CHAPTER 4 EXERCISES: MEDICATION ABORTION

The exercises refer to mifepristone and misoprostol regimens unless otherwise stated.

EXERCISE 4.1 (COUNSELING)

Purpose: To practice responses to questions that may arise during counseling. What would you tell patients who ask the following questions?

1. I live 4 hours from the clinic. Can I still get the abortion pill? Can it be delivered to me at home?

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2. What are my chances of needing an aspiration abortion?

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3. How will I know if I’m bleeding too much?

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4. What will I see when the pregnancy passes?

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5. My partner wants me to keep this pregnancy. Will they know that I had an abortion?

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6. I got a judicial bypass and my parents don’t know I’m having an abortion. Is MAB the right method for me?

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7. I took abortion medicines I got online. Does that have to be reported?

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8. I have irregular periods, and had a positive pregnancy test – a surprise as I’m taking testosterone as a transgender male.
   1. What workup do I need before a medication abortion?
   2. How can I get an ultrasound if I live in a state that bans abortion?

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EXERCISE 4.2 (FOLLOW-UP TRIAGE BY TELEHEALTH OR IN-PERSON CARE)

Purpose: To practice responding to follow-up questions that may arise via telehealth or in-person care. How would you respond and triage the following questions, trying to minimize ED referrals (given cost and dangers)?

1. I vomited 3 hours after using the mifepristone, what should I do?

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2. My pills fell in the toilet (after vaginal use; or vomited after buccal or sublingual use). What should I do?

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3. I took the misoprostol 2 hours ago. Now my temperature is 100.5° F and I feel like I have the flu.

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4. I took pills but had no bleeding

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5. One week after pills I still have ongoing pregnancy symptoms

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6. I have ongoing positive urine pregnancy test at 5 weeks after misoprostol

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7. If followed with serial hCGs, and the initial level is 782 IU/L and rises to 5530 IU/L on Day 4 after mifepristone and misoprostol.

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8. If being followed up after MAB with ultrasound:
   1. How do you counsel and manage someone with uterine debris on US, but no symptoms?
   2. How do you counsel and manage someone with the same US, but ongoing cramping and moderate vaginal bleeding?

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EXERCISE 4.3 (COMPLICATIONS)

Purpose: To practice management of complications after medication abortion, how would you manage the following situations?

1. I took the misoprostol 2 days ago and passed the pregnancy yesterday, but now my temperature is 101.5 ° F.

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2. I’m in a lot of pain (after misoprostol).
   1. What can I do, and must I go to the emergency department?
   2. What if the pain is mostly on one side?

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3. I took misoprostol a few hours ago, but have soaked 5 maxi-pads in the last 3 hours.
   1. Should I take the misoprostol I have at home, before I go to the emergency department?
   2. What would you evaluate (exam and / or labs)?
   3. What management would you offer?
   4. What are indications for a uterine aspiration after MAB?

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4. A person at 7 weeks by LMP with 3 prior cesareans, is following up after medication abortion and experienced no bleeding. What is your differential?

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