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

License

EARLY ABORTION TRAINING CURRICULUM Copyright © 2020 by UCSF Bixby Center for Global Reproductive Health. All Rights Reserved.