Analgesia requirements and predictors of analgesia use for women undergoing medical abortion up to 22 weeks of gestation H. Hamoda, P.W. Ashok, G.M.M. Flett, A. Templeton Objective To assess analgesia use and the predictors for requiring analgesia in women undergoing medical abortion at all gestations up to 22 weeks. Design Retrospective observational study. Setting Aberdeen Royal Infirmary, Scotland. Population Consecutive women undergoing medical abortion under the terms of the 1967 Abortion Act. Methods Analgesia requirements and characteristics of women undergoing abortion were analysed using logistic regression. Main outcome measures The effect of age, gestation, reproductive history, route and dose of misoprostol administration on analgesia requirements. Results Of the total 4343 women included in this review, 3139 women (72%) required analgesia. Of these, 3054 women (97%) used oral analgesia, 75 women (2.4%) used opiates while 10 women (0.3%) had diclofenac sodium given rectally. There was no significant difference in analgesia use whether women used the vaginal or sublingual route of misoprostol administration. Logistic regression showed a significant positive association with gestation at termination (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.05 – 1.12), number of misoprostol doses used (OR 1.31, 95% CI 1.13–1.51) and induction to abortion interval (OR 1.08, 95% CI 1.03–1.12) and a negative association with the age of women undergoing abortion (OR 0.98, 95% CI 0.97–0.99) and previous live birth (OR 0.43, 95% CI 0.33–0.56). Conclusions Analgesia requirement was significantly higher in women of younger age, higher gestation, longer induction to abortion interval and with increased number of misoprostol doses used while women with previous live birth were significantly less likely to use analgesia. INTRODUCTION Medical abortion using the anti-progesterone mifepris- tone and the prostaglandin analogue misoprostol is now well established at all gestations with studies reporting high efficacy and good patient acceptability. 1–7 During 2001, a total of 176,364 abortions were carried out in England and Wales, and of these, 13% were undertaken medically. 8 During the year 2002, 11,594 abortions were carried out in Scotland, and of these, 56% were carried out medically. 9 Abdominal pain is one of the most common adverse effects of medical abortion. 5,10 – 14 However, analgesia requirements for medical abortion, reported in the litera- ture, have varied widely. 15 Westhoff et al. 13 reported that analgesia use in women undergoing medical abortion up to 63 days of gestation increased with higher gestation, younger age and in nulliparous women. We carried out this review to assess analgesia require- ments in women undergoing medical abortion at all ges- tations up to 22 weeks. The aim was to assess the effect of age, gestation, reproductive history and route and dose of misoprostol administration on analgesia requirements in the population of women studied. METHODS Women undergoing medical abortion under the terms of the 1967 Abortion Act at the Aberdeen Royal Infirmary during the period November 1997 to August 2003 were included in this review. At the initial clinic appointment, women up to 13 weeks of gestation were given information on both medical and surgical methods by the medical staff and pregnancy counselling nurses prior to deciding on an abortion method, while those at gestations of 13 weeks or above were offered medical abortion. Exclusion criteria for receiving medical abortion were extremely unusual but included the following: suspected ectopic pregnancy, chronic adrenal failure, long term corticosteroid treatment, haemorrhagic disorders or treatment with anticoagulants, known allergy to mifepristone and smokers over the age of 35 with ECG abnormalities. BJOG: an International Journal of Obstetrics and Gynaecology September 2004, Vol. 111, pp. 996–1000 D RCOG 2004 BJOG: an International Journal of Obstetrics and Gynaecology www.blackwellpublishing.com/bjog Department of Obstetrics and Gynaecology, University of Aberdeen, UK Correspondence: Dr H. Hamoda, Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Foresterhill, Cornhill Road, Aberdeen AB25 2ZD, UK. DOI:10.1111/j.1471-0528.2004.00235.x