Oral versus buccal misoprostol for early abortion in the family medicine setting

Two important methods for increasing access to medication abortion are through integrating medication abortion into primary care settings and by expanding the gestational age at which medication abortions can be provided. Previous studies have shown the efficacy of vaginal misoprostol up to 63 days gestation. Following four deaths involving the use of vaginal misoprostol, there has been a shift toward using oral or buccal misoprostol. There have been no studies documenting the efficacy of these routes beyond 56 days gestation, however, thereby limiting access for women at later gestations. Additionally, there have been no previous studies comparing outcomes of medication abortion provision between family planning sites and primary care settings. Our family medicine clinic was one of seven practices involved in this randomized clinical trial comparing oral versus buccal administration of misoprostol up to 63 days gestation. The other six clinics were family planning sites. Women were randomized to receive mifepristone followed by 800 mg of misoprostol either orally or buccally. Data were collected regarding efficacy, patient satisfaction, and complications. A secondary analysis was performed comparing results between our family medicine site and the family planning sites. Buccal misoprostol was found to be more efficacious than oral beyond 49 days. Efficacy and patient satisfaction were similar between the family medicine and family planning sites. Finally, there was a trend toward fewer surgical interventions at the family medicine site. This study demonstrates the efficacy of medication abortion using buccal misoprostol to 63 days and confirms that medication abortion in the family medicine setting is safe and acceptable.