Medical versus surgical termination of pregnancy at 13-20 weeks

Published on 09/22/10 by DOI: 10.1111/j.1471-0528.2010.02712.x

Women find surgical termination of pregnancy (TOP) in the second trimester more acceptable than medical termination, according to a new study published in BJOG.





Researchers undertook a randomised controlled trial of women accepted for TOP at 13-20 weeks looking at the psychological impact, acceptability and clinical effectiveness of medical versus surgical termination.

The study looked at 122 women who agreed to be randomly assigned either to have a medical termination of pregnancy (MTOP, 60 women) using mifepristone and misoprostol or a surgical termination (STOP, 62 women). Twelve women decided to continue their pregnancy leaving 52 women in the MOTP group and 58 in the STOP group.

The results showed that in general women preferred STOP and found it less painful. Women who had MTOP experienced more pain on the day of the procedure (43% versus 23%) and more bleeding (37% versus 4%).

All women in the trial were invited back two weeks later and were asked about bleeding and pain post-procedure, but only 66 women either attended the clinic or completed the follow-up questionnaire – 30 in the MTOP group and 26 in the STOP group.

All 26 women in the STOP group who were followed up would opt to have the same procedure again but only half (53%, 16/30) in the MTOP group. None of the women in the STOP group said the procedure was worse than expected, compared with half (53%, 16/30) in the MTOP group.

107 women declined to participate in the trial because they already had a strong preference for a particular method; 67% of them said they preferred STOP.

Teresa Kelly, Honorary Clinical Research Associate from the University of Newcastle upon Tyne and co-author on the paper said: “We found from this study that undertaking research in TOP is difficult because where there is a choice most women express a strong preference for one method over another and in this study this was clearly surgical; but there is limited access for surgical termination. Obtaining follow up data from studies in this area is also challenging.

“This is the first randomised controlled trial of medical versus surgical termination at these later gestations using currently recommended medical protocol but it still failed to achieve the numbers required.

“The findings show that women prefer the surgical method. The study also produced some evidence that the surgical method is associated with better short term psychological outcome but this evidence needs confirming by undertaking a larger trial that is adequately powered. The implications from these results indicate that women should have the option of surgical termination.”

Professor Philip Steer, BJOG editor-in-chief, said: “Not all women have the same priorities regarding the procedure for TOP. Some prefer to avoid an anaesthetic while others want a speedy and less painful procedure. It is therefore important that women are given a choice of method allowing for personal preferences.

“This study will help healthcare professionals to advise women seeking TOPs about the benefits and disadvantages of the two methods. Termination of pregnancy is the most commonly performed gynaecological procedure in England and Wales. As this was a small study, further such investigations regarding women’s experiences are justified.”

The study: Kelly T, Suddes J, Howel D, Hewison J, Robson S. Comparing medical versus surgical termination of pregnancy at 13-20 weeks of gestation: a randomised controlled trial. BJOG 2010;117:1512–1520. DOI: 10.1111/j.1471-0528.2010.02712.x

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