The safety and efficacy of early abortion medications have been reported

Medical abortion is safe and effective even when performed before the sixth week of pregnancy, according to a recent study published in New England Journal of Medicine.¹

In 2023, there were 35,550 abortions in Sweden, and more than 60% occurred before the seventh week of pregnancy. Abortion is usually performed after confirmation of an intrauterine pregnancy by ultrasound. This delay is to ensure that the pregnancy is not ectopic, defined by the embryo sticking outside the uterus.¹

Ectopic pregnancy may be life-threatening for women, if the termination is not done with medicine. The type of pregnancy can be determined by ultrasound when it is done at 5 to 6 weeks of pregnancy.¹

According to Karin Brandell, a gynecologist at the Karolinska University Hospital and the author of the study, many women who want to terminate a pregnancy want to get this procedure as soon as possible. However, the data on the effectiveness of early abortion remain unclear.¹

Researchers conducted the Very Early Medical Abortion Study (VEMA) with more than 1,500 women at 26 clinics. Participants had access to an abortion 4 weeks to 6 or delayed abortion by 5 to 6 weeks. Abortion was performed using mifepristone and misoprostol in both groups.¹

The women in the study were 6 weeks pregnant and had no ectopic pregnancy at the start of the study. Terminated pregnancy was recorded as the primary outcome of the study.¹

Of the 1504 participants, 754 were in the early group and 750 were in the normal group.² A successful abortion rate of 95.2% was reported in the initiation group during the intention-to-treat analysis, vs 95.3% in the standard group. This showed an overall difference between the group of -0.1%.

In the initial group, 1.3% of patients developed an ectopic pregnancy, vs 0.8% of the normal group. One case of prediagnosis eruption was reported in the first cohort. The rates of serious adverse events were 1.6% in the early initiation group and 0.7% in the standard group, with most of them being uncomplicated hospitalizations for ectopic pregnancy or incomplete abortion.²

These results showed non-inferiority from abortion drugs prior to confirmation of intrauterine pregnancy versus conventional treatment, delayed. Clearly, the desire to abort as soon as possible was expressed in both groups, and the first group had less pain and bleeding.¹

According to Kristina Gemzell-Danielsson, professor of obstetrics and gynecology at Karolinska Institutet and project leader of the VEMA study, safety and efficacy are the same even in unrecognized ectopic pregnancy.¹

In the future, researchers hope to find the effectiveness of a new combination of drugs for early abortion in patients with ectopic pregnancy. In addition, new birth control methods are being developed using mifepristone, which is one of the important components of medical abortion. It can be taken at a lower dose than when used for medical abortion.¹

“Abortion is a political issue as well as a medical issue,” said Brandell. “In Sweden, a woman can repeat this procedure a week after she fails to have an early abortion. But a woman in Texas, where abortion is prohibited after the sixth week, cannot. and it was important to show that early abortion is equivalent to the current standard practice during pregnancy.”¹

References

1. Early medical abortion is very effective and safe. EurekAlert. November 6, 2024. Accessed November 7, 2024.
2. Brandell K, Jar-Allah T, Reynolds-Wright J, et al. A randomized trial of very early medical abortion. New England Journal of Medicine. 2024;391(18):1685-1695. doi:10.1056/NEJMoa2401646