Health sites :-
Enhancing the Safety of Medical Abortion :-
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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