Medical abortion performed at home
Marija Rebolj Stare University Clinical Centre Maribor, Maribor, Slovenia - firstname.lastname@example.org
Introduction: At the University Clinical Centre, Maribor, the start of medical abortions was in the year 2006, with a full service from July 2007. With the recognition of its course and a lack of major complications, we decided to perform medical abortions up to 63 days of gestation in the outpatient clinic. A complete working plan was done, with exact briefings for all enrolled. Methods: On 24 February 2014 we started with outpatient medical abortions. At visit all reports (ultrasound report, blood haemoglobin level, blood type, Rh factor, ICT) and possible contraindications were evaluated. In case of uncertainty we repeated tests. Written explanation and patient consent, ambulance report, strict instructions were featured, for term and preterm control if needed. Analgesic therapy was prescribed. Oral intake of mifepristone 200 mg was followed, after 36-48 hours, with vaginal insertion of 4 pills of misoprostol 200 mcg. We advised attendance of adult and one week of sick leave. Two weeks later we performed follow-up. Results: Between 24 February and 3 April.2014, 47 patients aged 16.4-41.3 years, were enrolled. Average gestation was 52 (37-62) days. Seven didn't come to check-up; they probably had no problems. In 4 patients medical abortion failed and pregnancies were ongoing. Two had surgical abortion and 2 medical by extended protocol - one complete, one with curettage due to residua. For 36 patients medical abortion was successful. At 30 patients was complete, 6 had residua (15-31 mm) with high βHCG level (460-21164). Two were directed to hysteroscopy and 4 had curettage. Prophylactic antibiotic therapy was given once, prior to curettage. No transfusion was needed. Conclusions: Medical abortion at home proved to be safe for gestations up to 63 days of duration. Complications such as bleeding, residua or infection did not occur more often than at hospitalization. Failed medical abortions tended to occur; that confirms a need for a check-up some patients are avoiding.