EARLY ABORTION OPTIONS
Adapted from, 2014 RHAP/RHEDI, and Management of Unintended and Abnormal Pregnancy
A person-centered approach to discussing medication versus aspiration abortion includes discussing timing of completion, amount of bleeding, instrumentation, and need for privacy/discretion. These may impact external factors like childcare, work/school schedule, housing situation and are important in determining the best option for their abortion.
| Medication Abortion with Mife/Miso | Aspiration Abortion | |
|---|---|---|
| Quick Summary for Patient | “Both work very well, are safe, and do not change your chances of having a safe and healthy pregnancy in the future if that is something that you’d want.” | |
| “You take one pill first, then take 4 different pills later which will cause cramping and bleeding. The pregnancy will usually pass within a few hours. Different people experience this method differently; we can give you some pain pills to help with any discomfort you might feel.” | “This is a 5-10 minute procedure in the office where we empty the contents of the uterus. There are several options for reducing procedure-related pain that I can review with you.” | |
| Gestational Age | Up to 11 weeks in most U.S. practices Beyond 11 weeks in some countries |
Aspiration to 14-16 weeks Dilation and Evacuation beyond 14-16 weeks |
| Advantages | Patient has control over where the abortion takes place Avoids procedure 96-98% of the time More support options possible May be perceived as more natural, like a miscarriage Options for personalizing the experience |
Procedure takes 5 -10 minutes Usually less post-procedure bleeding Options for mild, moderate or deep sedation Able to leave the office visit not pregnant Medical and nursing staff are there to support with patient No routine follow up needed |
| Disadvantages | Process takes 1-2 days (sometimes longer) May experience heavier and longer bleeding and cramping Less control over the time during which bleeding and cramping occurs May see fetal tissue May require follow up |
Requires in-person clinical setting Risks of instrumentation Risks of sedation/anesthesia, if used Will need a driver if using anesthesia May be fewer options for personal support person(s) during procedure Suction machine may be audible |
| Protocol | Take medication at home/private space or clinic | Procedure in office or hospital |
| Effectiveness | < 63 days, 95-99% (See Chap 4 Table) 64-77 days, with 2nd miso dose 99.6% 71-77 days, with 2nd miso dose 97.6% If fails, will need repeat dosing or aspiration |
Over 99% If fails, will need repeat aspiration |
| Duration | One to several days to complete | One visit (with the exception of mandatory waiting periods); 5-10 minute procedure |
| Pain | Mild to strong cramps after taking the 2nd misoprostol, lasting a few hours or days | Mild to strong cramps during and just after the procedure |
| Bleeding | Possible heavier bleeding with clots Bleeding, possibly with small clots, can persist on and off for 1-2 weeks or more |
Heaviest bleeding during procedure Light bleeding can persist for 1-2 weeks or more; may also pass clots during this time |
| Pain management | Oral pain medication | Options include: Oral pain medication Local anesthesia Moderate or deep sedation (may require travel or more $) |
| Safety | Used safely for > 25 years At least 10-fold safer than continuing a pregnancy to term |
Used safely for > 45 years At least 10-fold safer than continuing a pregnancy to term |