Woman Dies from Abortion Pill

 

by: Jamie Walker

From: The Australian

March 19, 2012 12:00AM

AUSTRALIA has had its first death of a woman using the abortion pill to terminate her pregnancy at home.

Health regulator the Therapeutic Goods Administration issued a notice to doctors and clinics to review their follow-up care in light of the “bedroom abortion” gone wrong.

The woman, unnamed by authorities, had been treated by the country’s largest private abortion service, Marie Stopes International Australia, in 2010. She is believed to have developed a streptococcus A infection and died of sepsis.

The death, confirmed only now, is the only one to be linked to use of RU486 since its introduction to Australia in 2006 and is believed to be the first in at least a decade involving a sanctioned elective abortion. The case was reported to a coroner, but no inquest was convened despite the rarity of abortion-related deaths in Australia.

Informed of it yesterday, the overseer of the Australian Institute of Health and Welfare’s national maternal deaths register, Elizabeth Sullivan, said she could not recall another woman dying from an abortion in the 12 years she had kept the statistics.

Both Marie Stopes International Australia and the TGA refused to release details of the RU486 fatality, citing patient confidentiality. The drug, also known as mifepristone, can only be prescribed by specially licensed doctors and is mostly used in early medical abortion by the ninth week of pregnancy.

MSIA clinical services director Jill Michelson said of the woman’s death: “This is a tragic outcome and our sympathies are with her family. The coroner dispensed with holding an inquest, and the case is closed.”

Ms Michelson said the woman had died of sepsis “some days after” having the medical abortion at one of MSIA’s 14 Australian clinics.

She could not say whether there had been further contact between the service and the woman. Asked when the woman became ill, Ms Michelson said: “It was certainly not in the initial period” after the abortion.

MSIA has supervised 18,000 medical abortions in Australia since 2009 using RU486 in combination with a second abortion drug, misoprostol. At the clinic, the patient receives the standard 200mg tablet of RU486 and is sent home with instructions to take the misoprostol 24 hours later to complete the process.

The woman is counselled on what to expect and symptoms to watch for in case of a complication, and is also urged to have someone else to monitor her.

Some medical abortion services insist on meeting the “support person” to ensure they know when to call for help, but this is not the case with MSIA.

Take-up of medical abortion, as an alternative to conventional surgery, is accelerating in line with experience in the US and Europe, where up to half of all of elective terminations are now carried out with RU486.

In the six-month period to June 30 last year – the latest for which figures are available – the drug was given to an extra 5383 Australian women, a spike of 48 per cent. About 85,000 abortions a year are performed in Australia, mostly for women who choose not to continue pregnancy. MSIA operates clinics in Queensland, NSW, Victoria, ACT and Western Australia.

After being notified of the death, the TGA wrote to all authorised RU486 prescribers, recommending they review their protocols. “Where necessary,” it advised, patient information and consent documents should be changed to include active follow-up by medical staff to “exclude infections, incomplete abortion and therapeutic failure”.

The TGA said clinics should ensure they had patients’ 24-hour contacts plus a back-up number, and ask the woman to commit to reporting in between 48 and 72 hours after taking RU486.

Strep A infection was once one of the heaviest maternal killers of women, but is readily treatable with antibiotics, if caught early.

“It is a very old fashioned way to die,” one prominent abortion doctor told The Australian. “Any doctor that got near this poor woman would have given per penicillin, and she would probably have lived.”

Advocates of early medical abortion point out that deaths are very rare – about 1.1 per 100,000 cases, on the basis of US research – and it is much safer for the woman than having a child, where eight die for every 100,000 live births.

 

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