Early and very early medical abortion
Hôpital Trousseau, Paris, France
Early medical abortion will be defined in this presentation by termination of pregnancies with Mifepristone/Misoprostol when no visible gestational sac is visible on ultrasound. Very early medical abortion will be defined by termination of pregnancies before the date of expected menstruation. Providers are reluctant to provide medical abortion so early mainly because of the fear of a missed diagnosis of ectopic pregnancy. Consequences for women are not negligible: repeated consultations, repeated ultrasound, repeated HCG could delay the termination of the pregnancy and induce problems of costs, confidentiality or emotional distress. Arguments will be presented to reassure providers about the possibility to provide early medical abortion safely. A protocol for follow up of early medical abortion will be presented based on correct information given to the women (especially symptoms that must induce a visit to the emergency service) and serum HCG testing seven days after the medical abortion. The second argument is the possibility of a reduced efficacy of medical abortion in the early period of pregnancy which was suggested in one study. Published data on this fact will be presented. Finally very early medical abortion will also be considered in this presentation on the basis of recent studies.
FAQ, Frequently Asked Questions in abortion care
Ellen Wiebe1, Philippe Faucher2 1University of BC, Vancouver, Canada, 2Hôpitaux Universitaires Est Parisien, Paris, France - email@example.com
Women presenting for abortion come with questions, both voiced and unvoiced. They often believe misinformation about exaggerated risks of infertility and depression and many are worried about pain. Abortion providers want to choose the best protocols and to relieve the unnecessary anxiety and pain. In this session we will address four issues. 1. Pain control: How can we best relieve the anxiety about pain and the pain of medical and surgical abortions? We will discuss the use of local and general anaesthesia, intravenous sedation, oral medications and non-pharmaceutical methods of pain control. 2. Antibiotic prophylaxis: What is the evidence about preventing endometritis in medical and surgical abortions? We will present the number needed to treat (NNT) with antibiotic prophylaxis in order to prevent each case of endometritis so that we can make the best choices for our patients. 3. Reproductive outcome: What is the actual risk of infertility (including Asherman's syndrome), miscarriage, premature delivery and abnormal placental insertion after abortions? We know these risks are low, but we need to address the anxieties of our patients as well as our colleagues. 4. Long-term sequelae: What are the actual risks of psychological problems and of breast cancer after abortions? There has been so much bad science on these topics and we need to assess the validity of the evidence. We will also address the issue of how to communicate this evidence effectively to our patients and our colleagues.