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Medication Abortion In Early Pregnancy PowerPoint Presentation

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Published on : Aug 07, 2014
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Slide 1 -

Medication Abortion In Early Pregnancy Induced termination of early intrauterine pregnancy using medications

Slide 2 -

6.4 Million Pregnancies/Year in the U.S. 51% Intended 24% Unintended Used Contraception 25 % Unintended Used No Contraception Finer, 2006 (2002 data)

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Unintended pregnancy rate: by race/ethnicity/income Unintended pregnancies per 1,000 women Finer, 2006

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Outcomes of Unintended Pregnancies (Approximately 3.1 Million Annually) Finer, 2006 (2002 data) % of unintended pregnancies

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89% of abortions occur in the first 12 weeks of pregnancy Under 9 weeks 9-10 weeks 11-12 weeks Guttmacher Institute, 2004 data

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Abortion Access 87% of counties have no abortion provider 35% of women live in these counties 25% of women travel > 50 miles to find provider Source: Jones et al., 2008; Kaiser Family Foundation % of Women in Counties with No Abortion Provider

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Primary care shortage areas: with and without family physicians Graham Center, 2000

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Abortion in Family Medicine: Training Issues

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Could training family physicians in medication abortion make a difference?

Slide 10 -

Abortion in Family Medicine: Implementation Issues

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Wanted versus unwanted pregnancy: consequences

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Medication & Aspiration Abortion: both safe and effective

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Safety of Abortion First trimester abortions DO NOT increase risk of: Infertility Ectopic pregnancy Miscarriage Birth defect Preterm or low-birth-weight delivery Sources: Boonstra, 2006 Virk, J et al, NEJM, 2007

Slide 14 -

Medication Abortion Regimens: Three Choices Mifepristone + Misoprostol Methotrexate + Misoprostol Misoprostol alone

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Most common med abortion regimen in US: Mifepristone/Misoprostol

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Medication Abortion: Advantages 95-99% effective Avoids surgical and anesthetic risk Greater patient autonomy & privacy Less invasive More “natural”

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Aspiration Abortion: Advantages Slightly more effective (about 99%) Shorter time to completion Shorter bleeding duration Can be performed later in gestation

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Mifepristone-Misoprostol Regimens

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Cervical Ripening MIFEPRISTONE Causes progesterone blockade Decidual Necrosis Detachment MISOPROSTOL Causes uterine cramping & expulsion

Slide 20 -

Misoprostol

Slide 21 -

Yolanda 22 years old Requests a pregnancy test

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Counseling issues Review all options Assure that decision is hers

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Establish gestational age

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Rule out contraindications Allergy to meds Adrenal insufficiency Current steroid use Coagulopathy or anticoagulant use IUD in place No access to follow-up

Slide 25 -

Indications for sonography

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Yolanda Gestational age: 6 weeks

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Patient agreement

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Yolanda takes mifepristone in your office

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At home: Yolanda takes pain medication, then misoprostol

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Follow-up visit 4 - 14 days later Assure completion Process experience Review contraceptive choice

Slide 31 -

Phone calls after medication abortion

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Clostridium sordellii 6 deaths in North America due to toxic shock with Clostridium following medication abortion Similar deaths, however, also seen following miscarriage, childbirth, trauma, & surgery CDC: no causal link between medications and these incidents Source: CDC 2006, FDA 2006

Slide 33 -

Methotrexate + Misoprostol medication abortion

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Misoprostol-only medication abortion 800 mcg vaginally > 1 dose may be needed

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Conclusion From pregnancy diagnosis through week nine, medication abortion is safe and effective. As its success depends on accessibility and counseling, medication abortion is well suited to the family medicine home.

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