Differences in pain, bleeding, and satisfaction during medical abortion at very early gestations

Little is known regarding the impact of gestation on pain, bleeding duration, and satisfaction in early medical abortion (termination of pregnancy). This study aimed to determine if pain experience, bleeding duration, and overall satisfaction with medical abortion differed across four ultrasound-defined categories of early pregnancy.

This is a secondary analysis of the multicenter VEMA-trial, a randomized clinical trial on the efficacy and safety of very early medical abortion before confirming pregnancy location (the VEMA-trial, EudraCT 2018-003675-35, ClinicalTrials.gov NCT03989869). The present study included participants with normally developing pregnancies and known abortion outcomes, including complete abortion, incomplete abortion, and ongoing pregnancy, that is, pregnancy still progressing after medical abortion. Participants were grouped by ultrasound findings at the time of abortion into pregnancy of unknown location, early, normally sited pregnancy (empty sac), and normally sited pregnancy with visible yolk sac or visible embryo. Pain experience was measured on the 0-10 numeric rating scale (higher values for more pain), duration of bleeding in days, and satisfaction on a 0-6 scale (higher values indicating greater satisfaction).

Altogether 1253 participants were included: 18% (224 participants) with pregnancy of unknown location, 38% (476) with early, normally sited pregnancy, 24% (301) with visible yolk sac, and 20% (252) with visible embryo. Pain scores were lowest in the pregnancy of unknown location group (mean 5.2 ± SD 2.3) and highest in the pregnancy with visible embryo group (6.2 ± 2.4). Bleeding duration was shortest for pregnancies of unknown location (4.9 ± 3.2) and longest for those with visible embryo (7.5 ± 5.3). Mean satisfaction was over 5 in all groups, highest in early, normally sited pregnancies (5.7 ± 0.7). In regression analyses, both pain scores and bleeding duration increased with advancing ultrasound findings. The pregnancy of unknown location group reported the least pain (1.02 points lower, 95% Confidence Interval [CI] -1.46 to -0.57) and the shortest bleeding duration (34% shorter, incidence rate ratio 0.66, 95% CI 0.61 to 0.71) compared to pregnancies with visible embryo.

More advanced ultrasound findings are associated with higher pain scores and longer bleeding duration in very early medical abortion, whereas satisfaction is high across ultrasound-defined categories.