C-section, painful childbirth tied to severe pain during medical abortion

History of caesarean delivery and painful childbirth appear to contribute to severe pain during medical abortion beyond known risk factors of nulliparity, dysmenorrhea, and gestational duration, according to a study.

Researchers conducted a secondary analysis of a randomized trial in which two prophylactic pain management regimens during medication abortion were evaluated. A total of 556 participants (median age 24 years, 50.9 percent parous) were included. They were randomly allocated to groups given (1) tramadol 50 mg and one placebo pill, (2) ibuprofen 400 mg and metoclopramide 10 mg, or (3) two placebo pills. In addition to the study treatment, the participants were allowed to take additional oral analgesia, including ibuprofen 400 mg and acetaminophen 500 mg/codeine 10 mg, every 4 hours as needed.

The primary outcome was maximum pain score within 8 hours after taking misoprostol. Pain was self-assessed using an 11-point (0–10) numeric rating scale recorded in paper diaries.

Of the participants, 273 (49.1 percent) experienced severe pain (score ≥8 out of 10) during medical abortion. In multivariable analyses, pain showed a positive association with dysmenorrhea (odds ratio [OR], 1.16, 95 percent confidence interval [CI], 1.07–1.26) and higher gestational duration (OR, 1.05, 95 percent CI, 1.01–1.09). On the other hand, pain had a negative association with multiparity (OR, 0.35, 95 percent CI, 0.23–0.53). There was a marginal association between severe pain and higher anticipated pain score (OR, 1.10, 95 percent CI, 0.99–1.23).

Among multiparous participants, the odds of experiencing severe pain during medical abortion were greater for those with a history of caesarean delivery (OR, 3.49, 95 percent CI, 1.24–9.77), severe pain in childbirth (OR, 2.36, 95 percent CI 1.03–5.42), and dysmenorrhea (OR, 1.22, 95 percent CI, 1.08–1.39). A trend towards an association was found between longer gestational duration and severe pain (OR, 1.05, 95 percent CI, 0.99–1.11).

Sociodemographic variables, including younger age, marital status, financial stability, and anxiety or depression, were not associated with pain.

In light of the findings, the researchers suggested that the range of factors associated with increased pain during medical abortion should be discussed prior to the procedure. “This information can help individuals make informed decisions about their abortion method and, for those choosing medication abortion, better prepare for and optimize their pain management.”