First-trimester abortion protocols in hospitals compared to office-based settings in Switzerland – a national survey study in Switzerland

Abstract PurposeSimplified first-trimester abortion protocols are well established as they facilitate access to services and improve patient satisfaction without compromising safety. However, data on abortion protocols across Switzerland by facility type are lacking. Therefore, the first aim of this study was to analyse hospital-derived abortion protocols, as opposed to office-based protocols, across Switzerland in terms of their acceptance among women. The second aim was to assess abortion protocols and outcomes of specialised general practitioners (GPs) following simplified protocols.MethodsThis study consists of two parts. (i) A nationwide questionnaire was distributed among hospitals and private practices covering details of abortion protocols and numbers between April and July, 2019. The primary endpoint was the proportion of women undergoing an abortion after the first consultation at the chosen facility (adherence), regarding the complexity of abortion protocols in each setting. (ii) A retrospective study was conducted to analyse the outcomes of office-based institutions with simplified abortion procedures over a period of 10 years from January, 2008, to December, 2018. (BASEC-No. Req-2018-01031).Results (i) Office-based facilities showed less complex abortion protocols, resulting in a significantly higher probability of undergoing an abortion after the first consultation than hospitals. Their protocols allowed for a higher gestational age by medical means, and they offered mifepristone intake within the first consultation along with fewer staff members involved and a lower number of overall consultations. (ii) From 5,495 women, a total of 5,274 patients were included, of which the incidence of complications requiring surgery was at a low of 2.5%. ConclusionThis study highlights that simplified abortion protocols are crucial to ease access to abortion services, as represented by higher adherence in office-based facilities. Simplified protocols in abortion services are safe, and repetitive counselling and in-person visits should only be reserved for selected cases.