Medical abortion, early treatment
Peter Safar MD, Head of Department of Obstetrics and Gynaecology
Humanis-Klinikum Korneuburg, Austria,
Board member of the Regional Executive Commitee of the IPPF/EN
Most women are faced with unnecessary obstacles in access to termination of a very early pregnancy, even when their decision for termination is clear.
Frequently the treatment of medical abortion is delayed until a foetal cardiac activity can be seen on ultrasound. Additionally women are sometimes subject to several ß-hCG tests in the serum. Treatment is delayed until a viable intrauterine pregnancy can be diagnosed, usually around 6 1/2 weeks LMP.
Our experience is presented with medical abortion in very early pregnancy. We also follow patients and repeat ß-hCG in these cases, but we start medical abortion immediately. Patients are counselled about the possibility of an ectopic pregnancy or a missed abortion in cases where no foetal cardiac activity or even no gestational sac can be seen on ultrasound.
Serum ß-hCG is done prior to treatment and repeated at follow-up after one week. There is a marked decline below 20% of the initial value when the abortion has been successful. Sometimes the combination with the serum level of progesteron could be precise the diagnosis.
So far we have not had one persistent ectopic pregnancy in more than 5 years and over 2.000 cases. If an ectopic pregnancy would be detected at follow up the treatment option with MTX or laparoscopy can be discussed in time.
Medical abortion with mifepristone and misoprostol in the early and very early pregnancy is safe and very well accepted by women. The success rate is high and side effects of strong bleeding or pain are infrequent.
Very early medical abortion
Peter Safar MD Head of Department*,**, Christian Fiala MD, PhD**
Humanis Klinikum Korneuburg*, Gynmed Clinic Vienna, Austria**
Positive heart rate,fetal viability or at least the presence of the cul de sac in ultrasonografic
scanning are at the moment still the basic conditions for most of the abortion service
providers to start with the medical induced abortion.
But the wish of many women, after a clear decision making is different:
they want to start the procedure as soon as possible!
Presenting case reports we describe our standarts, procedures and follow up programmes
for patients which allowes us to start medical abortion with Mifepristone and Misoprostol
right after the early detection (postive HCG test) of an unwanted pregnancy..
Following our guidelines we are able to minimize the risks and the complications of
undetected ectopic and molar pregnancies.