ABSTRACT
Early medical therapeutic abortion has been available in the UK since the early 1990s and is licensed up to 63 days gestation. Similar methods of achieving uterine evacuation have been developed for early miscarriage. Regimens use PG analogues, usually preceded by the antiprogesterone mifepristone. Success rates (i.e. total avoidance of surgery) is achieved in 95-98% of cases. Thirteen and a half thousand medical terminations were undertaken <9 weeks in 2000. Forty percent of NHS cases were dealt with medically but only 4% of cases managed by other purchasers. RCTs show high
CONSULT OTHER TOPICS
Complications of surgical management for therapeutic abortion and miscarriage (p 90)
Termination of pregnancy and maternal cardiac disease (p 101) Therapeutic abortion-indications and the Abortion Act (p 87) Upper tract pelvic infection (p 13)
Early medical termination/medical evacuation of the uterus
The regimens used for evacuation of the uterus for miscarriage and therapeutic abortion are very similar. When mifepristone is used, the priming dose of 200 mg is given 36-48 hours before PG analogues. Various regimens are described using different types, dosages and routes of administration for PG analogues. The main complications to consider are: abortion/miscarriage in the priming phase, heavy bleeding or collapse, no products of conception (POC) passed/failed medical methods and infection. These will be reviewed in the following mini-action plans.
