EARLY ABORTION OPTIONS

Adapted from 2014 RHAP/RHEDI, and Management of Unintended and Abnormal Pregnancy. 2009: p.138.

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). There might also be external factors (e.g., childcare, work/school schedule, housing situation) that make one option a better fit.

Medication Abortion Aspiration Abortion
Quick Summary for Patient “Both work very well, both are safe, and neither change your chances to get pregnant in the future.”
“You take one pill that stops the pregnancy from growing, then take other pills later, which will cause cramping and bleeding.” This is quick, done with me, on an exam table with instruments inside you.”
Gestational Age Up to 10 weeks in U.S. Aspiration up to 14 weeks
D&E beyond 14 weeks
Advantages Occurs wherever patient chooses
Avoids invasive procedure
More support options possible
Perceived as more natural, like a miscarriage
Procedure over in 5-10 minutes
Generally less bleeding after the procedure is done
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
The abortion happens at home
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 Mifepristone (See Chapter 7 )
Misoprostol 0-72 hours later
Procedure in office
Effectiveness 95-99% up to 9 weeks, 91-93% up to 10 weeks
If fails, will need aspiration
Over 99% of the time
If fails, may 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 > 20 years
At least 10 fold safer than continuing a pregnancy to term
Used safely for > 40 years
At least 10 fold safer than continuing a pregnancy to term