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CHOICE BETWEEN EVA AND MEDICATION ABORTION

Women who choose Medication Abortion usually prefer to get their abortion at home, consider that EVA is “more invasive” and are willing to accept a higher risk of bleeding, pain and time loss. Some women may be misinformed on the facts or risk of EVA. Other women may dislike the idea of “having a procedure” because of moral opposition to abortion and may unintentionally be deceiving themselves into considering that an induced miscarriage “would not be the same” as getting an Early Vacuum Aspiration (EVA) because “it appears to be more natural”; may be "like having a heavy period”; or it may “feel more acceptable because of the way it takes place”.

Women are not optimal candidates for a Medication Abortion if: they wish to minimize their participation in the termination; are anxious to have the abortion over with quickly; are unwilling to wait for the miscarriage to occur; do not have someone else at home that knows what is happening; do not have a telephone available; have language barriers that may interfere with her communicating with her doctor; or do not have the ability to deal with possible emergencies during the first 2 or 3 weeks. We strongly advise that a support person be with the patient or at least be close by and has the means to quickly transport her within an hour to a hospital or to our clinic in the event of hemorrhage or any other complication.

Medication abortion should be used with caution in: women with a serious illness, such as active liver disease, sickle cell or severe anemia, severe heart disease, uncontrolled seizure disorder, Immune Deficiency Disorder/ HIV, or diabetes that is not well controlled; or in women that would find it unacceptable that products of conception and/or clots may be passed at an inconvenient time or place; are unwilling to stop breastfeeding for three days after the abortion pill; have active alcohol/drug addiction; or have severe vomiting (hyperemesis) or other conditions that cause nausea, vomiting or diarrhea which may be aggravated by misoprostol..

Some women should not have a medication abortion. This includes women who: (a) have a pregnancy that on ultrasound is past 10 wks LMP; (b) have or might have an ectopic pregnancy, particularly if there is no visible gestational sac on ultrasound;  (c) currently have an intrauterine device (IUD) that cannot be removed without damaging the pregnancy in the process (for example, if the string of the IUD is not visible);  (d) have a bleeding disorder (coagulopathy); (e) take an anticoagulant medication to thin their blood; (f) take certain steroid medicines;       (g) have chronic adrenal failure.

Asthma is not a contraindication.

Complications of medication abortion:

In rare but possible situations, very heavy bleeding (defined as soaking one pad per hour for longer than 12 hours or passing blood clots that would fill a cup within one hour) and/or severe pain, may require an emergency D&C or additional treatment or care that if not provided at our facility will be the patient's financial responsibility and at her own expense. The chances of this happening are less than 1%

Bleeding, passing clots and cramping are usually more severe than during a menstrual period because the medication abortion causes a miscarriage. Bleeding, and cramping are a normal part of the abortion process. Some patients say that the bleeding was not as heavy as expected. Bleeding and/or spotting lasts on average 9-16 days but may normally continue for as long as six weeks.

In large clinical trials, the infection rate was approximately 0.9%.  Fatal infections with Clostridium sordellii and perfringens have been reported in North America but are rare. Symptoms seen with such infections include weakness, nausea, vomiting, or diarrhea with or without abdominal pain that persists after expulsion of the pregnancy. Patients typically lack a fever but have rapid pulse, low blood pressure and very high red and white cell counts.

EVA offers the following advantages over Medication Abortion:

a) EVA will efficiently complete the abortion in a matter of minutes and may require only one office visit. EVA entails less time lost from work and other activities. Medication Abortion  may takes more time (up to two weeks) to be completed.

b) the failure rate of EVA is practically zero when the gestational sac is visible on ultrasound. An ultrasound can be performed immediately following the EVA - while the patient is still on the operating table - to verify the success of the procedure and avoid abortion failures. In comparison, the failure rate with medication abortion is 5-8% and detecting the failure takes about 14 days.

c) EVA provides more certainty to the question of an undiagnosed, early ectopic pregnancy. Medication abortion carries a higher probability of missing an ectopic pregnancy because it relies only on the ultrasound, which in early pregnancy is not specific. Ectopic pregnancy may be accompanied by an intrauterine decidual reaction that may mimic the appearance of an early gestational sac; and similar images may be present in non pregnant patients with infections, myomas and/or bleeding disorders. If the ultrasound exam is not diagnostic of uterine pregnancy, a medication abortion can not be used. Instead, if the patient does not want to wait to repeat the ultrasound a few days later, an early vacuum aspiration may be done without delay with two hCG titers performed immediately prior to the EVA and 24 hours thereafter to verify that the pregnancy has been terminated and is not an ectopic pregnancy.

d) EVA can be performed earlier - even when a gestational sac is not found on ultrasound - as long as we can confirm a positive pregnancy test. In comparison, the medication abortion must be cancelled if a visible ultrasound gestational sac is not found, because neither mifepristone nor misoprostol are effective in treating ectopic pregnancy.

e) Patients may experience less bleeding, pain and psychological ill-effects; and recover faster after an EVA. EVA is performed under intravenous sedation that enhances the patient's comfort and decrease her recollection of the events surrounding the procedure.

