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Medical vs. Surgical Abortion: Comparing Efficacy, Acceptability, and Cost

The efficacy, patient acceptability, and cost of medical and surgical abortion were compared in this U.S. clinical trial. Of 947 women inquiring about a medical abortion or an abortion study, 50 agreed to be randomized to medical abortion (n=25) or surgical abortion (n=25). Of the remaining women, 329 chose a medical abortion; 568 chose a surgical abortion, continued the pregnancy, or experienced a miscarriage. Analysis was limited to the randomized patients. Pregnancies did not exceed 49 days' gestation, documented by vaginal ultrasound. Medical-abortion patients received oral methotrexate, followed 6 to 7 days later by self-administered vaginal misoprostol. Surgical-abortion patients underwent manual vacuum aspiration under local anesthesia.

Among medical-abortion patients, 20 (83%) experienced complete abortion by study day 15, 2 underwent surgical abortion, and 2 miscarried between days 15 and 36. One surgical-abortion patient experienced a hematometra that required reaspiration. Oral narcotics were used by more than three quarters of the medical-abortion group and by none of the surgical-abortion group.

Among women randomized to surgical abortion, 92% indicated they would choose that approach for a future abortion whereas only 63% of women randomized to medical abortion would choose that option again. Although the overall amount of staff time expended for the care of both groups was similar, the midlevel clinician (a physician assistant) spent more time with the medical-abortion patients whereas the physician spent more time with the surgical-abortion patients. Overall costs were approximately 10% higher for surgical abortions than for medical abortions.

Comment: The recruitment process for this study clarified that the majority of women seeking early abortions will indicate a preference of abortion method. For candidates who do not indicate a preference, these findings show that those having a medical abortion are less satisfied with their method, likely reflecting the great amount of pain and bleeding associated with this approach. Optimally, all women presenting for early abortion should be offered a choice of a medical or surgical approach.

— AM Kaunitz

Published in Journal Watch Women's Health February 6, 2001

Citation(s):

Creinin MD. Randomized comparison of efficacy, acceptability and cost of medical versus surgical abortion. Contraception 2000 Sep 62 117-124.

• Medline abstract (Free)