A pilot study of acceptability of RU486 and ONO 802 in a Chinese population

Medical Abortion

OBJECTIVE

This guideline reviews the evidence relating to the provision of first-trimester medical induced abortion, including patient eligibility, counselling, and consent; evidence-based regimens; and special considerations for clinicians providing medical abortion care.

INTENDED USERS

Gynaecologists, family physicians, registered nurses, midwives, residents, and other healthcare providers who currently or intend to provide pregnancy options counselling, medical abortion care, or family planning services.

TARGET POPULATION

Women with an unintended first trimester pregnancy.

EVIDENCE

Published literature was retrieved through searches of PubMed, MEDLINE, and Cochrane Library between July 2015 and November 2015 using appropriately controlled vocabulary (MeSH search terms: Induced Abortion, Medical Abortion, Mifepristone, Misoprostol, Methotrexate). Results were restricted to systematic reviews, randomized controlled trials, clinical trials, and observational studies published from June 1986 to November 2015 in English. Additionally, existing guidelines from other countries were consulted for review. A grey literature search was not required.

VALUES

The quality of evidence in this document was rated using the criteria described in the Report of the Canadian Task Force for Preventive Medicine rating scale (Table 1).

BENEFITS, HARMS AND/OR COSTS

Medical abortion is safe and effective. Complications from medical abortion are rare. Access and costs will be dependent on provincial and territorial funding for combination mifepristone/misoprostol and provider availability.

SUMMARY STATEMENTS

Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care

RECOMMENDATIONS

Introduction Pre-procedure care Medical abortion regimens Providing medical abortion Post-abortion care.

Women's perceptions on medical abortion

The reasons why women choose medical abortion vary in different countries. In most countries, the most common reasons for choosing medical abortion are as follows: (a) avoidance of surgery or general anesthesia; (b) perception that it is safer; and (c) perception that it is more natural than a surgical procedure. In most studies, over 80% of women who chose medical abortion found it acceptable and would choose the same method again if they needed another abortion in the future. They would also recommend this procedure to other women who need an abortion. In selected women, the administration of misoprostol at home was also acceptable. The acceptability of medical abortion may decrease with increasing gestational age of pregnancy, failure of medical abortion, prolonged bleeding and high levels of discomfort and anxiety during the abortion procedure. There was no significant difference in the emotional responses or incidences of psychiatric morbidity between women undergoing medical and women undergoing surgical abortion.

Development and evaluation of the abortion attributes questionnaire

This paper describes the development and evaluation of the Abortion Attributes Questionnaire (AAQ), an instrument designed to assess the perceived importance of specific characteristics of abortion methods. Women receiving medical abortions (n=186) and women who chose surgical procedures (n=118) completed the AAQ. Participants were asked to rate how important each of 21 characteristics would be "when choosing between surgical and medical abortion." Factor analyses revealed that the AAQ consists of four factors and, as subscales, the factors have good internal reliability. The validity of the AAQ was established through discriminant function and analysis and results indicated that three of the four factors predicted choice. Taken together, these findings provide empirical support for the constructs measured by the AAQ.

The relationship of contextual factors to women's perceptions of medical abortion

This study explores how personal values and the social context of women's lives influence their perceptions of a new reproductive technology, medical abortion. The major objective is to examine the interrelationship between perceived attributes of medical abortion (number of clinic visits, availability early in pregnancy, seeing the expelled products of conception, and unfamiliar method) and the context of a woman's life. Data were collected in eight focus group interviews with a demographically diverse sample of 73 women who were potential users of mifepristone and were analyzed using content analysis techniques. Findings indicate that a woman's perceptions and choice of an abortion method are grounded in the circumstances of her life, and multiple factors enter into the decision-making process. Contextual and personal factors (residence, social support, cultural background, religion, ambivalence towards abortion, and employment) interact with specific attributes of the method to determine acceptability and choice.

Medical versus surgical abortion: a survey of knowledge and attitudes among abortion clinic patients

A survey of 405 abortion clinic patients identified confusion regarding the purpose of RU 486 and lack of commitment to required follow-up visits, suggesting a need for widespread educational efforts.

Listening and learning from women about mifepristone: implications for counseling and health education

The careful, reflective, and honest way in which the women in the study analyzed, questioned, and explored the benefits and disadvantages of a mifepristone abortion compared with vacuum aspiration yielded an extensive list of information needed by women to make informed choices as well as an understanding of the diverse social contexts in which choices are made. Needed information identified by this study included technical information about the drugs themselves and their mechanisms of action, roles and responsibilities of health personnel, and descriptions of other women's experiences with mifepristone. A multiplicity of factors entered the decision-making process, demonstrating at the same time a complexity and flexibility of thought. In their hypothetical evaluation of mifepristone, women weighed such factors as experience with childbirth, spontaneous abortion and vacuum aspiration, specific issues for teenagers, lack of a support system, experience with herbal emenagogues and nonprescription drugs intended as abortifacients, and the relative dependence on health care providers. Social, personal, and cultural factors entered into women's interpretation of the different options. These socio-cultural contexts can profoundly influence decisions and potentially affect clinical outcomes. If health care professionals are not proactive, do not fully provide answers to questions (even if unasked), and fail to probe for specific life circumstances, then poor choices and poor outcomes may follow with long term negative consequences for clients.(ABSTRACT TRUNCATED AT 250 WORDS)

RU 486: an alternative to surgical abortion

After 5 years of use in more than 100,000 European women, RU 486, an antiprogestin medication used as a medical abortifacient, has recently come under scrutiny in the United States. This article discusses the current and potential uses of RU 486. Also addressed are the history, advantages, and disadvantages of medical abortion (including the acceptability of the method from a woman-centered perspective); new clinical trials; and ethical issues.

