¹Zentrum für Klinische Studien, Universität Witten/Herdecke, Witten, Germany
²Gyn-Praxis Nova Berlin, Berlin, Germany
³Vivantes Neukölln, Berlin, Germany
⁴Zentrum für Klinische Studien, Universität Witten/Herdecke, Lehrstuhl für Klinische Pharmakologie, Universität Witten/Herdecke, Witten, Germany
⁵Philipp-Klee-Institut für Klinische Pharmakologie des Helios Universitätsklinikums Wuppertal, Wuppertal, Germany

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Background: In 2023, more than 100,000 abortions were performed in Germany. A relevant proportion of abortions are conducted as outpatient visits using self-administered abortion drugs. According to the guidelines, antiemetics and analgesics are recommended as concomitant medication but details are lacking. Up to now, there is only few data which medication is given to women in the outpatient setting.

Materials and Methods: A nationwide online survey among physicians was conducted using LimeSurvey. Physicians were asked to participate if they offer medical abortion according to information provided by the German Medical Association and the association Doctors for Choice Germany e.V. A descriptive statistical analysis was conducted using SPSS.

Results: Out of all the invitations sent out (n=282), n=75 responses were received (response rate 26.6%). Finally, n=55 responses met the predefined inclusion criterion (at least one reported medication regimen) and were included in our analysis .

The majority of physicians were female (80%), practice in a metropolis (61.8%), and had a specialization in gynecology and obstetrics (90.9%). 54.5% had more than ten years of professional experience, 54.5% offered only medical abortion while 45.5% also perform surgical abortion.

Almost all physicians reported a combination of mifepristone (usually 200mg or 600mg orally) and misoprostol (200–800µg in varying dosages and forms of administration) as abortion medication. In most cases, standard dosing regimens are used but patient-related individual adjustments (e.g. due to gestational age) are often made. Analgesic medication is predominantly based on ibuprofen, often supplemented by other analgesics such as paracetamol or codeine. Some physicians reported also the use of butylscopolamine. Dimenhydrinate was the most frequently used antiemetic usually administered on an as needed base.

Conclusion: This survey highlights for the first time a considerable heterogeneity in the practical implementation of medical abortion in Germany. In particular, there are not only discrepancies regarding the drugs used for inducing abortion but also regarding concomitant analgesic and antiemetic medication.

The results of this survey underline the need for observational studies and clinical trials in this setting as well as the development of specific guidelines ensuring an optimum treatment of this vulnerable population.