{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T23:39:07Z","timestamp":1792798747459,"version":"4.5.0"},"reference-count":16,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T00:00:00Z","timestamp":1754870400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"V\u00e4stra G\u00f6taland Region","award":["ALFGBG3050, ALFGBG-966228"],"award-info":[{"award-number":["ALFGBG3050, ALFGBG-966228"]}]},{"name":"Region Stockholm and Karolinska Institutet","award":["FoUI-954072"],"award-info":[{"award-number":["FoUI-954072"]}],"id":[{"id":"https:\/\/ror.org\/056d84691","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Gothenburg Society of Medicine","award":["974195"],"award-info":[{"award-number":["974195"]}]},{"name":"Region Stockholm","award":["LS 2018-1257 and RS 2019-1054"],"award-info":[{"award-number":["LS 2018-1257 and RS 2019-1054"]}],"id":[{"id":"https:\/\/ror.org\/02zrae794","id-type":"ROR","asserted-by":"crossref"}]},{"name":"the Hjalmar Svensson\u2019s fund","award":["HJSV2021003"],"award-info":[{"award-number":["HJSV2021003"]}]},{"name":"the Swedish Research Council","award":["2021-01042"],"award-info":[{"award-number":["2021-01042"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Sex Reprod Health"],"accepted":{"date-parts":[[2025,7,20]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Medical abortion beyond 12 weeks\u2019 gestation increases experienced pain. The effectiveness of pain management protocols remains to be evaluated.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a secondary analysis of a randomised controlled trial, conducted in six Swedish hospitals from 2019 to 2022, investigating home administration of the first misoprostol dose. Paracetamol 1000\u2009mg and a non-steroidal anti-inflammatory drug (NSAID) were provided with the first misoprostol dose and subsequent breakthrough pain medication as required. We recruited persons &gt;18 years of age, with a viable singleton pregnancy between 12 weeks+1\u2009day and 21 weeks+6\u2009days of gestation. We collected data on patient-reported pain using a visual analogue scale (VAS, 0\u2013100\u2009mm) at fetal expulsion and maximum pain assessed retrospectively prior to discharge. We collected data on the use of breakthrough pain medication, satisfaction scores with pain relief, and VAS scores before\/after administration of breakthrough analgesia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 425 individuals. The participants reported a mean VAS of 39.1 (SD 34.4) at expulsion and 65.4 (SD 28.6) as maximum pain (assessed after abortion before discharge) and 352\/425 (82.8%) received breakthrough pain medication, with 266\/425 (62.6%) receiving an oral opioid, 163\/425 (38.4%) a paracervical block (PCB) and 86\/425 (20.2%) a parenteral opioid. A total of 357\/392 (91.1%) participants were satisfied with the pain relief. Administration of a PCB alone or following an opioid resulted in the largest decrease in VAS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Many participants reported high VAS scores but most of them were satisfied with their analgesic treatment. A PCB was associated with the highest effectiveness in alleviating pain.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjsrh-2024-202691","type":"journal-article","created":{"date-parts":[[2025,8,11]],"date-time":"2025-08-11T17:20:19Z","timestamp":1754932819000},"page":"19-25","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Pain management for medical abortion beyond 12 weeks of gestation: a cross-sectional study in Sweden"],"prefix":"10.1136","volume":"52","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3480-9177","authenticated-orcid":false,"given":"Johanna","family":"Rydelius","sequence":"first","affiliation":[{"name":"Department of Gynecology and Obstetrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden"},{"name":"Gynecology and Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7184-9165","authenticated-orcid":false,"given":"Helena","family":"Kopp Kallner","sequence":"additional","affiliation":[{"name":"Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden"},{"name":"Department of Obstetrics and Gynecology, Danderyd Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2020-4695","authenticated-orcid":false,"given":"Ove","family":"Karlsson","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Intensive Care, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden"},{"name":"Department of Anesthesiology and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2405-0662","authenticated-orcid":false,"given":"Helena","family":"Hognert","sequence":"additional","affiliation":[{"name":"Department of Gynecology and Obstetrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden"},{"name":"Gynecology and Reproductive Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6516-1444","authenticated-orcid":false,"given":"Kristina","family":"Gemzell-Danielsson","sequence":"additional","affiliation":[{"name":"Department of Women's and Children\u2019s Health, Karolinska Institute, Stockholm, Sweden"},{"name":"Karolinska University Hospital, Stockholm, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,8,11]]},"reference":[{"key":"2026102002201438000_52.1.19.