{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,30]],"date-time":"2025-08-30T00:02:55Z","timestamp":1756512175328,"version":"3.44.0"},"reference-count":23,"publisher":"Wiley","issue":"9","license":[{"start":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T00:00:00Z","timestamp":1751414400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100008994","name":"European Society of Contraception and Reproductive Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100008994","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004047","name":"Karolinska Institutet","doi-asserted-by":"publisher","award":["ALF 2022\u20102025"],"award-info":[{"award-number":["ALF 2022\u20102025"]}],"id":[{"id":"10.13039\/501100004047","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100003744","name":"Stiftelsen Handlanden Hjalmar Svenssons","doi-asserted-by":"publisher","award":["HSV2024011"],"award-info":[{"award-number":["HSV2024011"]}],"id":[{"id":"10.13039\/501100003744","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Little is known regarding the impact of gestation on pain, bleeding duration, and satisfaction in early medical abortion (termination of pregnancy). This study aimed to determine if pain experience, bleeding duration, and overall satisfaction with medical abortion differed across four ultrasound\u2010defined categories of early pregnancy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>This is a secondary analysis of the multicenter VEMA\u2010trial, a randomized clinical trial on the efficacy and safety of very early medical abortion before confirming pregnancy location (the VEMA\u2010trial, EudraCT 2018\u2010003675\u201035, ClinicalTrials.gov NCT03989869). The present study included participants with normally developing pregnancies and known abortion outcomes, including complete abortion, incomplete abortion, and ongoing pregnancy, that is, pregnancy still progressing after medical abortion. Participants were grouped by ultrasound findings at the time of abortion into pregnancy of unknown location, early, normally sited pregnancy (empty sac), and normally sited pregnancy with visible yolk sac or visible embryo. Pain experience was measured on the 0\u201310 numeric rating scale (higher values for more pain), duration of bleeding in days, and satisfaction on a 0\u20136 scale (higher values indicating greater satisfaction).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Altogether 1253 participants were included: 18% (224 participants) with pregnancy of unknown location, 38% (476) with early, normally sited pregnancy, 24% (301) with visible yolk sac, and 20% (252) with visible embryo. Pain scores were lowest in the pregnancy of unknown location group (mean 5.2\u2009\u00b1\u2009SD 2.3) and highest in the pregnancy with visible embryo group (6.2\u2009\u00b1\u20092.4). Bleeding duration was shortest for pregnancies of unknown location (4.9\u2009\u00b1\u20093.2) and longest for those with visible embryo (7.5\u2009\u00b1\u20095.3). Mean satisfaction was over 5 in all groups, highest in early, normally sited pregnancies (5.7\u2009\u00b1\u20090.7). In regression analyses, both pain scores and bleeding duration increased with advancing ultrasound findings. The pregnancy of unknown location group reported the least pain (1.02 points lower, 95% Confidence Interval [CI] \u22121.46 to \u22120.57) and the shortest bleeding duration (34% shorter, incidence rate ratio 0.66, 95% CI 0.61 to 0.71) compared to pregnancies with visible embryo.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>More advanced ultrasound findings are associated with higher pain scores and longer bleeding duration in very early medical abortion, whereas satisfaction is high across ultrasound\u2010defined categories.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.15177","type":"journal-article","created":{"date-parts":[[2025,7,2]],"date-time":"2025-07-02T10:30:57Z","timestamp":1751452257000},"page":"1665-1671","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differences in pain, bleeding, and satisfaction during medical abortion at very early gestations"],"prefix":"10.1111","volume":"104","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4740-5948","authenticated-orcid":false,"given":"Frida","family":"Gyllenberg","sequence":"first","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"},{"name":"Department of General Practice and Primary Health Care University of Helsinki and Helsinki University Hospital  Helsinki Finland"},{"name":"Department of Women's and Children's Health Uppsala University  Uppsala Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0548-3374","authenticated-orcid":false,"given":"Karin","family":"Brandell","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"},{"name":"Division of Gynecology and Reproductive Medicine Karolinska University Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tagrid","family":"Jar\u2010Allah","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy Sahlgrenska University Hospital, University of Gothenburg  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Helena Kopp","family":"Kallner","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences at Danderyd Hospital Karolinska Institutet  Stockholm Sweden"},{"name":"Department of Obstetrics and Gynecology Danderyd Hospital  Stockholm Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"John","family":"Reynolds\u2010Wright","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Health, Institute for Regeneration and Repair University of Edinburgh  Edinburgh UK"},{"name":"Chalmers Centre NHS Lothian  Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Clare","family":"Boerma","sequence":"additional","affiliation":[{"name":"Family Planning Australia  Sydney New South Wales Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sharon","family":"Cameron","sequence":"additional","affiliation":[{"name":"Centre for Reproductive Health, Institute for Regeneration and Repair University of Edinburgh  Edinburgh UK"},{"name":"Chalmers Centre NHS Lothian  Edinburgh UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2405-0662","authenticated-orcid":false,"given":"Helena","family":"Hognert","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy Sahlgrenska University Hospital, University of Gothenburg  Gothenburg Sweden"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8671-130X","authenticated-orcid":false,"given":"Oskari","family":"Heikinheimo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Janina","family":"Kaislasuo","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology University of Helsinki and Helsinki University Hospital  Helsinki Finland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6516-1444","authenticated-orcid":false,"given":"Kristina","family":"Gemzell\u2010Danielsson","sequence":"additional","affiliation":[{"name":"Department of Women's and Children's Health Karolinska Institutet  Stockholm Sweden"},{"name":"Division of Gynecology and Reproductive Medicine Karolinska 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