Simplified medical abortion screening: a demonstration project
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RAYMOND, Elizabeth G., TAN, Yiling, COMENDANT, Rodica, SAGAIDAK, Irina V., HODOROGEA, Stelian, GRANT, Melissa, SANHUEZA, Patricio, VAN PRATT, Emigdio, GILLESPIE, Ginger, BORAAS, Christy, WEAVER, Mark, PLATAIS, Ingrida, BOUSIÉGUEZ, Manuel, WINIKOFF, Beverly. Simplified medical abortion screening: a demonstration project. In: Contraception, 2018, nr. 4(97), pp. 292-296. ISSN 0010-7824. DOI: https://doi.org/10.1016/j.contraception.2017.11.005
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Contraception
Numărul 4(97) / 2018 / ISSN 0010-7824 /ISSNe 1879-0518

Simplified medical abortion screening: a demonstration project

DOI:https://doi.org/10.1016/j.contraception.2017.11.005

Pag. 292-296

Raymond Elizabeth G.1, Tan Yiling1, Comendant Rodica2, Sagaidak Irina V.2, Hodorogea Stelian2, Grant Melissa3, Sanhueza Patricio4, Van Pratt Emigdio4, Gillespie Ginger5, Boraas Christy6, Weaver Mark7, Platais Ingrida1, Bousiéguez Manuel1, Winikoff Beverly1
 
1 Gynuity Health Projects, New York,
2 Centrul de Instruire în Domeniul Sănătăţii Reproductive (CIDSR),
3 Carafem, Chevy Chase, MD,
4 Secretariat of Health, Mexico City,
5 Institute for Family Health, New York,
6 Planned Parenthood Minnesota, North Dakota, South Dakota, Minneapolis, MN,
7 University of North Carolina School of Medicine
 
 
Disponibil în IBN: 8 mai 2018


Rezumat

Objectives: The objectives were to evaluate the safety and acceptability of outpatient medical abortion in selected women without a pretreatment ultrasound or pelvic examination. Study design: We conducted a prospective case-series study to estimate the incidence of serious adverse events (death, life-threatening event, hospitalization, transfusion or any other medical problem that we judged to be significant), surgical completion of the abortion and satisfaction in women provided with medical abortion without a pretreatment ultrasound or pelvic examination. We enrolled 406 women requesting medical abortion in Moldova, Mexico and the United States. To be eligible, a woman must have been certain that her last menstrual period started within the prior 56 days, have had regular menses before the pregnancy, not have used hormonal contraceptives in the prior 2 months (in the United States and Mexico) or 3 months (in Moldova), have no risk factors for or symptoms of ectopic pregnancy, and not have had an ultrasound or pelvic exam in this pregnancy. One site also excluded women with uterine enlargement on abdominal palpation. Each participant received mifepristone (200 mg orally) and misoprostol (400 mcg sublingually in Moldova; 800 mcg buccally at all other sites) and was followed until complete abortion, defined as requiring no further treatment. Results: Of the 365 (90%) participants who provided sufficient follow-up information for analysis, 347 (95%) had complete abortion without additional treatment, 5 (1%) had surgical aspiration, and 10 (3%) had extra misoprostol. Three participants (1%) had serious adverse events; these included two hospital admissions for heavy bleeding managed with aspiration and one diagnosis of persistent gestational sac 19 days after enrollment. Most (317, 90%) participants were pleased with omitting the pretreatment ultrasound and pelvic exam. Conclusions: In this study, medical abortion without screening ultrasound or pelvic exam resulted in no serious adverse events that were likely to have been prevented by those tests and was highly acceptable. Implications: Screening for medical abortion without exam or ultrasound shows promise as a means for increasing access to this service. More research is needed to develop screening criteria that are more inclusive and simpler for clinical use.

Cuvinte-cheie
Ectopic pregnancy, Last menstrual period, medical abortion, ultrasound

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