Johanna Rydelius: Medical abortion – safe to start at home

Bild

JOHANNA RYDELIUS
Dissertation defense: 16 May  2025 (click for details)
Doctoral thesis: Clinical management of medical abortion beyond 12 gestational weeks
Research area: Obstetrics and Gynecology
Sahlgrenska Academy, The Institute of Clinical Sciences

Abortions performed after 12 weeks of pregnancy account for a minority of all procedures, but the risk of abortion-related complications is higher in this group. In Sweden, about 5 percent of abortions occur after 12 weeks, a proportion that has remained stable in recent years.

"My research focuses on improving clinical abortion care for individuals undergoing an abortion after 12 weeks of pregnancy. This involves shortening hospital stays, simplifying procedures, and providing greater flexibility and autonomy for those seeking an abortion. It also includes examining safety aspects of treatment options and facilitating contraceptive use after abortion," says Johanna Rydelius, specialist in gynecology and obstetrics at the Section for Benign Gynecology at Sahlgrenska University Hospital and a doctoral student at the Institute of Clinical Sciences.”

In countries where abortion is legal, medical abortions are becoming more common compared to surgical procedures, expanding access for those who need them. 

"After 12 weeks of pregnancy, both surgical and medical methods are used. The medical method is less dependent on the abortion provider's expertise and is preferable in certain contexts. Unfortunately, access to abortion after 12 weeks is more limited, often due to legal aspects but also sometimes due to a lack of inpatient care facilities or other resources."

Significantly shorter hospital stays

One study in the thesis involved pregnant individuals aged 18 and older who underwent a medical abortion between weeks 12 and 22. The treatment consists of two different medications that work together to terminate the pregnancy. Both groups took mifepristone at the abortion clinic as per standard protocol. Then, 24–48 hours later, participants in one group took the first dose of misoprostol at home two hours before going to the hospital. The other group took the first dose upon arrival at the healthcare facility.

"Our most important finding is that it is both effective and safe for a person undergoing an abortion between weeks 12 and 22 to take the first abortion medication at home before heading to the clinic for the remaining treatment. More patients were able to undergo their abortion as an outpatient procedure, and hospital stays were significantly shorter."

Improved access empowers pregnant women

Johanna Rydelius believes that their findings could improve access to abortion services globally, including in resource-limited countries. Self-managed medical abortions play a crucial role in expanding access and have empowered pregnant women in various settings.

Figure 1 from thesis. Abortion Incidence. Average annual number of abortions/1000 women (aged 15-49): 2015-2019. Source: Bearak J et al., Country-specific estimates of unintended pregnancy and abortion incidence: a global comparative analysis of levels in 2015–2019, BMJ Global Health. https://gh.bmj.com/content/7/3/e007151. 
Collected from https://data.guttmacher.org/countries/map?topics=405&dataset=data

What has been the most rewarding and challenging aspect of the PhD project?
"It has been incredibly rewarding and highly relevant to conduct two large clinical trials. During the COVID-19 pandemic, we faced challenges in keeping participant enrollment going, but we also took the opportunity to study how the pandemic affected abortion care, which led to a separate study."

 Text: Susanne Lj Westergren