Letters Medical abortion

Authors’ reply

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3199 (Published 24 May 2011) Cite this as: BMJ 2011;342:d3199
  1. Maarit Niinimäki, consultant gynaecologist1,
  2. Oskari Heikinheimo, chief physician2
  1. 1Department of Obstetrics and Gynaecology, University Hospital of Oulu, Finland
  2. 2Department of Obstetrics and Gynaecology, Helsinki University Central Hospital, Helsinki, Finland
  1. oskari.heikinheimo{at}helsinki.fi

We showed that medical abortion has no additional short term adverse events or complications in adolescents compared with adults.1 Thus medical abortion can be used as an alternative to surgical abortion once the decision to terminate the pregnancy has been made. About 90% of the women treated medically did not need surgical intervention.

Previous studies, including the meta-analysis by Shah and colleagues,2 indicate that repeat surgical abortion is a risk factor for premature delivery. However, less is known on the effect(s) of previous medical abortion on the risk of prematurity. A recent study performed in China indicated that repeat surgical, but not medical, abortion was associated with increased risk (odds ratio 1.22 (95% confidence interval 1.03 to 1.64) v 1.03 (0.53 to 1.63)) of prematurity in subsequent pregnancies.3 Similarly, a Danish cohort study found no difference in the incidence of prematurity after medical or surgical abortion in the first trimester.4 Thus offering a choice of medical or surgical abortion is not likely to increase the risk of preterm delivery in subsequent pregnancies. We therefore fail to follow the logic in Johnston’s letter.5 Providing women with a choice between medical and surgical abortion in early pregnancy does not increase the rate of repeat induced abortion either.6 Nevertheless, the possible effect(s) of medical abortion on future pregnancy warrants further studies.


Cite this as: BMJ 2011;342:d3199


  • Competing interests: None declared.


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