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Medication Abortion In Early Pregnancy

Medication Abortion In Early Pregnancy. Induced termination of early intrauterine pregnancy using medications. 6.4 Million Pregnancies/Year in the U.S. 24% Unintended Used Contraception. 51% Intended. 25 % Unintended Used No Contraception. Finer, 2006 (2002 data).

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Medication Abortion In Early Pregnancy

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

  2. 6.4 Million Pregnancies/Year in the U.S. 24% Unintended Used Contraception 51% Intended 25 % Unintended Used No Contraception Finer, 2006 (2002 data)

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

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

  5. 89% of abortions occur in the first 12 weeks of pregnancy 11-12 weeks 9-10 weeks Under 9 weeks Guttmacher Institute, 2004 data

  6. 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 % of Women in Counties with No Abortion Provider Source: Jones et al., 2008; Kaiser Family Foundation

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

  8. Abortion in Family Medicine:Training Issues

  9. Could training family physicians in medication abortion make a difference?

  10. Abortion in Family Medicine: Implementation Issues

  11. Wanted versus unwanted pregnancy: consequences

  12. Medication & Aspiration Abortion:both safe and effective

  13. 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

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

  15. Most common med abortion regimen in US: Mifepristone/Misoprostol

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

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

  18. Mifepristone-Misoprostol Regimens

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

  20. Misoprostol

  21. Yolanda 22 years old Requests a pregnancy test

  22. Counseling issues Review all options Assure that decision is hers

  23. Establish gestational age

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

  25. Indications for sonography

  26. Yolanda Gestational age: 6 weeks

  27. Patient agreement

  28. Yolanda takes mifepristone in your office

  29. At home:Yolanda takes pain medication, then misoprostol

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

  31. Phone calls after medication abortion

  32. 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

  33. Methotrexate+ Misoprostolmedication abortion

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

  35. 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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