Can nurses offer early medical abortion as safely and effectively as physicians? A randomized controlled non-inferiority trial in Mexico City public legal abortion sites.

The allocated provider for the intervention group were nurses. On day 1 clinical care and initiation of medical abortions (MA) from their allocated provider (nurses or physicians) began. This included counseling, a vaginal/pelvic exam, an abdominal ultrasound, and dispensation of 200mg of oral mifepristone taken on-site under provider supervision. Women were then given 800 micro grams of misoprostol (in 4 tablets of 200 micro grams each) with instructions to self –administer them buccally at home, 24 hours after the site visit. As part of the counseling women received on day 1, participants were provided with a card with instructions for contacting a study representative in the event of any questions or concerns, and were given an flyer containing information on expected side effects and also of potential serious events hat may require prompt medical attention, such as heavy bleeding, fever, and abnormal vaginal discharge. During the follow-up visit between days 7-15, abortion completion was assessed through a review of clinical symptoms and bleeding history and an abdominal ultrasound in order to confirm non-pregnancy, both administered by the assigned provider (nurse or phyrsician). When the process was deemed to be not yet complete, participants received an additional dose of 800 micro gramsof misoprostol (to be taken buccally at home) with a request to return for follow up one week later. If providers (nurses and physicians) felt a surgical intervention was warranted or if a woman requested it—a manual vacuum aspiration (MVA) was provided at the same site. All MVA procedures were carried out by an Ob-Gyn specialist, not part of the study.