Very early medical abortion before confirmed intrauterine pregnancy.

INTRODUCTION

Medical abortion using mifepristone and misoprostol is effective and safe, but evidence is limited in very early gestation before ultrasound confirmation of an intrauterine pregnancy (IUP).

METHODS

This single-centre prospective cohort study included 100 women between 2023 and 2025 who requested medical abortion up to 6+0 weeks of gestation and had a non-confirmed IUP on ultrasound (empty cavity or sac-like structure without embryonic pole). Participants initiated immediate medical abortion according to the WHO-recommended protocol. The primary outcome was complete abortion without the need for surgical intervention.

RESULTS

Complete abortion was achieved in 95% of the participants without the need for surgical intervention. The ectopic pregnancy rate was 2%, all of which were diagnosed before rupture. 2% required additional medical treatment, and 2% surgical intervention. No serious adverse events occurred.

CONCLUSIONS

Medical abortion before visible IUP is as effective as standard treatment. Very early medical abortion can be implemented safely and effectively with structured follow-up, allowing for earlier treatment without compromising safety.

FUNDING: None.

TRIAL REGISTRATION: The study was approved by the University Hospital of Southern Denmark, Sygehus Sønderjylland, record no.:24/44840.