Several advantages when medical abortion is started at home
Being at home is as safe as at the hospital when a medical abortion after twelve weeks of pregnancy is initiated. These are the findings of a study conducted at Karolinska Institutet and the University of Gothenburg and published in The Lancet. When starting at home, day patient care is usually sufficient, and women are satisfied with the treatment.
In the case of medical abortion up to and including the tenth week of pregnancy, the procedure used is a so-called home abortion. At ten to twelve weeks, day patient care is most commonly used, while s medical abortion after twelve weeks of pregnancy may have a longer course requiring an overnight stay in hospital.
The current study included 457 women in Sweden who were planning to have a medical abortion after 12 weeks of pregnancy. The treatments in the study were conducted in 2019-2022. The aim was to investigate the need for hospitalization if treatment was started at home.
About half of the participants were randomly assigned to take the first dose of the abortion medicine misoprostol at home in the morning, two hours before admission to the gynecological hospital ward. Others were randomized to follow the usual healthcare routine and take the first dose after arrival on the ward.
Benefits in the home group
The researchers measured how many people suffered a complication or needed surgical intervention in connection with the abortion. Participants' pain was assessed repeatedly during treatment, and specific satisfaction surveys were also conducted.
The results show that 71 percent of those who initiated their abortion at home could be treated as day patients, compared to 46 percent of those who started in hospital, which is a statistically significant result.
The incidence of severe complications during and after the abortion was low, and the proportion of participants requiring surgical intervention was 6.4 percent in the home group and 8.5 percent in the hospital group, confirming previous research in this area.
The majority of study participants were very satisfied with the treatment; 86 percent in the home group and 81 percent in the hospital group. However, significantly more people in the home group, 78 percent, preferred the treatment they were randomized to, compared to 49 percent in the hospital group.
The researchers assess that a higher proportion of patients would only need day patient care for a medical abortion after 12 weeks of pregnancy if they were offered to take the first dose of misoprostol at home. A change that can bring several benefits.
“Providing day patient care for this group of patients could allow countries with limited access to inpatient treatment to expand their abortion care. Day patient care is also potentially less costly for both the healthcare system and the individual patient. Being able to start their own medical treatment at home also promotes patient autonomy,” says Kristina Gemzell Danielsson, Professor at the Department of Women's and Children's Health, Karolinska Institutet, who led the study.
The study included Danderyd Hospital, Karolinska University Hospital, Sahlgrenska University Hospital, Södersjukhuset and Örebro University Hospital.
Publication
“A Randomised Trial of First dose of Misoprostol Administration at Home or in Hospital for Medical Abortion between 12-22 gestational weeks - The PRIMA (PRIMing At home) Trial”, Johanna Rydelius, Helena Hognert, Helena Kopp-Kallner, Karin Brandell, Joanna Romell, Karin Zetterström, Pia Teleman, Kristina Gemzell-Danielsson, The Lancet, online August 30, 2024.