Pain during Medical Abortion in early Pregnancy
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Women experience pain during a medical abortion, yet optimal pain management remains unclear. the pain experience and need for analgesics during early medical abortion (approx 63 days of gestation) among teenage and adult women were studied. predictive factors of severe pain were also assessed

Out of 140 primigravid women; 60 teenagers and 80 adult women aged between 25 to 35 years old. Teenager group included 19 women under the age of 18 years old (minors). The abortion was performed with mifepristone (200mg) followed by vaginal misoprostol (800μg), mainly self‐administered at home among adults. Minors were hospitalized during misoprostol administration. Pain medication consisted of ibuprofen 600mg and paracetamol 1000mg, first doses taken simultaneously with misoprostol and repeated, if needed, up to three times daily. Additional opiates (mainly tramadol or oxycodone) were administered at hospital if needed. Pain was measured using visual analogue scale.

The maximal pain VAS was 75 and 57.7% of all women experienced severe pain during abortion care. 93.5% of women needed additional analgesics in addition to prophylactic pain medication. Teenagers needed additional analgesics more often than adults; 38.0% of all teenagers received additional opiates compared to 7.9% in adult women. Severe pain was associated with the history of dysmenorrhea, anxiety at baseline and emesis during abortion. Hospital administration of misoprostol did not lower the risk for severe pain experience.

Pain intensity was high for both teenaged and adult women undergoing medical abortion, yet satisfaction on care was high. More effective analgesics than ibuprofen and paracetamol should be offered to all women undergoing an early medical abortion, especially to those with a history of dysmenorrhea. Also, routine use of antiemetics might be advisable.