RU486 combined with PGE1 analog in voluntary termination of early pregnancy--a comparison of recent findings with gemeprost or misoprostol

This paper addresses itself to comparing the findings from more recent studies on the termination of early pregnancy in women by a medical method involving a combination of RU486 and gemeprost (a PGE1 analog which is administered as a vaginal pessary) or RU486 and misoprostol (an orally active PGE1 analog). In particular, the data in these studies relating to (i) time to expulsion of the conceptus and (ii) duration of vaginal bleeding have been compared by statistical tests. It was shown that the shortest time to expulsion after PGE1 was when gemeprost was administered at 48hr following RU486. There was also an increased duration of bleeding with this treatment. These findings are discussed in relation to women's attitudes toward abortion methods especially in regard to preferring a decreased induction-abortion interval and a duration of bleeding of less than 14 days.

Comparison of medical abortion with surgical vacuum aspiration: women's preferences and acceptability of treatment

OBJECTIVES

To assess women's preferences for, and the acceptability of, medical abortion and vacuum aspiration in the early first trimester.

DESIGN

Patient centred, partially randomised trial. Medical abortion was performed with mifepristone 600 mg followed 48 hours later by gemeprost 1 mg vaginal pessary. Vacuum aspiration was performed under general anaesthesia.

SETTING

Teaching hospital in Scotland.

PATIENTS

363 women undergoing legal induced abortion at less than nine weeks' gestation.

MAIN OUTCOME MEASURES

Women's preferences for method of abortion before abortion; acceptability judged two weeks after abortion by recording the method women would opt to undergo in future and by semantic differential rating technique.

RESULTS

73 (20%) women preferred to undergo medical abortion, and 95 (26%) vacuum aspiration; 195 (54%) were willing to undergo either method, and were allocated at random. Both procedures were highly acceptable to women with preferences. Gestation had a definite effect on acceptability in randomised women; at less than 50 days there were no differences, but between 50 and 63 days vacuum aspiration was significantly more acceptable.

CONCLUSIONS

Women who wish to use a particular method should be allowed their choice, regardless of gestation. Women of 50-63 days' gestation without preferences for a particular method are likely to find vacuum aspiration more acceptable. A patient centred, partially randomised trial design may be a useful tool in pragmatic research.

Further acceptability evaluation of RU486 and ONO 802 as abortifacient agents in a Chinese population

Of 144 consecutive women who requested early induced abortion, 99 (68.7%) and 45 (31.3%) women chose RU486 combined with ONO 802 (medical method) and suction evacuation (surgical method), respectively. Logistic regression analysis of covariates showed that age and marital status were significantly correlated with the acceptability and hence the choice of the medical method. There were also more working women in this medical group. Previous experience of induced abortion had no influence on the current choice of the abortion method. This group of women appeared to have a tendency of treating their disease with medication rather than with surgery if the condition would allow. They expressed fear about surgery. The long induction-abortion interval of three days will have to be tolerated, but the duration of bleeding should be minimised in order to improve the acceptability of the drug. RU486 is an alternative abortion method which should be made widely available.

Conditions for choosing between drug-induced and surgical abortions

In France, pregnant women with amenorrhoea of no more than 49 days intending to terminate pregnancy can choose between a surgical abortion via vacuum aspiration under local or general anesthesia and a drug method combining Mifepristone orally administered (RU 486 degrees), with a prostaglandin analogue. This prospective survey was conducted to study the conditions under which women choose their abortion method, and to evaluate the acceptability of each method after the abortion. The data gathered from 488 women were analyzed according to their initial decision, and then according to the method actually used. The majority (62%) chose RU 486. The women's choice was found to be linked to sociodemographic characteristics such as age, education, occupation, geographic origin, and certain attitudes towards pregnancy, as well as to the individual criteria of each method. The women who chose the drug protocol had most often already made their decision before going to the family planning center (68%), having been advised by their doctor (20%). They were slightly less satisfied with the abortion experience than they had expected: 12.4% were unsatisfied in the RU group and 3.6% in the aspiration group. They needed more rest and quiet afterwards (50%) than the other women. They were distinguished by their desire to verify the expulsion (63%). The length of pregnancy is therefore not the only criterion to be considered when recommending one or other of these methods: the women concerned have different requirements and should have several possibilities to choose from.

RU 486/prostaglandin: considerations for appropriate use in low-resource settings

Antiprogestins represent a new class of promising drugs in fertility regulation, especially in early termination of pregnancy. RU 486 (mifepristone), manufactured by Roussel-Uclaf and marketed under the international trade name Mifegyne, is an antiprogestin tablet that is used sequentially with a prostaglandin for non-surgical termination of pregnancy. It has been chosen as a pregnancy termination method by over 100,000 women in France since its regulatory approval there in 1988. In addition, RU 486/prostaglandin was approved in July 1991 for use in the United Kingdom and an application for approval is being considered in Sweden. In Western Europe, it seems, RU 486/prostaglandin is increasingly accepted by medical experts, regulatory officials and women as an alternative to vacuum aspiration or dilation and curettage (D&C) for early pregnancy termination.

As the use of RU 486/prostaglandin becomes more established, health practitioners and women's health advocates are beginning to consider the feasibility of using this method for pregnancy termination in low-resource settings.