Expanding a woman's options to include home use of misoprostol for medical abortion up until 76 days: an observational study of efficacy and safety

INTRODUCTION: Home use of misoprostol for medical abortion is increasingly being practiced. With gestational length up to 70 days, it is considered effective, safe and acceptable by women. Knowledge of safety and efficacy with longer gestations is limited and studies are required to expand women's options to include this method of abortion. MATERIAL AND METHODS: A retrospective cohort study was designed to compare home use of misoprostol for medical abortion at gestational length 64-76 days to its use at 57-63 days. Primary outcome was success rate. Success was defined as complete uterine evacuation without the need of surgical intervention due to incomplete abortion and no failed abortion with ongoing pregnancy. Secondary outcomes were rates of unscheduled return visits, telephone consultations, admissions to hospital, infections and the need for blood transfusion. RESULTS: We included 397 women, 270 within 57-63 days of gestation and 127 within 64-76 days of gestation at abortion. Success rate was 95.6% at 57-63 days and 93.7% at 64-76 days. The difference was not statistically significant (P = .431). The rate of unscheduled return visits was high overall but not significantly different in relation to gestational length at abortion (> 63 days; 20.5% vs < 64 days; 16.3%, P = .308). CONCLUSIONS: Our study indicates that home use of misoprostol for medical abortion at 64-76 days gestation may be as safe and effective as at 57-63 days. Further studies with larger sample sizes are needed to confirm our findings and to explore the acceptance of and experiences among women performing abortion at home at greater gestational length, before further implementation in clinical practice.