Curettage after mifepristone-induced abortion: Frequency, timing, and indications

OBJECTIVE: To characterize women who underwent curettage after medical abor tion with mifepristone and vaginal misoprostol, to describe when curettage occurred and the reasons for the intervention, and to categorize the indica tions for curettage according to a simple classification schema. METHODS: These analyses used data from two multisite, randomized controlled trials sponsored by Abortion Rights Mobilization. In the first study, wome n pregnant less than 63 days received 200 mg of mifepristone and 800 mug of vaginal misoprostol to use 48 hours after taking mifepristone. In the seco nd study, women pregnant less than 56 days were randomly assigned to insert vaginal misoprostol at 1, 2, or 3 days after mifepristone administration. Case report forms and clinical case notes of all women who underwent curett age were examined. RESULTS: Of the 4393 women enrolled in both studies, 116 (2.6%, 95% confide nce interval 2.1%, 3.1%) curettages were identified. The gestational age an d a history of prior elective abortion were associated with the rate of cur ettage. The distribution of indications for curettage included bleeding, 61 (53%); continuing pregnancy, 17 (15%); patient request; 36 (31%); and inde terminate, 2 (1.7%), The timing of curettage differed by the indication and scheduled interval between study visits. The distribution of the timing wa s bimodal. One subset of women, 44 (38%), underwent curettage in the first study week and another subset, 43 (37%), during weeks 3-5. CONCLUSION: Curettage after medical abortion with mifepristone and vaginal misoprostol is rare. At least one half of the curettages were performed for persistent bleeding several weeks after treatment. Both acute heavy bleedi ng and continuing pregnancy are extremely rare. (C) 2001 by the American Co llege of Obstetricians and Gynecologists.