Abortion Care
Medication and procedural abortion
Know gestational-age limits, regimens, and complication management. Medication abortion with mifepristone 200 mg followed 24–48 hours later by misoprostol 800 mcg buccal or vaginal is highly effective through 70 days (10 weeks); evidence supports use through 77 days, and misoprostol-only regimens require higher, repeated doses and are less effective. Exclude ectopic pregnancy by risk assessment and ultrasound when indicated, and give Rh immune globulin to Rh-negative patients. Expect bleeding and cramping; give NSAIDs and antiemetics. Follow-up can be clinical, telephone, or self-assessment with a low-sensitivity pregnancy test, but persistent symptoms need evaluation for continuing pregnancy, retained tissue, or ectopic.
Procedural abortion includes manual or electric vacuum aspiration and dilation and evacuation (D&E). Cervical preparation with misoprostol or osmotic dilators reduces injury, especially at later gestations; antibiotic prophylaxis is recommended for aspiration. Complications include hemorrhage, infection, perforation, retained products, and cervical laceration. Treat heavy bleeding with uterine massage, uterotonics, and aspiration if retained tissue; suspect perforation with severe pain, vasovagal symptoms, or bowel/pelvic findings.
Traps: assuming a positive pregnancy test weeks after abortion means failure-hCG can persist; using serum hCG alone to diagnose success early; failing to offer all contraceptive methods immediately; and overlooking ectopic pregnancy in a patient with bleeding after medication abortion.
Worked example: a patient at 9 weeks requests medication abortion. Counsel that mifepristone–misoprostol is effective but slightly less so than aspiration, review warning signs, provide RhIg if indicated, and offer an IUD at follow-up or immediately after aspiration.