Medical versus surgical termination of early pregnancy: satisfaction with care, emotional impact and acceptability of the procedure

Authors

  • Prasanna L. Akkenapally Department of Obstetrics and Gynaecology, Kamineni Academy of Medical Sciences and Research Centre Hyderabad, Telangana, India
  • Vasundhara Kamineni Department of Obstetrics and Gynaecology, Kamineni Academy of Medical Sciences and Research Centre Hyderabad, Telangana, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20163005

Keywords:

Early abortion, Psychological impact, Preference

Abstract

Background: Aim of the study was to compare the satisfaction with care and acceptability of the procedure next time between medical and surgical termination of pregnancy (TOP) and the factors affecting it.

Methods: This is a prospective observational study conducted at Jyothi Maternity Centre, a project of population health services of India (PHSI). Total 213 women were included in the study, of these 108 women received medical termination of pregnancy (MTOP) and 105 received surgical termination of pregnancy (STOP). Questionnaires regarding satisfaction with care, experience of care, psychological rating scales and acceptability were given at the follow- up visit at two weeks. The data was collected and computed for statistical analysis.

Results: Women in both the groups were similar with respect to age, marital status, socioeconomic status, educational status and parity. The mean age was 24 years. The success rate with STOP (100%) was more than MTOP (79.6%), with p -value of 0.001. The experience of care comparing the semantic variables showed MTOP to be less painful and safer, while STOP was good and faster. The total mean impact scores and depression scores of MTOP were higher than STOP and it was statistically significant with p- values of 0.010 and < 0.001 respectively. The acceptability rate with MTOP was 79.6% and with STOP 95.2%.

Conclusions: Satisfaction with both the methods of medical and surgical abortion is high. Acceptability of the procedure next time was more with surgical abortion. MTOP had higher emotional impact.

References

Bruyn MD. The acceptability and accessibility of safe abortion: a literature review. Knowledge. hivos; 2015. Available at https://www.researchgate.net/publication/274082829_The_acceptability_and_accessibility_of_safe_abortion_A_literature_review.

Guttamacher institute and WHO. facts on induced abortion world-wide. Fact Sheet. Geneva, WHO, 2012. Available at https://www.guttmacher.org/fact-sheet/facts-induced-abortion-worldwide.

Kulier R, Kapp N, Gülmezoglu AM, Hofmeyr GJ, Cheng L, Campana A. Medical methods for first trimester abortion. Cochrane database syst. Rev., Chichester, UK: John Wiley and Sons, Ltd; 2011;9(11):CD002855.

Winikoff B, Dzuba IG, Creinin MD, Crowden WA, Goldberg AB, Gonzales J, et al. Two distinct oral routes of misoprostol in mifepristone medical abortion. Obstet Gynecol. 2008;112(6):1303-10.

Von Hertzen H, Huong NTM, Piaggio G, Bayalag M, Cabezas E, Fang AH, et al. Misoprostol dose and route after mifepristone for early medical abortion: a randomised controlled noninferiority trial. BJOG An Int J Obstet Gynaecol. 2010;117(10):1186-96.

Creinin MD, Grossman DA. Society of Family Planning. American college of obstetricians and gynaecologists. Practice Bulletin No. 143: medical management of first-trimester abortion. Obstet Gynecol. 2014;123(3):676-92.

Chai J, Wong CYG, Ho PC. A randomized clinical trial comparing the short-term side effects of sublingual and buccal routes of misoprostol administration for medical abortions up to 63 days gestation. Contraception. 2013;87(4):480-5.

Raymond EG, Shannon C, Weaver MA, Winikoff B. First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review. Contraception. 2013;87(1):26-37.

World Health Organisation (WHO). Safe abortion: Technical and policy guidance for health systems. second edi. Geneva, WHO; 2003. Avaialble at http://apps.who.int/iris/bitstream/10665/70914/1/9789241548434_eng.pdf3.

Guerrero JM, Castaño PM, Schmidt EO, Rosario L, Westhoff CL. Music as an auxiliary analgesic during first trimester surgical abortion: a randomized controlled trial. Contraception. 2012;86(2):157-62.

Borgatta L, Kattan DR, Stubblefield PG. Surgical techniques for first-trimester abortion. Glob Libr Women’s Med. [ISSN:1756-2228(tel:1756-2228)];2012. Available at http://www.glowm.com/section_view/heading/Surgical%20Techniques%20for%20First-Trimester%20Abortion/item/439.

Ware JE, Hays RD. Methods for measuring patient satisfaction with specific medical encounters. Med Care. 1988;26(4):393-402.

Henshaw RC, Naji SA, Russell IT, Templeton AA. Comparison of medical abortion with surgical vacuum aspiration: Women’s preferences and acceptability of treatment. BMJ 1993;307:714-7.

Rosén AS, Nystedt L, Bygdeman M, Lundström V. Acceptability of a nonsurgical method to terminate very early pregnancy in comparison to vacuum aspiration. Contraception. 1979;19(2):107-17.

Horowitz M, Wilner N, Alvarez W. Impact of event scale: a measure of subjective stress. Psychosom Med. 1979;41:209-18.

Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-70.

Rausch M, Lorch S, Chung K, Frederick M, Zhang J, Barnhart K. A cost-effectiveness analysis of surgical versus medical management of early pregnancy loss. Fertil Steril. 2012;97(2):355-60.

Wu JP, Godfrey EM, Prine L, Andersen KL, MacNaughton H, Gold M. Women’s satisfaction with abortion care in academic family medicine centres. Fam Med. 2015;47(2):98-106.

Woldetsadik MA, Sendekie TY, White MT, Zegeye DT. Client preferences and acceptability for medical abortion and MVA as early pregnancy termination method in Northwest Ethiopia. Reprod Health. 2011;8:19.

Rodriguez M, Seuc A, Kapp N, von Hertzen H, Huong N, Wojdyla D, et al. Acceptability of misoprostol-only medical termination of pregnancy compared with vacuum aspiration: an international, multicentre trial. BJOG An Int J Obstet Gynaecol. 2012;119(7):817-23.

Broen A, Moum T, Bødtker A, Ekeberg Ø. The Course of mental health after miscarriage and induced abortion: a longitudinal, five year follow-up study. BMC Med. 2005;3:18.

Crandell L. Psychological outcomes of medical versus surgical elective first trimester abortion. Nurs Womens Health. 2012;16:296-307.

Loeber OE. Motivation and satisfaction with early medical versus surgical abortion in the Netherlands. Reprod Health Matters. 2010;18:145-53.

Downloads

Published

2017-02-03

Issue

Section

Original Research Articles