INSTRUCTIONS for MEDICATION ABORTION


Before you choose to have a medication abortion, you and the counselor will discuss the Patient Information Notebook  and other documents explaining the Medication Abortion.

Please be advised that you will be given the Evidence-Based Regimen, which is different than FDA-Approved labeling, as discussed earlier.

On the first visit (Day 1) the doctor will do a sonogram to accurately determine the stage of pregnancy; perform blood work; administer you with a shot of Rhogam if your blood type is Rh-negative; have you swallow one pill of Mifeprex; and provide you with four small tablets of misoprostol.

On the next day (Day 2), at home, you will tuck the four tables of misoprostol between the cheek and gum (buccal administration), or under the tongue (sublingual administration). Any remnants of the tablets are to be swallowed after 30 minutes. Since you can expect cramping and bleeding and perhaps vomiting and diarrhea, and a rise in temperature, you should drink plenty of fluids and eat lightly and avoid spicy or fried foods the day before and the day you use the misoprostol tablets.

We recommend dose of mifepristone is one 200 mg tablet followed 24 hours later by 800 micrograms (4 tablets) of buccal misoprostol. Given buccally, the four mifepristone tablets are tucked between the cheek and gum, two tablets on each side of the mouth. Alternatively, the four tablets may be placed sublingually (under the tongue). The tablets are allowed to dissolve for 30 minutes after which the remaining fragments are swallowed.

The interval between mifepristone and misoprostol must be extended to 36-48 hours if the misoprostol is used orally and is swallowed immediately. We do not recommend administering misoprostol that way

Stay at home at least 8 hours after using the misoprostol. The majority of women will have miscarried in 8 hours but it may take longer. If you have children, someone must be able to watch your children for you.

You may use Ibuprofen 800 mg for a maximum of three times a day for pain relief.

If you do not have substantial bleeding, you will need to come back for a visit and repeat the dose of misoprostol in 24 hours. If you fail to bleed after the second dose of misoprostol you should promptly return for another visit because this may indicate that you may have an undiagnosed ectopic pregnancy. Medication Abortion has a 5 - 8% failure rate which may require having a suction curettage either because of ongoing or excessive bleeding; an incomplete abortion (tissue remaining in the uterus but there is no growing embryo); or an ongoing viable pregnancy (a growing pregnancy) which occurs in less than 1% of cases.

Patients are precluded from changing their mind after taking the medications or in the eventual possibility of drug failure. The abortion must be surgically completed because these medications may cause congenital malformations.

Call us if you soak more than two (2) maxi pads per hour for more than 4 hours or pass clots larger than a lemon for two hours in a row; bleed heavily for more than 12 hours in a row; run a temperature over 100.4 degrees for more than 4 hours; or if fever starts a few days after using misoprostol, because it may be due to an infection;feel strong nausea or throw up for more than four hours; are in pain, even with painkillers; have an allergic reaction to the medicine. In case of a medical emergency, or if you can not reach the clinic, call 911 and report to the closest hospital emergency room.

If you call us, please get first the phone number of your nearest 24-hour pharmacy and make sure that it is open.

Our doctor in on staff at Broward General Medical Center.

YOUR FOLLOW UP EXAM

It is very important that you come back no later than in two weeks for a repeat vaginal ultrasound to find out if the medication abortion was successful or not. The importance of the follow-up visit to confirm complete abortion can't be stressed enough, because of the possibility to continued pregnancy in the absence of bleeding (or even after bleeding); and the risk of fetal malformations after using misoprostol during the first trimester of pregnancy

Contraception may be started immediately after confirmation of a complete abortion. However, patients must wait 10-14 days to repeat a vaginal ultrasound and find out if the abortion was successful or not.

You may contact us at any of the following numbers:
Toll Free: (800) 867-1693 Local calls: (954) 772-HELP (4357) or (954) 772-0933 
You also may text your message to: (954) 805-5821


Our address is: 2100 E Commercial Blvd, Fort Lauderdale, Florida 33308-3822

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