Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings

Aubert Agostini; Laura Miquel; Hélène Herman-Demars; Sandrine Frantz; Marie Sicot; for RYMMA investigator group

doi:10.1007/s40122-023-00477-2

Evaluation of Pain and Use of Analgesics during Medical Termination of Pregnancy in Real-Life Settings

Pain Ther. 2023 Apr;12(2):563-574. doi: 10.1007/s40122-023-00477-2. Epub 2023 Feb 25.

Authors

Aubert Agostini¹, Laura Miquel², Hélène Herman-Demars³, Sandrine Frantz⁴, Marie Sicot⁵; for RYMMA investigator group

Collaborators

Affiliations

¹ Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, la Conception Hospital, Aix Marseille Université, 147 Boulevard Baille, 13005, Marseille, France. aubert.agostini@ap-hm.fr.
² Department of Obstetrics and Gynecology, Assistance Publique - Hôpitaux de Marseille, la Conception Hospital, Aix Marseille Université, 147 Boulevard Baille, 13005, Marseille, France.
³ Medical Department, Nordic Pharma SAS, Paris, France.
⁴ CHU de Bordeaux, Endocrinology and Metabolism, Reproductive Medicine Unit, Bordeaux, France.
⁵ Department of Obstetrics and Gynecology, Centre Hospitalier Universitaire de Grenoble, 38700, La Tronche, France.

Abstract

Introduction: Women frequently report pain associated with medical termination of pregnancy (MToP), and its management can differ largely between centres. This study aimed at evaluating in real-life settings pain related to MToP and its management in France.

Methods: This was a non-interventional prospective, longitudinal study run in 23 centres between 2015 and 2016 that included 893 pregnant women. Pain was reported by women prior any curative analgesic intake (CAI) through a five-level Likert scale (absence, mild, moderated, severe, extreme). Modalities of analgesic prophylaxis prescription (APP) and intake (API) and CAI were collected. Risk factors were investigated using ordinal logistic regression (for pain) or logistic regression (for CAI) with stepwise selection of variables.

Results: APP was prescribed to 657 (73.7%) women irrespective of the gestational age, among whom 386 (73.7%) took the treatment. Out of 740 women who documented their pain symptoms prior to any CAI, few declared no pain (n = 94, 12.7%) or intense pain (n = 88, 11.9%). The majority reported mild or moderate pain (n = 558, 75.4%). On multivariate analysis adjusted on gestational age, increasing initial [odds ratio (OR) 1.25, 95% confidence interval (CI) 1.06-1.47] or total dose (OR 1.15, 95% CI 1.05-1.26) of misoprostol taken were independent factors associated with risk of more pain. When adjusting for gestational age, initial dose of misoprostol (OR 1.69, 95% CI 1.45-2.66) and pain experienced (OR 3.58, 95% CI 2.82-4.55) were significantly associated with higher risk of CAI while API (OR 0.52, 95% CI 0.36; 0.75) was negatively associated.

Conclusions: Most of the women received an APP, but not all used it. API and gestational age were not related to different risks of more pain following MToP, whereas history of at least one child showed a negative association. Higher doses of misoprostol were strongly associated with both pain and CAI. API was associated with a decreased risk of CAI.

Keywords: Medical termination of pregnancy; Mifepristone; Misoprostol; Pain management.