A significant international study led by researchers from Karolinska Institutet has found that medication abortions can be safely and effectively administered before the sixth week of pregnancy, challenging current clinical practices that typically require confirmation of an intrauterine pregnancy via ultrasound. The findings, published in The New England Journal of Medicine, suggest a shift in how early abortions are managed.
In Sweden, there were 35,550 reported abortions in 2023, with over 60% occurring before the end of the seventh week of gestation. Traditionally, the procedure is delayed until an ultrasound confirms that the pregnancy is intrauterine, primarily to exclude the risk of ectopic pregnancy—where the embryo implants outside the uterus, often in the fallopian tubes. Ectopic pregnancies can be life-threatening and are not resolved through medication abortion, which typically requires confirmation of a pregnancy by the fifth or sixth week.
Dr. Karin Brandell, the study’s first author and a gynecologist at Karolinska University Hospital, emphasized the urgency for women who know they want an abortion to have it performed as soon as possible. “Women often find out very early if they’re pregnant, and many want to terminate the pregnancy quickly,” she noted.
The VEMA (Very Early Medical Abortion) study involved over 1,500 women from 26 clinics across nine countries who requested abortions before ultrasound confirmation of intrauterine pregnancy. Participants were randomly assigned to either a delayed abortion group, where treatment began after pregnancy confirmation (weeks 5 to 6), or an early abortion group (weeks 4 to 6). Both groups received a combination of mifepristone and misoprostol.
At the start of the study, all participants were under six weeks pregnant and showed no symptoms or risk factors for ectopic pregnancy. The primary outcome measured was the rate of complete abortion.
Professor Kristina Gemzell-Danielsson, a senior physician at Karolinska University Hospital and project leader of the VEMA study, stated, “Very early medical abortion was just as effective and safe to perform, even in cases of undiagnosed ectopic pregnancy.”
Results showed that over 95% of women in both groups achieved a complete abortion. However, there were differences in the rates of incomplete procedures. In the delayed treatment group, 4.5% required additional surgical intervention due to incomplete abortion, while 0.1% continued their pregnancy. In the early group, 3% of pregnancies continued, and 1.8% required surgery. Notably, 1% of all participants had an ectopic pregnancy.
Women in the early abortion group reported experiencing less pain and bleeding compared to those in the delayed group. Both groups expressed a strong desire for the procedure to be performed as quickly as possible.
Dr. Brandell highlighted the political implications of abortion access, noting, “In Sweden, a woman can repeat the procedure a week after a failed early abortion. However, in Texas, where abortion is banned after the sixth week, this option is not available. It was crucial to demonstrate that early abortion is equivalent to the standard procedure conducted at a later stage of pregnancy.”
Looking ahead, the researchers aim to investigate whether a new drug combination for early abortion could also be effective for treating ectopic pregnancies. They are also working on developing new contraceptives based on mifepristone, which could potentially be administered in lower doses to prevent unwanted pregnancies.
The study received funding from various organizations, including the Swedish Research Council and the European Society of Contraception and Reproductive Health. Conflicts of interest related to the research are disclosed in full in the published study.
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