serial quantitative human chorionic gonadotropin (hCG) testing. The remaining patients had hCG testing and were not treated until intrauterine or ectopic pregnancy was determined (i.e., delay-for-diagnosis group).