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Home use of misoprostol for early medical abortion has long been an established practice in several countries. It is a safe, effective, and dignified means of obtaining a legal abortion, with a low risk of complications. In the UK, however, the practice has only recently been permitted. Prior to the change, women were required to attend a clinic to be observed taking the drug, before being discharged to go home and see through the process. The requirement to attend a clinic was a result of political rather than medical reasoning; a desire not to provoke pro-life groups. It also highlighted an inconsistency whereby misoprostol was prescribed for home use to women who had suffered an incomplete miscarriage. Failure to permit home use of misoprostol for early medical abortion has caused women to suffer trauma when experiencing the effects of the drug when returning home from clinics, in addition to acting as an obstacle to access for women living in remote areas with no nearby clinic. Through an overview of recent developments in UK abortion policy, I demonstrate the lack of good, medical reasons for the delayed change. Further, I suggest appropriate future steps to be taken by policymakers.

The objective of this review was to assess early and late benefits and harms of different management options for first-trimester miscarriage. Surgical uterine evacuation remains the most effective and the quickest method of treatment. Depending on the clinical situation, medical treatment using misoprostol (missed miscarriage) or expectative attitude (incomplete miscarriage) does not increase the risk of complications, neither haemorrhagic nor infectious. However, these alternatives generally require longer outpatient follow-up, which leads to more prolonged bleeding and not planned surgical procedures.

a Department of Cardiology, Eastern Health, 8 Arnold Street, Box Hill, Victoria 3128, Australia b Monash University, Eastern Health Clinical School, 5 Arnold Street, Box Hill, Victoria 3128, Australia c Department of Obstetrics and Gynaecology, Eastern Health, 8 Arnold Street, Box Hill, Victoria 3128, Australia d Department of Cardiology, Austin Hospital, 145 Studley Road, Heidelberg, Victoria 3084, Australia

We explored the incidence of gestational trophoblastic disease (GTD) amongst products of conception (POC) specimens received for histopathological examination at Royal North Shore Hospital, a major Australian teaching hospital. We reviewed all 1035 pathology reports for POC from 2009. The mean age was 34.64 years with the mean age of those with GTD being 34.87 years. Twenty-three (2.58%) were hydatidiform moles with 17 (2%) being partial (PM) and six (0.58%) being complete (CM). There we no other forms of GTD in this year. Excluding cases with known ectopic pregnancy, there were 34 (3.3%) cases where there was no evidence of intrauterine gestation. The usual reasons given for performing routine histological examination of products of conception are to exclude gestational trophoblastic disease or the possibility of an ectopic pregnancy causing raised beta-HCG in the absence of a viable intrauterine gestation and therefore mimicking incomplete miscarriage. The diagnostic yield of histology for these two diagnoses was 5.9%. We then audited pathology reports from 1999 to 2009 and found that the numbers of POCs submitted for histological analysis ranged from 934 to 1230 per annum and that 1.82% of all submitted POCs were molar with a PM:CM ratio of 3.8. We conclude that routine histological examination of POCs, despite being a relatively low yield test, is still highly relevant.

In a retrospective study of 112 women, the effectiveness of three sequential oral doses of misoprostol was evaluated for the treatment of incomplete miscarriage. We report our experience with this regimen, which achieved a complete miscarriage rate of 85%. Surgical intervention was required in 17 women (15%). The regimen appears to be effective in terms of a high rate of complete miscarriage, and it is safe.