Pain during medical abortion in early pregnancy in teenage and adult women

Introduction Women experience pain during medical abortion, yet optimal pain management remains unclear. We studied the pain experience and need of analgesics during early medical abortion (= 70) during abortion care and 93.5% of women needed additional analgesics in addition to prophylactic pain medication. Teenagers needed additional analgesics more often than adults (5 [3-8] vs 3 [2-6] times,P = .021); 38.0% of all teenagers (64.7% of the minors) received additional opiates compared with 7.9% in adult women. Severe pain (VAS >= 70) was associated with history of dysmenorrhea (adjusted odds ratio [OR] 2.60 [95% confidence interval [CI] 1.21-5.59,P = .014]), anxiety at baseline (2.64 [1.03-6.77],P = .044) and emesis during abortion (5.24 [2.38-11.57],P <.001). Hospital administration of misoprostol did not lower the risk for severe pain experience (OR 0.84 [95% CI 0.34-2.05],P = .694). Satisfaction with care was high in study population (median VAS 91 [interquartile range 79-97]) and was not associated with the use of narcotic analgesic or place of misoprostol administration. Conclusions Pain intensity was high both in teenage and adult women undergoing medical abortion, yet satisfaction on care was high. More effective analgesics than ibuprofen and paracetamol should be offered to all women undergoing early medical abortion, especially to those with history of dysmenorrhea. Also, routine use of antiemetics might be advisable.Peer reviewe

Patient-controlled intravenous versus on-demand oral, intramuscular or mcs intravenous administration of oxycodone during medical induced abortion from 64 to 128 days of Gestation : A randomized controlled trial

Publisher Copyright: © 2022 The AuthorsObjective: To compare oxycodone administration via intravenous patient-controlled analgesia (IVPCA) vs on-demand administration during late-first- and second-trimester medically induced abortion. Study design: A prospective randomized controlled study. We enrolled women between 64 to 128 days of gestation in the study between June 2016 and August 2018. Participants were randomized to receive oxycodone either via IVPCA or given on-demand orally, intramuscularly, or intravenously. Pain intensity and satisfaction with care were measured using the visual analogue scale (VAS, 0–100mm). Results: Altogether 99 participants were randomized: 48 in IVPCA group and 51 in on-demand group. Median gestational age was similar between groups (74 days [Interquartile range, IQR 69–81] in the IVPCA group vs 72 [69–80] in the control group, p = 0.587). Peak maximal pain was severe in both groups (median pain VAS was 62 [IQR 44–84] and 71 [IQR 56–90], p = 0.52). The odds for severe pain (highest pain VAS≥70) were similar between the groups (IVPCA group OR 0.51 [95% Confidence Interval 0.22–1.18], p = 0.118). In contrast, the odds for mild or tolerable pain (highest pain VAS≤40) were higher in the IVPCA group (OR 4.06 [95% CI 1.05–16.04], p = 0.043). Nevertheless, satisfaction with care was high (VAS 94 [89–100]) in both groups. Of those experiencing severe pain, 94.0% declared pain medication as adequate. Conclusion: Women often experience severe pain during medical abortion irrespective of the mode of opiate administration. Oxycodone administration via IVPCA permits women to self-administer analgesics when experiencing pain, raising the odds for mild or tolerable pain during abortion care. Satisfaction with care was high.Peer reviewe