Ilana Dzuba

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    Outpatient medical abortion in the later first trimester: is it possible? desirable?

    Ilana G. Dzuba Gynuity Health Projects, New York, USA - idzuba@gynuity.org

    First trimester medical abortion is typically provided through 63 days gestational age as an outpatient service. Nonetheless, many women with pregnancies more advanced than 63 days wish to avoid a surgical procedure and would opt for medical management if offered. But can women with 64 day gestations or 72 day gestations or 80 day gestations avoid facility-based management with multiple repeat doses of misoprostol and, therefore, heightened side-effects? Recent studies explored the use of an outpatient approach with more advanced first trimester pregnancies to establish efficacy, side-effect profile, acceptability to women and to determine any change in outcomes compared with medical abortions in the previous gestational week. Results support the use of outpatient regimens through 77 days of gestation and suggest new counselling considerations. Successful medical abortion appears to decrease in the 12th gestational week. Expanding provision of medical abortion for additional weeks of pregnancy would increase access, including for those women for whom suction curettage is not feasible.