How Far Is Too Far

In Australia, 31% of unintended pregnancies result in abortion. The rate of unintended pregnancies is 1.4 times higher in rural Australia. In the recent years, medication abortion (MA) has gained a lot of popularity and has replaced the need for a more intense, surgical abortion, in most instances. MA through MS-2 Step regimen (mifepristone/misoprostol) requires intake of two pills in a precise, sequential manner which then results in at-home medical abortion during the first trimester. Women residing in rural areas of Australia can benefit greatly from this convenient method of abortion. MS-2 has been available in Australia since 2012 and has a high success rate (97%). While generally safe, there is a rare risk of haemorrhage (0.1%) post-MA, requiring blood transfusion. Although rare, this complication can become life-threatening if occurred in an individual residing in an area with no nearby facilities capable for providing blood transfusion. 

In 2023, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG) released a detailed document containing Abortion Care Guidelines on medical or surgical abortion. While the document suggested that “Clinical judgement should be used to evaluate selective testing of haemoglobin and blood group prior to abortion in women at increased risk of haemorrhage, including but not limited to anaemia or advanced gestation (Good practice point 3)”, there were no clear guidelines on how to determine women that may be at a risk for a haemorrhage post-MA requiring blood transfusion or on the safe distance from blood transfusion-providing facilities for MA recipients. In addition, the RANZCOG Abortion Care Guidelines in their recommendations for future research stated assessing the following question, “Is there a subgroup of women at higher risk of complications who should be recommended to have an ultrasound? For example, previous uterine surgery, greater risk of ectopic pregnancy”. 

The aim of this project is to: 

• Describe the timing, incidence, urgency and associated patient and clinical characteristics related to post-medical abortion blood transfusion;
• Investigate experiences of abortion care among remote residents and their health care professionals; and
• Triangulate quantitative and qualitative findings to create knowledge synthesis outputs to inform the decisions of clinical practice guideline committees, health care professionals, and patients.