Authors' response to: Medical versus surgical termination of pregnancy in primigravid women—is the next delivery differently at risk?


Authors' Reply


We wish to thank Zaman and colleagues for their interest in our work.

The Finnish Register of Induced Abortion, which we used in our study, contains information on the method of termination of pregnancy (TOP). The database does not provide precise information on the medication or doses used to perform medical TOP. However, a national guideline on the care of women seeking TOP (first published in 2001, and updated in 2007 and 2013) recommends the use of 200 mg mifepristone followed by 0.8 mg misoprostol administered either vaginally or sublingually.[1] The guideline is widely followed in Finland.

In the main analysis women, who underwent surgical evacuation after medical TOP or surgical re-evacuation after surgical TOP were included. However, as pointed out in our article,[2] the aim of the study was to compare the influence of the primary method of TOP per se. Therefore women who required surgical re-evacuation after surgical TOP, or evacuation after medically induced TOP, were excluded before the sub-analysis.

One of the limitations of our study is that we did not have exact data on late miscarriages. This issue has been studied in a large register-based Danish study, in which medical TOP was not associated with an increased risk of spontaneous abortions compared with surgical TOP.[3]