Individual research recommendation details

Recommendation ID

NG140/4

Question

For women who are having medical abortion between 10⁺¹ and 12⁺⁰ weeks, what is the efficacy and acceptability of expulsion at home compared with expulsion in a clinical setting?

Any explanatory notes
(if applicable)

Why the committee made the recommendation

These recommendations are based on the evidence on the safety of home expulsion. Separate recommendations were made for women up to and including 9⁺⁶ weeks gestation and women at 10⁺⁰ weeks gestation due to the legal limit at which misoprostol can be taken at home.

Comparing women up to and including 9⁺⁰ weeks' gestation at the time they take mifepristone with women who take it between 9⁺¹ and 10⁺⁰ weeks, the evidence on home expulsion showed no difference in:

• the risk of serious complications, such as the need for emergency care or hospitalisation, haemorrhage needing transfusion, or 500 ml or more blood loss

• the rate of adverse events such as pain, vomiting and diarrhoea.

It was unclear whether or not there was a difference in rates of completed abortion without the need for surgical intervention in women who were up to and including 9⁺⁰ weeks when home expulsion was performed or between 9⁺¹ and 10⁺⁰ weeks. Evidence on patient satisfaction showed it was the same in both groups.

The committee noted that the evidence on women having home expulsion up to and including 12⁺⁰ weeks was from a single low-quality study from settings outside the UK. They agreed that further research on home expulsion up to and including 12⁺⁰ weeks in the UK would be beneficial to inform future practice and made a research recommendation.

How the recommendation might affect current practice

Currently, medical abortion with expulsion at home is offered for women who are up to and including 10⁺⁰ weeks gestation at the time they take mifepristone in some areas, but only up to and including 9⁺⁰ weeks in others. As well as standardising practice, the recommendations are likely to result in more women being able to have an early medical abortion at home. In current practice women need to be admitted to hospital and have to wait for bed availability. Expanding home expulsion would reduce the number of women admitted to hospital, reducing waiting times.

Full details of the evidence and the committee's discussion are in evidence review G: expulsion at home for early medical abortion.

Source guidance details

Comes from guidance

Abortion care

Number

NG140

Date issued

September 2019

Other details