By Margarita Nahapetyan
Researchers at Planned Parenthood, America's largest abortion provider, have found that taking the abortion pill orally instead of vaginally and in combination with antibiotics, reduces the number of serious infections and death associated with the drug by 93 per cent.
However, it is not clear yet whether the new findings are going to make any change in medical practice. The reaction to the study results was different, with the majority of experts to agree that it was reasonable to switch to the oral method, but some were not sure about routinely prescribing antibiotics, which can lead to side effects, for a procedure with a very low infection rate.
Medical practitioners started to look for alternative ways to prescribe the treatment after 4 women from the United States and one woman in Canada died in 2005 from a rare bacterial infection after taking the abortion pill. "When medical abortion was first introduced, there was little concern about the risk of infection, because there is no use of instruments in the cervix or uterus unless the procedure fails. However, it is clear that serious infections do occur," the researchers wrote.
More than one million women in the U.S. have received abortion pills since their first approval in 2000. In 2008, 184,000 women used the pills, said a spokeswoman for Danco Laboratories, which markets the drug. The pills work only in the first months of pregnancy, up to 63 days, and still account for a small proportion of the more than 1 million abortions performed on a yearly basis in the USA.
The treatment implies receiving two different drugs - step number one is Mifeprex, also known as RU-486, and then, two days later, another drug - misoprostol. The regimen approved by the Food and Drug Administration (FDA) required that both drugs are being taken by mouth. But recent research demonstrated that receiving the second drug vaginally produces better results, and many providers switched to the new method in spite of the fact that it is not legal. Another method, the buccal route, in which the misoprostol drug is placed between the gums and the cheek and needs to be dissolved, was also found to work better when compared to swallowing. This method allows the drug to get directly into the bloodstream through the thin mucus membranes.
In their study, Planed Parenthood looked at the records of 227,823 women who had undergone abortion procedures at its clinics from January 2005 to June 2008. Of all those women, 92 had developed serious infections. In March 2006, the experts started giving misoprostol pillt orally, asking the women to let it dissolve in the mouth. What is more, all women were either prescribed antibiotic drugs or some of them were given antibiotics if, according to the test results, they had either of two sexually transmitted diseases, chlamydia or gonorrhea.
In July 2007 the rules were changed one more time and it was decided that everyone was given antibiotics, without undergoing tests. The first change reduced the infection rate by 73 per cent, and a combination of antibiotics with the abortion pill cut the rate by additional 20 per cent. By the time the study was completed, there were only 3 infections observed in 46,777 women who used the treatment.
The study is the first to examine and analyze the effects of changes implemented by Planned Parenthood and few other abortion providers in 2006, when serious infections and a number of lethal outcomes were associated with the pills use. The investigators suspected that putting pills into the vagina was somehow related to the development of infections. The results revealed that after the switching from the vaginal to the buccal method and routinely giving antibiotics - infection rates were significantly reduced to 0.06 per 1,000 abortions, from 0.93 per 1,000.
"Our goal was to make a safe procedure even safer," said Mary Fjerstad, a nurse practitioner and the a principal investigator of the study. She added: "Our data demonstrate that there was a reduction in serious infections when we switched to a nonvaginal route of misoprostol administration. But I do not want to come down on the side of saying that everybody everywhere should give antibiotics with every medical abortion. Providers should decide that."
The findings are reported in the Juy issue of the New England Journal of Medicine.