Do U.S. Medication Abortion Practices Follow Evidence-Based Guidelines?

Research is needed on optimal antibiotic and analgesic use
Research is needed on optimal antibiotic and analgesic use

Findings from a cross-sectional survey of U.S. and Canadian abortion facilities showed medication abortion practices were in line with evidence-based guidelines. The study, led by Heidi E. Jones, from CUNY School of Public Health, New York, was published in PLOS One.

A total of 703 abortion facilities in the U.S. and 94 in Canada were surveyed to estimate the prevalence of medication abortion practices and to compare the regional differences. Of these, 383 U.S. and 78 Canadian facilities responded. Between June to December 2013, facility administrators and clinicians (up to 5 per facility) answered questions on gestational limits and the number of abortions performed in 2012. At the time of the study, mifepristone was not approved in Canada. 

The data showed 95.3% of U.S. facilities offered first trimester medication abortion vs. 25.6% in Canada. Specifically, 85.4% of U.S. facilities offered medication abortion through 63 days last menstrual period (LMP) and 83.3% of Canadian facilities offered through 49 days LMP. 

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In Canada, all providers were physicians whereas nearly half (49.4%) were advanced practice clinicians in the U.S. In Canada, all providers used misoprostol; concomitant methotrexate was given 85.3% of the time. In the U.S., 91.4% of providers used mifepristone 200mg and misoprostol 800mcg, of which 96.7% were taken at home. 

In-person follow-up visits were required by over 75% of providers in both U.S. and Canada, which typically included an ultrasound. The majority of U.S. providers (87.7%) commonly prescribed antibiotics compared with 26.2% of Canadian prescribers; the most common treatments in the U.S. were 7-day doxycycline (64.2%) and azithromycin (2.91%) compared to metronidazole (31.2%), 1-day doxycycline (18.8%), or azithromycin (18.8%) in Canada. Non-steroidal anti-inflammatory drugs (NSAIDs) were the most commonly reported analgesic used with opioid prescriptions varying by region (56.3% U.S. vs. 13.1% Canada; P<0.001). 

Overall, the study authors found medication abortion practices adhered to evidence-based guidelines in the U.S. and Canada. "Efforts to update practice based on the latest evidence for reducing in-person visits and increasing provision by advanced practice clinicians could strengthen these services and reduce barriers to access," concluded Jones. More studies are needed on the best antibiotic and analgesic use, the authors added. 

For more information visit plos.org.