Early medical abortion (EMA) using mifepristone is an effective option with a favourable safety profile, according to the authors of the first large-scale Australian study of the drug published online by the Medical Journal of Australia.
The study analysed the outcomes of over 13 000 women who had an EMA (up to 63 days gestation) between 2009 and 2011 using mifepristone, which is also known as RU486. The data were collected from women who had EMAs at Marie Stopes International Australia (MSIA) clinics. MSIA doctors are among around 200 doctors around Australia who are authorised to prescribe mifepristone for EMA.
Dr Philip Goldstone, medical director of MSIA, and coauthors found that clinic administration of mifepristone and later self-administration of buccal misoprostol to complete the abortion process at home had a low failure rate (3.5%), and low rates of haemorrhage (0.1%) and known or suspected infection (0.2%). One woman, who did not seek medical advice despite signs of infection for a number of days, died from sepsis.
The authors found that the process was also well tolerated, with most women reporting the experience to be as they had expected or better than expected. “While the potential risk of serious infection should be kept in mind and monitored, these results indicate that the mifepristone – buccal misoprostol regimen is an effective option for Australian women seeking an abortion up to 63 days of gestation.”
In an editorial in the same issue, Cairns gynaecologists Professor Caroline de Costa and Dr Michael Carrette wrote that the findings backed up extensive overseas studies that had shown mifepristone to be both safe and effective for EMA.
However, they were concerned about some of the reported outcomes, which they said had implications for the national provision of mifepristone. It was vital that arrangements for emergency care in the rare event of complications were well documented. “Access to a telephone helpline alone is insufficient, especially for women in rural areas”, they wrote.
Also, not all women were suitable candidates for the procedure because the abortion is usually completed at the woman’s home. “Some women in poor socioeconomic circumstances and those who cannot find a suitable support person may be better served by surgical abortion”, the authors wrote.
Some women, such as those travelling long distances, might need to have the medical abortion in a day surgery, they noted.
“We look forward to EMA being available to all Australian women who request it, and wish to see EMA recognised as being as safe as a surgical alternative.”
Medical Journal of Australia