Termination of pregnancy with the mifepristone–misoprostol combination has greater risk for rare, short-term adverse events (SAEs) than a procedural induced abortion (IA), researchers report. “The current findings parallel those seen in the management of miscarriage, in which suction aspiration is associated with superior safety compared with mifepristone–misoprostol, in terms of fewer serious complications, including red blood cell transfusion, uterine perforation, hysterectomy, and intensive care unit admission, as well as in achieving complete miscarriage,” the authors add.
The population-based cohort study was conducted in Ontario using records for 39,856 women who were dispensed mifepristone–misoprostol as outpatients and 65,176 women undergoing procedural IA at 14 weeks’ gestation or earlier within nonhospital outpatient clinics (comparison 1) and 8,861 women undergoing ambulatory hospital-based procedural IA at an estimated 9 weeks’ gestation or less (comparison 2). The mean age of participants at the time of IA was about 29 years, one third were primigravidae, 6% resided in rural areas, and 25% resided in low-income neighborhoods.
Based on a primary composite outcome of any SAE (severe maternal morbidity, end-organ damage, intensive care unit admission, or death) within 42 days after IA, the authors found these results: “In comparison 1, SAEs occurred among 133 women after mifepristone–misoprostol IA (3.3 per 1000) versus 114 after procedural IA (1.8 per 1000) (relative risk [RR], 1.87 [95% CI, 1.44 to 2.43]; absolute risk difference [ARD], 1.5 per 1000 [CI, 0.9 to 2.2]). The respective rates of any adverse event were 28.9 versus 12.4 per 1000 (RR, 2.33 [CI, 2.11 to 2.57]; ARD, 16.5 per 1000 [CI, 14.5 to 18.4]). In comparison 2, SAEs occurred among 133 (3.4 per 1000) and 27 (3.3 per 1000) women, respectively (RR, 1.04 [CI, 0.61 to 1.78]). The respective rates of any adverse event were 31.2 versus 24.9 per 1000 (RR, 1.25 [CI, 1.04 to 1.51]).”
Editorial: Noting that this study found fewer than 6 deaths associated with abortion in Ontario from 2017 to 2020, an editorialist writes: “In the United States, abortion-related deaths are also extremely rare, but maternal deaths are not. When Roe v. Wade was decided in 1973, death from childbirth was estimated to be 4 times as likely as death from legal abortion. Afterward, as abortion became safer, childbirth apparently became more dangerous. Some observed increase may be related to improved reporting. However, it is unlikely that maternal deaths are overreported, and in 2019, maternal mortality (defined as death from a pregnancy-related cause during pregnancy or within 42 days after delivery) was the sixth leading cause of death among U.S. girls and women aged 15 to 34 years, accounting for more deaths among females in those ages than deaths from diabetes and cerebrovascular diseases combined. By 2020, maternal mortality had increased to be more than 50 times as deadly as abortion. Disadvantaged groups face an even greater risk. If all abortions had not occurred that year, maternal mortality could have been even higher, by 24% overall and by 39% for non-Hispanic Black women.…”