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Annals of Family Medicine 7:527-533 (2009)
© 2009 Annals of Family Medicine, Inc.
doi: 10.1370/afm.1051
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Early Abortion in Family Medicine: Clinical Outcomes

Ian M. Bennett, MD, PhD1,2, Margaret Baylson, MD1, Karin Kalkstein, MD3, Ginger Gillespie, MD4, Scarlett L. Bellamy, ScD5 and Joan Fleischman, MD, MPA6

1 Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
2 Leonard Davis Institute of Health Economics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
3 Department of Family Medicine, Jamaica Hospital Medical Center, Jamaica, New York
4 Family Medicine, Beth Israel Medical Center, New York, New York
5 Department of Biostatistics and Epidemiology University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
6 Weill Medical College of Cornell University New York, New York

CORRESPONDING AUTHOR: Ian M. Bennett MD, PhD, Department of Family Medicine and Community Health, University of Pennsylvania School of Medicine, 2nd Floor Gates Pavilion 3400 Spruce St Philadelphia, PA 19104-4283, ian.bennett{at}uphs.upenn.edu

PURPOSE Clinical innovations have made it more feasible to incorporate early abortion into family medicine, yet the outcomes of early abortion procedures in this setting have not been well studied. We wished to assess the outcomes of first-trimester medication and aspiration abortion procedures by family physicians.

METHODS Prospective observational cohort study conducted from August 2001 to February 2005 of 2,550 women who sought pregnancy termination in 4 clinical practices of family medicine departments and 1 private office/training site.

RESULTS The rate of successful uncomplicated procedures for medication was 96.5% (95% confidence interval [CI], 95.5%–97.0%) and for aspiration was 99.9% (CI, 99.3%–1). Adverse events and complications of medication abortions were failed procedure (ongoing pregnancy; n = 19, 1.45%); incomplete abortion (n = 16, 1.22%); hemorrhage (n = 9, 0.69%); and patient request for aspiration (n = 1, 0.08%). One (0.08%) missed ectopic pregnancy was seen among patients receiving medication. Four types of adverse outcomes were encountered with aspiration: incomplete abortion requiring re-aspiration (n = 21, 1.83%); hemorrhage during the procedure (n = 4, 0.35%); missed ectopic pregnancy (n = 3, 0.26%); and minor endometritis (n = 1, 0.09%). Missed ectopic pregnancies were successfully treated in the inpatient setting without mortality (overall hospitalization rate of 0.16 of 100). All other complications were managed within outpatient family medicine sites. Rates of complication did not vary by experience of physician or by site of care (residency vs private practice).

CONCLUSIONS Complications of medication and aspiration procedures occurred at a low rate, and most were minor and managed without incident.




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TRACK Comments:

Read all TRACK Comments

Safety of abortion in the outpatient setting
Justine P Wu
Annals of Family Medicine, 16 Nov 2009 [Full text]
Attitudes of Patients to Abortion in Family Medicine
Ian M. Bennett
Annals of Family Medicine, 17 Nov 2009 [Full text]
More evidence that family physicians provide excellent abortion care
Megan M Greenberg
Annals of Family Medicine, 23 Nov 2009 [Full text]
Family Physicians provide abortions
Wendy Chavkin
Annals of Family Medicine, 23 Nov 2009 [Full text]
Response to Chavkin
Ian M. Bennett
Annals of Family Medicine, 23 Nov 2009 [Full text]
Response to Greenberg
Ian M. Bennett
Annals of Family Medicine, 23 Nov 2009 [Full text]
Training for abortion care
Larry Leeman
Annals of Family Medicine, 7 Dec 2009 [Full text]
Response to Leeman
Ian M. Bennett, et al.
Annals of Family Medicine, 18 Dec 2009 [Full text]

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