Oral abortion pill
The risk of serious infection and death has been cut by giving the "abortion pill" orally.
Giving the "abortion pill" orally instead of vaginally and with antibiotics cut the risk of serious infection and death by 93 percent, researchers at Planned Parenthood reported on Wednesday.

The threat of infection is now down to 1 in 16,000 from one in 1,000, the researchers reported in the New England Journal of Medicine.

"Our goal was to make a safe procedure even safer," Planned Parenthood's Mary Fjerstad said in a telephone interview.

The "abortion pill" consists of giving mifepristone, also known as RU-486, to stop the pregnancy and a second drug, misoprostol, two days later to help the body expel the fetus.

At Planned Parenthood, where about 97,000 women receive a medical abortion each year, misoprostol was initially given vaginally because it is easily absorbed there.

Doctors began exploring alternative ways to give the treatment after four women from the U.S. and one in Canada died from a rare bacterial infection after receiving the abortion pill in 2005.

"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.

In contrast, in Europe, where the treatment had been used far longer and the vaginal administration of misoprostol was less common, there were no deaths. In United Kingdom, pregnant women routinely received antibiotics.

So in March 2006, Planned Parenthood started giving misoprostol by mouth, telling women to let it dissolve between the cheek and the gum. That way it can go directly into the bloodstream through the thin mucus membranes.

In addition, all women were either given antibiotics or some women received antibiotics if tests showed that had either of two sexually transmitted diseases, chlamydia or gonorrhea.

In July 2007 the rules were changed again to give everyone antibiotics, without the testing.

The first change cut the infection rate by 73 percent.

Giving antibiotics to everyone shaved the rate by another 20 percentage points.

By the end of the study, there were only 3 infections out of 46,777 women who took the pills.

Fjerstad said she was not sure why taking the pill vaginally might cause infections. She also was unsure if the results would change how doctors practice elsewhere.

"I know some providers in other countries have said, 'We just don't have problems with infections.' If they don't, that's great. But they may not have enough followup to know what their rate of infection really is," she said.

"I think this will cause providers to consider what their regimen is, and I think they will at least think about whether antibiotics are appropriate in their environment."


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