Medical management of first-trimester abortion
2014; Elsevier BV; Volume: 89; Issue: 3 Linguagem: Inglês
10.1016/j.contraception.2014.01.016
ISSN1879-0518
Tópico(s)Maternal and fetal healthcare
ResumoContraception 89 (2014) 148 – 161 Clinical Guidelines Medical management of first-trimester abortion ☆ , ☆☆ , ☆☆☆ , ☆☆☆☆ , ★ , ★★ , ★★★ Society of Family Planning Clinical Guideline Over the past three decades, medical methods of abortion have been developed throughout the world and are now a standard method of providing abortion care in the United States. Medical abortion, which involves the use of medications rather than a surgical procedure to induce an abortion, is an option for women who wish to terminate a first-trimester pregnancy. Although the method is most commonly used up to 63 days of gestation (calculated from the first day of the last menstrual period), the treatment also is effective after 63 days of gestation. The Centers for Disease Control and Prevention estimates that 64% of abortions are performed before 63 days of gestation [1]. Medical abortions currently comprise 16.5% of all abortions in the United States and 25.2% of all abortions at or before 9 weeks of gestation [1]. Mifepristone, combined with misoprostol, is the most commonly used medical abortion regimen in the United States and Western Europe; however, in parts of the world, mifepristone remains unavailable. This document presents evidence of the effectiveness, benefits, and risks of first-trimester medical abortion and provides a framework for counseling women who are considering medical abortion. 1. Background 1.1. Medications currently used for medical abortion 1.1.1. Mifepristone Mifepristone, a derivative of norethindrone, binds to the progesterone receptor with an affinity greater than proges- terone itself but does not activate the receptor, thereby acting as an antiprogestin [2]. Its known actions on a uterus in pregnant women include decidual necrosis, cervical soften- ing, and increased uterine contractility and prostaglandin sensitivity [3,4]. Human studies have suggested that uterine contractility does not increase until 24–36 h after mifepris- tone administration [3]. At this point, the sensitivity of the myometrium to the stimulatory effects of exogenous Published concurrently in the March 2014 issue of Obstetrics & Gynecology. Copyright March 2014 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher. Requests for authorization to make photocopies should be directed to Copyright Clearance Center, 222 Rosewood Drive, Danvers, MA 01923, (978) ISSN 1099-3630 The American College of Obstetricians and Gynecologists, 409 12th Street, SW, PO Box 96920, Washington, DC 20090-6920 Medical management of first-trimester abortion. Practice Bulletin No. 143. American College of Obstetricians and Gynecologists. Obstet Gynecol Committee on Practice Bulletins — Gynecology and the Society of Family Planning. This Practice Bulletin was developed by the Committee on Practice Bulletins — Gynecology and the Society of Family Planning with the assistance of Mitchell D. Creinin, M.D., and Daniel A. Grossman, M.D. The information is designed to aid practitioners in making decisions about appropriate obstetric and gynecologic care. These guidelines should not be construed as dictating an exclusive course of treatment or procedure. Variations in practice may be warranted based on the needs of the individual patient, resources, and limitations unique to the institution or type of practice. 0010-7824/$ – see front matter © 2014 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.contraception.2014.01.016
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