Efficacy and safety of medical termination of pregnancy in a regional primary care setting

Abstract

BackgroundAustralia has demonstrated high efficacy and safety of medical termination of pregnancy (MToP) using a mifepristone–buccal misoprostol regime. The provision of medical termination services in primary care has the potential to alleviate access barriers, particularly in rural and regional populations. Large‐scale data are needed to support the expansion of this model.AimThe aim was to determine the efficacy and safety of nurse‐led MToP within a regional general practice clinic.MethodsA retrospective cohort study of patients prescribed MToP from October 2014 to April 2020. Clinic nurses assessed patient eligibility and provided information, non‐directive counselling and instructions. The general practitioner then confirmed eligibility, obtained informed consent and prescribed. Patients were administered 200 mg of mifepristone orally in a pharmacy and then self‐administered 800‐μg buccal misoprostol 36–48 h later at home.ResultsA total of 998 patients were included in this study, with the median patient age being 27.3 years and 30.3% of patients travelling over 100 km to access the service. MToP was successful in 965 (96.7%) patients. There were 36 (3.6%) complications, of which 33 were incomplete MToP. Haemorrhage requiring transfusion, pain requiring hospital treatment and suspected infection were rare, each having a frequency of one (0.1%). Our follow‐up rate was 74.8%, with a strong correlation identified between increased gestational age and decreased follow‐up (P < 0.001).ConclusionThis study is a large Australian example demonstrating high efficacy and safety of nurse‐led MToP within regional general practice. The establishment of similar services in rural and regional Australia may address geographical and financial barriers to termination access.