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Medication Abortion In Early Pregnancy PowerPoint Presentation

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Slide 1 - Medication Abortion In Early Pregnancy Induced termination of early intrauterine pregnancy using medications
Slide 2 - 6.4 Million Pregnancies/Year in the U.S. 51% Intended 24% Unintended Used Contraception 25 % Unintended Used No Contraception Finer, 2006 (2002 data)
Slide 3 - Unintended pregnancy rate: by race/ethnicity/income Unintended pregnancies per 1,000 women Finer, 2006
Slide 4 - Outcomes of Unintended Pregnancies (Approximately 3.1 Million Annually) Finer, 2006 (2002 data) % of unintended pregnancies
Slide 5 - 89% of abortions occur in the first 12 weeks of pregnancy Under 9 weeks 9-10 weeks 11-12 weeks Guttmacher Institute, 2004 data
Slide 6 - Abortion Access 87% of counties have no abortion provider 35% of women live in these counties 25% of women travel > 50 miles to find provider Source: Jones et al., 2008; Kaiser Family Foundation % of Women in Counties with No Abortion Provider
Slide 7 - Primary care shortage areas: with and without family physicians Graham Center, 2000
Slide 8 - Abortion in Family Medicine: Training Issues
Slide 9 - Could training family physicians in medication abortion make a difference?
Slide 10 - Abortion in Family Medicine: Implementation Issues
Slide 11 - Wanted versus unwanted pregnancy: consequences
Slide 12 - Medication & Aspiration Abortion: both safe and effective
Slide 13 - Safety of Abortion First trimester abortions DO NOT increase risk of: Infertility Ectopic pregnancy Miscarriage Birth defect Preterm or low-birth-weight delivery Sources: Boonstra, 2006 Virk, J et al, NEJM, 2007
Slide 14 - Medication Abortion Regimens: Three Choices Mifepristone + Misoprostol Methotrexate + Misoprostol Misoprostol alone
Slide 15 - Most common med abortion regimen in US: Mifepristone/Misoprostol
Slide 16 - Medication Abortion: Advantages 95-99% effective Avoids surgical and anesthetic risk Greater patient autonomy & privacy Less invasive More “natural”
Slide 17 - Aspiration Abortion: Advantages Slightly more effective (about 99%) Shorter time to completion Shorter bleeding duration Can be performed later in gestation
Slide 18 - Mifepristone-Misoprostol Regimens
Slide 19 - Cervical Ripening MIFEPRISTONE Causes progesterone blockade Decidual Necrosis Detachment MISOPROSTOL Causes uterine cramping & expulsion
Slide 20 - Misoprostol
Slide 21 - Yolanda 22 years old Requests a pregnancy test
Slide 22 - Counseling issues Review all options Assure that decision is hers
Slide 23 - Establish gestational age
Slide 24 - Rule out contraindications Allergy to meds Adrenal insufficiency Current steroid use Coagulopathy or anticoagulant use IUD in place No access to follow-up
Slide 25 - Indications for sonography
Slide 26 - Yolanda Gestational age: 6 weeks
Slide 27 - Patient agreement
Slide 28 - Yolanda takes mifepristone in your office
Slide 29 - At home: Yolanda takes pain medication, then misoprostol
Slide 30 - Follow-up visit 4 - 14 days later Assure completion Process experience Review contraceptive choice
Slide 31 - Phone calls after medication abortion
Slide 32 - Clostridium sordellii 6 deaths in North America due to toxic shock with Clostridium following medication abortion Similar deaths, however, also seen following miscarriage, childbirth, trauma, & surgery CDC: no causal link between medications and these incidents Source: CDC 2006, FDA 2006
Slide 33 - Methotrexate + Misoprostol medication abortion
Slide 34 - Misoprostol-only medication abortion 800 mcg vaginally > 1 dose may be needed
Slide 35 - Conclusion From pregnancy diagnosis through week nine, medication abortion is safe and effective. As its success depends on accessibility and counseling, medication abortion is well suited to the family medicine home.