Comparison of the clinical efficacy of surgical versus medical method for first trimester pregnancy termination in Iran: A quasi-experimental research

Saeed Husseini Barghazan; Mohamad Hadian; Aziz Rezapour; Setare Nassiri

doi:10.4103/jehp.jehp_582_22

Comparison of the clinical efficacy of surgical versus medical method for first trimester pregnancy termination in Iran: A quasi-experimental research

J Educ Health Promot. 2023 Apr 28:12:132. doi: 10.4103/jehp.jehp_582_22. eCollection 2023.

Authors

Saeed Husseini Barghazan¹, Mohamad Hadian¹, Aziz Rezapour², Setare Nassiri³

Affiliations

¹ Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran.
² Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran.
³ Endometriosis Research Center, Iran University of Medical Sciences, Tehran, Iran.

Abstract

Background: The surgical and medical options for management of pregnancy termination procedures are acceptable in practice but differ in clinical efficacy, costs, and patient experiences, and deciding what the best method is not clear always. This study aimed to compare clinical efficacy, outcomes, and patient acceptance of dilatation and curettage (D and C) versus medical abortion using misoprostol for first trimester of gestation in Iranian context.

Materials and methods: A prospective, multicenter, quasi-experimental research conducted from July 2021 to January 2022. The primary outcomes were the rate of composite complications or complete abortion. Data were analyzed with SPSS 18 using descriptive statistics, independent t-test, analysis of variance and non-parametric tests. Secondary outcomes were quality of life using EQ5D questionnaire, estimated blood loss, pelvic infection, pain level, hospital stay, and acceptability of intervention and relative risk as the effect size.

Results: Finally, 168 patients were included in this study. The composite complication rate among medical abortion patients is significantly more than that of surgical abortion patients (39.3% vs. 4.76%). The relative risk calculated 8.25 (3.05-22.26 CI). Medical abortion patients have experienced higher levels of ongoing bleeding, pain, and symptoms of pelvic infection. The higher level of acceptance has been reported by surgical group patients in comparison to the medical group patients (85.7% vs. 59.5%). Quality of life scores for surgical and medical group estimated 0.6605 and 0.5419, respectively.

Conclusion: Surgical method of abortion using D and C is a very safe and highly successful option in comparison to the medical method using misoprostol alone and is associated with better clinical outcomes, acceptance, and quality of life in first trimester of pregnancy among Iranian women.

Keywords: Dilatation and curettage; first pregnancy trimester; misoprostol; non-randomized controlled trials; quality of life.