Beverly Winikoff


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    Alternative ways for follow up Women who choose outpatient medical abortion
    are typically given an appointment for a follow up
    visit several days to two weeks after they have
    used the medications. Yet almost no women
    require intervention or additional treatment at
    such follow up visits. Providers and women have
    sought safe ways to reduce the number of women
    who need to return to the clinic. This presentation
    discusses strategies to reduce the need for
    universal return visits, including telemedicine, use
    of various electronic media, and the development
    and promise of semi-quantitative pregnancy tests,
    including data from recent research.

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    Misoprostol alone for abortion
    Beverly Winikoff, MD, MPH,
    Gynuity Health Projects, New York, USA
    In places where mifepristone is unavailable, misoprostol has emerged as an important
    basis of alternative medical abortion regimens. Both methotrexate + misoprostol and
    misoprostol alone have been used successfully for this purpose. While it appears that
    regimens of methotrexate + misoprostol may be more effective than misoprostol alone,
    other considerations have made misoprostol alone a more commonly used alternative
    outside of established services. The most effective regimens of misoprostol alone for early
    first trimester abortion have efficacy >85% and < 90%. Misoprostol may also be used
    alone for induction of abortion after 63 days’ LMP. So far, the vaginal route has been the
    most widely studied and commonly used route of administration for this indication, but it is
    likely that other routes, such as buccal and sublingual misoprostol, will have similar
    efficacy. This presentation will discuss the efficacy, safety, and side-effects of such
    alternative medical abortion regimens, as well as issues of cost. The role of non-
    mifepristone medical abortion will be explored in circumstances where abortion services
    are poor or non-existent as well as in circumstances where abortion services are well-
    developed but mifepristone is unavailable.

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    How do women manage antibiotic pills after medical abortion?

    Laura Frye, Erica Chong, Beverly Winikoff Gynuity Health Projects, New York, USA -

    Is it time to move away from routinely giving doxycycline to medical abortion patients? Objectives: Routine provision of antibiotics following medical abortion is common, yet practitioners and professional societies differ on the utility of this practice. Our study compares the side-effects experienced by women who were prescribed doxycycline following medical abortion to those who were not and assesses the adherence to one regimen. Methods: 581 women seeking medical abortion were enrolled in this prospective, observational study in nine study sites. They were recruited from 1) clinics that routinely prescribe a seven-day course of doxycycline (Doxy Arm) and 2) clinics that do not routinely prescribe any antibiotics (No Doxy Arm). Seven to fourteen days following the administration of mifepristone, women were asked to self-administer a computer-based survey. The survey asked about side effects experienced (both arms) and adherence to the regimen (Doxy Arm only). Results: Self-reported adherence to the doxycycline regimen was moderate: 44% reported missing at least one dose and 34% stopped taking the doxycycline before 7 days. There was a trend toward increased nausea in the Doxy Arm (48% vs. 41%; p=.06) and a statistically significant difference in vomiting (25% vs. 19%; p=.03). A small but noteworthy number of women were confused about various aspects of the different medicines they received or were prescribed, including misunderstanding the purpose of a medicine, claiming to not have received a drug despite medical chart confirmation and noting costs of filling prescriptions that were not received. Implications: In the absence of robust evidence that prescribing 7 days of doxycycline following medical abortion is effective at reducing serious infections, these data can assist in deciding whether routine provision is the most appropriate strategy. Given the limits of any patients' ability to follow multiple and varied instructions, it is worth considering the impact of adding doxycycline, especially when it is frequently advised to be taken with an anti-emetic.