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In response to reports of serious infections occurring after medical abortions in five North American women , Planned Parenthood Federation of America (PPFA) changed its medical abortion protocol to buccal rather than vaginal administration of misoprostol (following oral ingestion of mifepristone). All PPFA centers that provided medical abortions also adopted either routine administration of doxycycline or universal chlamydia screening. After reviewing subsequent trends in serious infections following medical abortions, PPFA mandated universal antibiotic administration for women who underwent the procedure. Now, investigators have assessed trends in incidence of serious infections after medical abortions in relation to the changes in PPFA’s protocols. Incidence was tracked during Period 1 (vaginal misoprostol; neither chlamydia screening nor antibiotic prophylaxis mandated), Period 2 (buccal misoprostol; either routine chlamydia screening with treatment as indicated or universal antibiotic prophylaxis), and Periods 3 and 4 (buccal misoprostol; universal doxycycline administration [periods differed only in maximum gestational age at abortion]).

From January 1, 2005, to June 30, 2008, almost 228,000 eligible women underwent medical abortions at PPFA centers, and 92 serious infections were reported. During the course of the study, rates of serious infection among PPFA medical abortion patients fell from 0.89 per 1000 to 0.06 per 1000, a relative decrease of 93% (P<0.05). Between Periods 1 and 2, the relative decline in infection rates was greater with routine antibiotic administration than with the screen-and-treat approach (P=0.04).

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