Blanchard Kelly, Lince-Deroche Naomi, Fetters Tamara, Devjee Jaymala, de Menezes Ilundi Durão, Trueman Karen, Sudhinaraset May, Nkonko Errol, Moodley Jack
Ibis Reproductive Health, 17 Dunster St, Suite 201, Cambridge, MA 02138, USA.
Ibis Reproductive Health, PO Box 1985, Parklands, 2121, Johannesburg, South Africa.
Contraception. 2015 Oct;92(4):330-8. doi: 10.1016/j.contraception.2015.07.001. Epub 2015 Jul 7.
Examine the feasibility of introducing mifepristone-misoprostol medication abortion into existing public sector surgical abortion services in KwaZulu-Natal, South Africa.
Cohort study of women offered medication or surgical abortion in a larger medication abortion introduction study. The sample included 1167 women seeking first-trimester abortion at four public sector facilities; 923 women at ≤9 weeks' gestation were eligible for medication abortion. Women who chose medication abortion took 200 mg of mifepristone orally at the facility and 800 mcg of misoprostol buccally (or vaginally if they anticipated or experienced problems with buccal administration) 48 h later at home, based on international research and global safe abortion guidelines. Women who chose surgical abortion received 600 mg of misoprostol sublingually or vaginally on the day of their procedure followed by manual vacuum aspiration 4 h later. Main outcome measures included proportion of eligible women who chose each method, proportion with complete abortion and proportion reporting adverse events.
Ninety-four percent of eligible women chose medication abortion. No adverse events were reported by women who chose surgical abortion; 3% of women in the medication abortion group reported adverse events and 0.4% reported a serious adverse event. Seventy-six percent of women received a family planning method at the facility where their received their abortion, with no difference based on procedure type. Medication abortion patients were significantly more likely to report they would choose this method again (94% vs. 78%, p<.001) and recommend the method to a friend (98% vs. 84%, p<.001).
Medication abortion was successfully introduced with low and acceptable rates of adverse events; most women at study facilities chose this option.
Mifepristone-misoprostol medication abortion was successfully integrated into public sector surgical abortion services in South Africa and was chosen by a large majority of women who were eligible and offered choice of early termination method; access to medication abortion should be expanded in South Africa and other similar settings.
研究在南非夸祖鲁 - 纳塔尔省现有的公共部门手术流产服务中引入米非司酮 - 米索前列醇药物流产的可行性。
在一项更大规模的药物流产引入研究中，对接受药物流产或手术流产的女性进行队列研究。样本包括1167名在四个公共部门机构寻求早期流产的女性；923名妊娠≤9周的女性符合药物流产条件。根据国际研究和全球安全堕胎指南，选择药物流产的女性在机构口服200毫克米非司酮，48小时后在家中口服800微克米索前列醇（如果预计或经历口腔给药问题则经阴道给药）。选择手术流产的女性在手术当天舌下或经阴道给予600毫克米索前列醇，4小时后进行人工负压吸引。主要结局指标包括选择每种方法的符合条件女性的比例、完全流产的比例以及报告不良事件的比例。
94%符合条件的女性选择了药物流产。选择手术流产的女性未报告不良事件；药物流产组3%的女性报告了不良事件，0.4%报告了严重不良事件。76%的女性在接受流产的机构接受了计划生育方法，且基于流产方式类型无差异。药物流产患者更有可能报告她们会再次选择这种方法（94%对78%，p<0.001）并向朋友推荐这种方法（98%对84%，p<0.001）。
药物流产成功引入，不良事件发生率低且可接受；研究机构中的大多数女性选择了这种方式。
米非司酮 - 米索前列醇药物流产成功纳入南非公共部门手术流产服务，并且大多数符合条件并可选择早期终止方法的女性选择了它；南非和其他类似环境应扩大药物流产的可及性。