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-0528.2004.00235.x"},{"key":"2026102002201438000_52.1.19.2","doi-asserted-by":"crossref","first-page":"140","DOI":"10.1016\/j.ejogrb.2010.12.035","article-title":"Association between gestational age and induction-to-abortion interval in mid-trimester pregnancy termination using misoprostol","volume":"156","author":"Vitner","year":"2011","journal-title":"Eur J Obstet Gynecol Reprod Biol"},{"key":"2026102002201438000_52.1.19.3","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dei216"},{"key":"2026102002201438000_52.1.19.4","doi-asserted-by":"crossref","first-page":"6","DOI":"10.1016\/j.contraception.2022.07.001","article-title":"Patient-controlled intravenous versus on-demand oral, intramuscular or mcs intravenous administration of oxycodone during medical induced abortion from 64 to 128 days of Gestation: A randomized controlled trial","volume":"115","author":"Kemppainen","year":"2022","journal-title":"Contraception"},{"key":"2026102002201438000_52.1.19.5","doi-asserted-by":"publisher","DOI":"10.1093\/humrep\/dev286"},{"key":"2026102002201438000_52.1.19.6","unstructured":"World Health Organization . WHO guidelines approved by the guidelines review committee. abortion care guideline. Geneva World Health Organization; 2022."},{"key":"2026102002201438000_52.1.19.7","doi-asserted-by":"crossref","unstructured":"Zwerling B , Edelman A , Jackson A , et al . Society of Family Planning Clinical Recommendation: Medication abortion between 14 0\/7 and 27 6\/7 weeks of gestation: Jointly developed with the Society for Maternal-Fetal Medicine. Am J Obstet Gynecol 2023. doi:10.1016\/j.ajog.2023.09.097","DOI":"10.1016\/j.contraception.2023.110143"},{"key":"2026102002201438000_52.1.19.8","doi-asserted-by":"crossref","first-page":"1348","DOI":"10.1111\/1471-0528.16212","article-title":"Pain management for medical and surgical termination of pregnancy between 13 and 24 weeks of gestation: a systematic review","volume":"127","author":"Jackson","year":"2020","journal-title":"BJOG"},{"key":"2026102002201438000_52.1.19.9","unstructured":"Socialdepartementet . SFS 1974:595. Ministry of Social Affairs. Abortlag. 2023. Available: https:\/\/rkrattsbaser.gov.se\/sfst?bet=1974:595"},{"key":"2026102002201438000_52.1.19.10","unstructured":"The Swedish National Board of Health and Welfare . Statistics about abortions in Sweden. 2024. Available: https:\/\/www.socialstyrelsen.se\/publikationer\/statistik-om-aborter-2024-2025-5-9592\/"},{"key":"2026102002201438000_52.1.19.11","unstructured":"Swedish Society of Obstetrics and Gynecology - Induced Abortion . Svensk f\u00f6rening f\u00f6r obstetrik och gynekologi. arbets - och referensgruppen f\u00f6r familjeplanering. 2018. Available: https:\/\/www.sfog.se\/dokument\/78-inducerad-abort\/"},{"key":"2026102002201438000_52.1.19.12","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(24)01079-1"},{"key":"2026102002201438000_52.1.19.13","doi-asserted-by":"publisher","DOI":"10.1016\/S1526-5900(03)00716-8"},{"key":"2026102002201438000_52.1.19.14","doi-asserted-by":"crossref","first-page":"451","DOI":"10.1016\/j.contraception.2019.08.007","article-title":"Feasibility of a hospital outpatient day procedure for medication abortion at 13-18\u202fweeks gestation: Findings from Nepal","volume":"100","author":"Blum","year":"2019","journal-title":"Contraception"},{"key":"2026102002201438000_52.1.19.15","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1016\/j.ijgo.2015.02.023","article-title":"A double-blind randomized controlled trial of mifepristone or placebo before buccal misoprostol for abortion at 14-21 weeks of pregnancy","volume":"130","author":"Dabash","year":"2015","journal-title":"Int J Gynaecol Obstet"},{"key":"2026102002201438000_52.1.19.16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjsrh-2024-202437"}],"container-title":["BMJ Sexual &amp; Reproductive Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjsrh-2024-202691","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T09:21:19Z","timestamp":1792488079000},"score":1,"resource":{"primary":{"URL":"https:\/\/jfprhc.bmj.com\/lookup\/doi\/10.1136\/bmjsrh-2024-202691"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,11]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,15]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bmjsrh-2024-202691"],"URL":"https:\/\/doi.org\/10.1136\/bmjsrh-2024-202691","relation":{},"ISSN":["2515-1991","2515-2009"],"issn-type":[{"value":"2515-1991","type":"print"},{"value":"2515-2009","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8,11]]}}}