SUMMARY POINTS

 

SKILL

  • Medication abortion (MAB) is technically simple. Most of what you learn in this chapter involves assessment, thorough counseling and evaluation of success.
  • Mifepristone 200 mg followed by misoprostol 800 mcg (buccal or vaginal) or 400 to 800 mcg (sublingual) is effective for gestational ages up to 70 days (FDA label 2016, NAF CPGs 2016; SFP Clinical Guidelines 2014).
  • Combined mifepristone/misoprostol regimens discussed here are more effective than misoprostol alone or methotrexate/misoprostol (NAF CPGs 2016).
  • Medication abortion accounted for 23% of all nonhospital abortions and 36% of abortions before nine weeks gestation in 2011. Of U.S. abortion providers, 17% offer only medication abortion (Jones 2014), which improves access.

SAFETY

  • Medication abortion is safe, effective and over 95% are successful without need for further intervention (Reeves 2016). Delayed bleeding is the most common complication (0.4-2.6%), and may require treatment or aspiration several weeks after the abortion (NAF Online 2016). This can usually be done in the outpatient setting.
  • Most of the medication abortion process occurs outside the office. You can:
    • Provide patients with a number to contact you for questions or concerns
    • Give your patients a list of “warning signs” that warrant a call or visit
    • Provide aspiration if needed, or refer to a back-up group that can.
  • For ectopic pregnancies, mifepristone-based regimens are ineffective and contraindicated for management, but methotrexate regimens may be considered.

ROLE

  • Your confidence in providing medication abortion will grow quickly as you:
    • Gain experience monitoring side effects and assessing success
    • Listen to your patients’ questions and success stories
    • Discuss your questions with more experienced colleagues
  • Early medication abortion is relatively easy to integrate into clinical services and may be an excellent starting place prior to offering uterine aspiration, allowing you to play an important role in expanding access for patients.