Marianne Racke


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    Medical abortion in the hospital or at home - Let the woman chose

    Monica Johansson and Marianne Racke, midwifes, Karolinska University Hospital, Division

    of Gynecology and Obstetrics Stockholm,  Sweden

    Introduction: The Board of Healt and Welfare approved medical abortion up to 9 weeks gestation in Sweden in September 1992. Today a majority of induced abortions are performed before 8 weeks and more than 50% of first trimester abortions are medical. The percetage varies between 30 to 90% between different hospitals. Hme-user of misoprostol is approvided since  September 2004.

    Procedure: Woman with a pregnancy length up to 63 days of amenorrhea, requesting  medical  abortion, are given the choice between the standard protocol of administration of misoprostol at the hospital and possibility of taken it at home.Information is given by a midwife at the first telephone contact, At the visit in the abortion clinic (day 1) the gestational age is established by menstrual history and confirmed by physical examination and endovaginal ultrasound examination. Whomen are counseled by gynecologist, as well as by a trained and experienced  nurse-midwife.

    The patients received 200 mg mifepristone orally at the hospital on day 1. The women are also given 4 tablets of misoprostol ( 200µg per tablet) to take vaginally at home 24-48h after mifepristone together with pain prophylaxis. The first follow –up to assess the outcome of treatment is performed by a thelephone call by the midwife within a few days after the treatment.

    Follow-up: Is performed on day 14 after the medical abortion.Outcome is evaluated using a urinary HCG test  with cut-off value of 500 IU/ml. If necessary, a gynecological examination, an ultrasound examination and seum HCG is performed.Follow-up is mandatory following medical abortion and also includes contraceptive counseling.

    Discussion: Home-user of misoprostol reduce the number of visit and improve access to medical abortion. Our data shows a high acceptabilly among women and their partners and confirms the safety and efficacy of home-use of mosoprostol. Women should be pffered this choice to allow more flexibility and privacy in their abortions.