Early abortion has been found to be effective and safe

Clinics and hospitals currently refuse to perform medical abortions until an ultrasound scan confirms an intrauterine pregnancy. However, a large international study led by researchers at the Karolinska Institutet now shows that the treatment can be equally effective and safe even before the sixth week of pregnancy. The study was published in The New England Journal of Medicine.

A total of 35,550 abortions occurred in Sweden in 2023; more than 60% of them before the end of the seventh week of pregnancy.

Usually, this procedure is held until the intrauterine pregnancy is confirmed by ultrasound of the vagina to rule out the possibility of an ectopic pregnancy, in which the fetus is standing outside the uterus, usually in the fallopian tubes. Ectopic pregnancy cannot be terminated by medical abortion and can be life-threatening for the woman. Ultrasound reveals pregnancy in the fifth to sixth week.

“Most women find out very quickly if they are pregnant, and most of them know if they want an abortion, and if so, they want it to happen as soon as possible,” says the first author of study Karin Brandell, gynecologist at Karolinska University. Hospitalist and medical student at the Department of Women’s and Children’s Health, Karolinska Institutet, Sweden.

“Observational studies have produced conflicting results regarding effectiveness, so we wanted to learn if early abortion is as effective and safe as waiting.”

Women from nine countries

The VEMA (Very early medical abortion) study included more than 1,500 women in 26 clinics in nine countries who requested an abortion before an ultrasound could confirm an intrauterine pregnancy. They were randomly assigned to either a delayed abortion as soon as the pregnancy was confirmed in utero (in the fifth to sixth week) or an early abortion (in the fourth to sixth week). . Both groups received two drugs—mifepristone and misoprostol.

At the start of the study, all participants were six weeks pregnant and did not develop symptoms of ectopic pregnancy (eg, abdominal pain or bleeding) or risk factors for an ectopic pregnancy. such (for example, pregnancy despite the colon or ectopic pregnancy). The outcome measure was termination of pregnancy (total abortion).

Kristina Gemzell-Danielsson, professor of obstetrics and gynecology at the same department of Karolinska Institutet, senior physician at Karolinska University Hospital, says: “Medical abortion was effective and safe to perform. , even during an unknown pregnancy and the leader of the VEMA study.

A political issue

In both groups, more than 95% of women had a complete abortion, but the number of failed procedures was different between the groups. With delayed treatment, treatment was incomplete in 4.5% of cases and required additional vacuum aspiration (surgery). In 0.1% of cases, the pregnancy continued.

In the first group, pregnancy continued in 3% of cases and 1.8% required surgery for incomplete abortion. A total of 1% of all participants had an ectopic pregnancy.

Women in the first group reported less pain and bleeding. In both groups, women also stated that they wished to have an abortion as soon as possible.

Dr. “Abortion is a political issue as well as a medical one,” says Brandell. “In Sweden, a woman can repeat the procedure a week after she fails to have an early abortion. But a woman in Texas, where abortion is prohibited after the sixth week, cannot able. It was therefore important to show that early abortion is now a common practice at the end of pregnancy.”

Abortion is better than contraception

Now researchers want to test whether the new combination of drugs for early abortion also works for ectopic pregnancy. They are also developing new contraceptives based on one of the current medical abortion components, mifepristone.

Professor Gemzell-Danielsson says: “It can be taken at a lower dose than abortion to prevent unwanted pregnancy with one tablet a week, or as needed.