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Changes Reduced Infections From Medical Abortion

Differences in drug use, delivery made a measurable impact in Planned Parenthood study

WEDNESDAY, July 8 (HealthDay News) -- Two changes to the way Planned Parenthood clinics perform medical abortion resulted in a 93 percent drop in the rate of serious infections, a new report says.

The changes involved administering the drug misoprostol to the area between the gum and the cheek (buccal administration), not the vagina, and introducing routine treatment with antibiotics.

"Planned Parenthood is very happy with the regimen," said Mary Fjerstad, lead author of a paper appearing in the July 9 issue of the New England Journal of Medicine.

"We've got the same head-to-head efficacy as with vaginal delivery and a significant reduction in infections. And, since we added antibiotics, we have a further drop in serious infections," added Fjerstad, a nurse practitioner who was director of clinical quality improvement at the Planned Parenthood Federation of America when the study was conducted. She is now a senior clinical advisor at Ipas, a nonprofit organization in El Cajon, Calif., dedicated to increasing women's sexual and reproductive rights.

Some 300 Planned Parenthood clinics in the United States provide medical abortion, which is an abortion induced by medication rather than surgery.

There are three methods of medical abortion: misoprostol alone; methotrexate followed by misoprostol; and mifepristone (the so-called "abortion pill") followed by misoprostol. The combination of mifepristone and misoprostol is the most commonly used method. Mifepristone received approval from the U.S. Food and Drug Administration for use in medical abortion in 2000.

From 2001 to March of 2006, Planned Parenthood health clinics generally provided medical abortions with a combination of mifepristone, given orally, followed 24 to 48 hours later with misoprostol administered vaginally.

Prior research had shown that the combination was successful in inducing abortions in 98.5 percent of cases.

But in 2005, authorities reported the deaths of five North American women from an otherwise rare bacterial infection -- Clostridium sordellii -- within a week of taking mifepristone.

In 2006, Planned Parenthood substituted buccal misoprostol for vaginal misoprostol along with either antibiotics or screening and treatment for chlamydia, a sexually transmitted bacteria.

The following year, the organization started requiring antibiotics for all medical abortions. Antibiotics have been shown to reduce infection rates after an abortion by 42 percent, the report said.

The authors reviewed the rate of serious infections after medical abortions in more than 227,000 women, comparing the risk in women to whom misoprostol was given vaginally (up to March 2006) with those who received buccal administration in concert with antibiotics.

The rate of serious infections dropped 73 percent from 0.93 per 1,000 abortions before introduction of buccal administration along with antibiotics or STD screening to 0.25 per 1,000 abortions after the switch, the researchers found. Adding antibiotics to the protocol dropped the rate of serious infections a further 76 percent.

The findings in this paper essentially validate Planned Parenthood's recent changes, Fjerstad said.

"Unless there was compelling evidence to the contrary, we just don't see any reason to make a change," she said.

Wendy Wright is executive vice president of Concerned Women for America, an organization that opposes abortion.

"This study…shows that the RU-486 [mifepristone] and misoprostol regimen can still cause serious complications to patients," Wright said. "While taking misoprostol orally rather than vaginally may reduce the risk, it does not eliminate consequences."

More information

For more on medical and surgical abortion, visit the University of California, San Francisco.

SOURCES: Mary Fjerstad, N.P., M.H.S., senior clinical advisor, Ipas, El Cajon, Calif.; Wendy Wright, executive vice president, Concerned Women for America, Washington, D.C.; July 9, 2009, New England Journal of Medicine

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