Pain management for medical abortion beyond 12 weeks of gestation: a cross-sectional study in Sweden

Medical abortion beyond 12 weeks' gestation increases experienced pain. The effectiveness of pain management protocols remains to be evaluated.

This was a secondary analysis of a randomised controlled trial, conducted in six Swedish hospitals from 2019 to 2022, investigating home administration of the first misoprostol dose. Paracetamol 1000 mg and a non-steroidal anti-inflammatory drug (NSAID) were provided with the first misoprostol dose and subsequent breakthrough pain medication as required. We recruited persons >18 years of age, with a viable singleton pregnancy between 12 weeks+1 day and 21 weeks+6 days of gestation. We collected data on patient-reported pain using a visual analogue scale (VAS, 0-100 mm) at fetal expulsion and maximum pain assessed retrospectively prior to discharge. We collected data on the use of breakthrough pain medication, satisfaction scores with pain relief, and VAS scores before/after administration of breakthrough analgesia.

We included 425 individuals. The participants reported a mean VAS of 39.1 (SD 34.4) at expulsion and 65.4 (SD 28.6) as maximum pain (assessed after abortion before discharge) and 352/425 (82.8%) received breakthrough pain medication, with 266/425 (62.6%) receiving an oral opioid, 163/425 (38.4%) a paracervical block (PCB) and 86/425 (20.2%) a parenteral opioid. A total of 357/392 (91.1%) participants were satisfied with the pain relief. Administration of a PCB alone or following an opioid resulted in the largest decrease in VAS.

Many participants reported high VAS scores but most of them were satisfied with their analgesic treatment. A PCB was associated with the highest effectiveness in alleviating pain.