Safety and efficacy from very early medication abortion reported

Safety and efficacy from very early medication abortion reported | Image Credit: © ivanko80 - © ivanko80 - stock.adobe.com.

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

In 2023, there were 35,550 abortions performed in Sweden, with over 60% occurring before the end of the seventh week of pregnancy. Abortion is often performed after confirmation of intrauterine pregnancy through vaginal ultrasound. This delay is to ensure the pregnancy is not ectopic, defined by the embryo attaching outside the uterus.¹

Ectopic pregnancies may be life-threatening to women, with termination not performed medically. The pregnancy type may be determined by ultrasound when performed at 5 to 6 weeks of pregnancy.¹

According to Karin Brandell, gynecologist at Karolinska University Hospital and study author, many women seeking pregnancy termination want to receive the procedure as soon as possible. However, data about the effectiveness of very early abortion remains unclear.¹

Investigators conducted the very early medical abortion (VEMA) study with over 1500 women across 26 clinics. Participants were randomized to receive either early abortion in weeks 4 to 6 or delayed abortion in weeks 5 to 6. Abortion was performed using mifepristone and misoprostol in both groups.¹

Women in the study were up to 6 weeks pregnant and without ectopic pregnancy at the start of the study. Terminated pregnancy was reported as the primary outcome of the analysis.¹

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

In the early-start group, 1.3% of patients developed ectopic pregnancy, vs 0.8% of the standard group. One case of rupture before diagnosis was reported in the early-start group. Rates of serious adverse events were 1.6% in the early-start group and 0.7% in the standard group, with most being uncomplicated hospitalizations for ectopic pregnancy or incomplete abortion.²

These results indicated noninferiority from medication abortion performed before confirmation of intrauterine pregnancy vs standard, delayed treatment. Notably, the desire to receive an abortion as soon as possible was expressed in both groups, and the early-start group had reduced pain and bleeding.¹

According to Kristina Gemzell-Danielsson, professor of obstetrics and gynecology at Karolinska Institutet and project leadet of the VEMA study, safety and efficacy are similar even in undiagnosed ectopic pregnancies.¹

In the future, the researchers hope to determine the efficacy of a new combination of drugs for early abortion in patients with ectopic pregnancy. Additionally, new contraceptive methods are being developed using mifepristone, one of the key components of medical abortions. It may be taken in a lower dose than when used for medication abortion.¹

“Abortion is a political as well as medical issue,” said Brandell. “In Sweden, a woman can repeat the procedure a week after a failed early abortion. But a woman in Texas, where abortion is banned after the sixth week, can’t. It was therefore important to show that early abortion is equivalent to current standard procedure at a later stage of pregnancy.”¹

References

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