Patients' experiences with pain and bleeding in first-trimester abortion care

Area of Science:

• Reproductive Health
• Clinical Obstetrics and Gynecology
• Patient-Reported Outcomes

Background:

• Abortion care is a common and safe medical procedure.
• Patient experience of pain and bleeding significantly impacts satisfaction.
• Limited research exists on factors influencing severe pain and bleeding in contemporary abortion methods.

Purpose of the Study:

• To identify clinical predictors of severe pain and heavy bleeding reported by patients undergoing first-trimester abortions.
• To analyze factors associated with the discrepancy between expected and experienced pain and bleeding.

Main Methods:

• Secondary analysis of a multicenter prospective cohort study.
• Included 644 participants undergoing medication or procedural abortion up to 11 weeks 6 days gestation.
• Logistic regression models assessed predictors of severe pain, heavy bleeding, and discordance between expected and experienced symptoms.

Main Results:

• One-fourth of participants reported severe pain; 35% reported heavy bleeding.
• Medication abortion, history of severe menstrual pain, and baseline depression predicted severe pain.
• Medication abortion regimen and baseline depression predicted heavy bleeding.
• First abortion experience, nulliparity, prior cesarean delivery, and baseline depression predicted pain discordance.

Conclusions:

• While most patients are prepared for abortion-related symptoms, severe pain and heavy bleeding are significant concerns for some.
• Identifying patients with risk factors for severe pain and heavy bleeding can guide anticipatory counseling.
• Improved anticipatory guidance incorporating identified risk factors may enhance the overall patient experience.