Medical versus surgical termination of pregnancy in primigravid women—is the next delivery differently at risk?



We read with interest the article by Männistö et al.[1] It is very relevant to our current practice because we often give women undergoing termination in the first trimester a choice between medical and surgical methods.

This is a large population-based study with a good ethics review and may therefore influence future practice. It is reassuring that neither medical nor surgical methods present greater risk to future pregnancies and both are viable options.

It would be interesting to look at the psychological outcome of medical versus surgical termination of pregnancy.[2] Suggested overall psychological outcomes, specifically quality of life, anxiety and depression, are markedly improved following either method.

It would be useful to know the regimens used in the study as they may differ from those used in the UK and from hospital to hospital.[3] For the combined regimen, the dosage of mifepristone can be lowered to 200 mg without significantly decreasing effectiveness. Vaginal misoprostol is more effective than oral misoprostol.

It may also be useful to include the group of women who underwent re-evacuation after the index termination because this could be related directly to the type of termination of pregnancy—whether medical or surgical. It would also be useful to include information about gestations below 22 weeks, which unfortunately were not in the registry. These pregnancies may have ended in late miscarriages as a result of cervical incompetence, which may or may not have resulted from type of termination. These data may therefore be useful to future practice.