EARLY ABORTION OPTIONS
Adapted from, 2014 RHAP/RHEDI, and Management of Unintended and Abnormal Pregnancy
When helping a patient decide on medication versus aspiration abortion, get a sense of what factors are important to them (e.g., timing of completion, amount of bleeding, instrumentation, need for privacy/discretion). Include external factors (e.g., childcare, work/school schedule, housing situation) that might make one option a better fit.
| Medication Abortion with Mife/Miso | Aspiration Abortion | |
|---|---|---|
| Quick Summary for Patient | “Both work very well, both are safe, and neither changes your chances to get pregnant in the future (if that’s what you want).” | |
| “You take one pill first, then take a different medicine later which will cause cramping and bleeding. The pregnancy will usually pass within a few hours.” | “This is done (with me), on an exam table in the office, with instruments inside you. You will be given medicine for pain, and it usually takes 5-10 minutes to complete.” | |
| Gestational Age | Currently up to 11 weeks in the U.S. Beyond 11 weeks in some countries |
Aspiration to 14-16 weeks D&E beyond 14-16 weeks |
| Advantages | Patient has more control over where the abortion takes place Avoids procedure More support options possible May be perceived as more natural, like a miscarriage. Options for personalizing the experience. |
Procedure over in 5 -10 minutes Usually less post-procedure bleeding Options for moderate or deep sedation Leaves the office visit not pregnant Medical staff members with patient |
| Disadvantages | Completed in multiple days May experience heavier and longer bleeding and cramps. There is less control over the time during which bleeding and cramping occurs. No clinical monitoring. May inadvertently see the fetus. |
Requires clinical setting Risks of instrumentation Risks of anesthesia, if used May be fewer options for support person(s) during procedure Suction machine may be audible |
| Protocol | Take medication at home or in a clinic | Procedure in office or hospital |
| Effectiveness | < 63 days, 95-99% (See Chap 4 Table) 64-77 days, with 2nd miso dose 99.6% 71-77 days, with 2nd miso dose 97.6% If fails, will need aspiration |
Over 99% of the time May need repeat aspiration |
| Duration | One to several days to complete | One visit; 5-10 minute procedure |
| Pain | Mild to strong cramps after taking misoprostol, lasting a few hours | Mild to strong cramps during and just after the procedure |
| Bleeding | Possible heavier bleeding with clots during the abortion Light bleeding can persist on and off for 1-2 weeks or more |
Heaviest bleeding during procedure Light bleeding can persist on and off for 1-2 weeks or more |
| Pain management | Oral pain medication | Options of: Oral pain medication Local anesthesia Moderate or deep sedation |
| Safety | Used safely for > 25 years At least 10-fold safer than continuing a pregnancy to term |
Used safely for > 45 years At least 10-fold safer than continuing a pregnancy to term |