More office-based physicians offering mifepristone. (Few Adverse Events).
These are the numbers that were reported at the annual meeting of the Association of Reproductive Health Professionals.
A reassuringly low rate of adverse events (<0.2% ) has led to a burgeoning interest in providing medical abortion, not just at family planning and abortion clinics, but also among physicians in solo or group practice, said Heather O'Neill, director of public affairs for Danco Laboratories, which manufactures mifepristone under the brand name Mifeprex.
Sales of the drug increased 33% in the first 6 months of 2002, compared with 2001, Ms. O'Neill said. Since providers order Mifeprex directly from the manufacturer, the company can track what types of providers are relying on it.
Although Planned Parenthood clinics and abortion providers associated with the National Abortion Federation are the highest-volume providers of medical abortion, "many, many private physicians" are now offering the service, and the number is growing, according to Ms. O'Neill.
Among 139 reported adverse events, 29 have involved hospitalization of a patient. Thirteen women have required multiple unit transfusions, most more than 10 days after the two-step process, which involves taking mifepristone orally and then, several days later, using misoprostol vaginally. Delayed bleeding, even 5-6 weeks after the procedure, has been reported and has prompted heightened efforts to alert patients to return for care in such cases.
Other adverse events have included the need for suction curettage in 39 patients, infection in 10, allergic skin reactions in 6, ectopic pregnancy in 5, and viable ongoing pregnancies in 49, 47 of which were surgically terminated.
Single cases of other adverse events, some of which may have been unrelated to the drug, included breast abscess; myocardial infarction; infection with adult respiratory distress syndrome; and hepatorenal failure and disseminated intravascular coagulation, believed to be the consequence of acetaminophen and alcohol abuse.
Two patients have died, one of overwhelming sepsis due to Clostridium sordelli and another due to hemorrhage from an undiagnosed tubal pregnancy.
In most cases, complications have been rare and easily managed, according to Mary Fjerstad, a nurse-practitioner who coordinates mifepristone training for the Planned Parenthood Federation.
Offering the new option to women is "gaining momentum" at clinics around the country with 63 affiliates at 127 sites now offering medical abortion.
The highest percentages of medical versus surgical first-trimester abortions at Planned Parenthood Clinics have taken place in Alabama, New Hampshire, New York, North Carolina, and Utah, Ms. Fjerstad reported.
In some cases, the medical option is making early, safe abortion available for the first time to women who cannot access metropolitan areas where surgical abortions are most often available, Ms. Ejerstad said.
Not everyone in attendance was convinced that rising acceptance of medical abortion is cause for celebration.
Dr. Warren M. Hem, director of the Boulder Abortion Clinic in Colorado, decried the "almost religious fervor" with which medical abortion has been received, "We really need to scrutinize these complication rates," Dr. Hem commented, singling out transfusion rates as cause for concern.
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|Publication:||Clinical Psychiatry News|
|Date:||Nov 1, 2002|
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