Can family doctors do safe first trimester abortions?

Originally published in MedPage Today

by Chris Emery, MedPage Today Contributing Writer

Complications from first trimester abortions performed by family practitioners are rare, and family doctors could help address abortion provider shortages across the U.S., a new study found.

Among more than 2,500 abortions performed by family physicians, abortion was successful without complications in 96.5% of patients using medications (95% CI 95.5% to 97.0%) and 96.5% using aspiration (95% CI 95.5% to 97.1%), according to a study published online Nov. 9 in the Annals of Family Medicine.

Of the women in the study who had an abortion, 1.45% (19 women) remained pregnant after the procedure, 1.22% (16) had an incomplete abortion, 0.69% (9) hemorrhaged, and one patient taking medication requested aspiration.

Doctors missed four cases of ectopic pregnancy — one in a patient taking medication to induce an abortion and three undergoing the aspiration procedure. All four of these cases required hospitalization.

“We found that rates of complications of first-trimester abortion care in family medicine clinical sites were very low and within the range of outcomes published for obstetrics-gynecology and specialty abortion sites,” Ian M. Bennett, MD, PhD, of the University of Pennsylvania School of Medicine, and colleagues wrote.

“With the exception of missed ectopic pregnancy, expected complications were managed by family physicians within the context of their practice without reliance on emergency services or those of specialists.”

While first-trimester abortions are among the most common outpatient medical procedures in the U.S. and have a very low risk of complications, few family physicians perform the procedure, the authors wrote.

“Currently most of these procedures are provided in specialized abortion referral sites,” they wrote. “The potential benefits of providing abortion in family medicine offices include improving access to care in areas where there are few abortion providers and supporting the medical home for patients whose primary care physician can provide continuity of care.”

Bennett and colleagues conducted a prospective study of 2,550 women who sought to terminate a pregnancy between August 2001 and February 2005 at four clinical practices of family medicine departments and one private office and training site in New York City and Philadelphia.

The clinical sites were part of the Early Options (EO) network, a collaborative practice-based research network whose goal was to develop abortion-training programs in family medicine residency programs.

The physicians in the EO network who conducted the procedures had a range of clinical abortion experience. All were required to have completed 50 supervised aspiration abortion procedures at specialized abortion centers and completed an eight-hour ultrasonography-training workshop for first-trimester pregnancy dating.

Rates of complication did not vary by experience of physician or by site of care, the study found.

The study was observational and thus vulnerable to bias, the authors wrote, but the use of prospective data collection using a standardized protocol reduced the chances of error and bias.

They also noted that the private practice where most of the abortions were carried out performed a large number of the procedures, and thus might have more expertise than a typical private practice.

However, there was no significant difference between complication rates at the private practice and the residency practices, suggesting the volume of procedures did not play a role in the outcomes.

The researchers also noted that the study included no long-term follow-up with patients, so it was possible that late complications could have gone unrecorded.

“This study validates the safety and efficacy of early abortion care by family physicians,” the authors concluded. “Family physicians who provide abortion care promote continuity of care and the patient-centered medical home and may help to ameliorate abortion provider shortages across the U.S.”

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