Medical versus surgical methods for first trimester termination of pregnancy
RHL practical aspects by Chien P and Thomson M
FIRST CONTACT (PRIMARY CARE LEVEL)
The results of this review with regards to surgical abortion do not apply to the primary health-care level because this procedure is normally not performed at this level. Where provision of abortion is not against the law, medical abortion (200 mg oral mifepristone followed by 800 μg vaginal misoprostol 1–3 days later) can potentially be carried out at the primary care level provided adequate counselling, ultrasound scanning facilities, and monitoring and follow-up are available.
REFERRAL HOSPITAL (SECONDARY CARE) LEVEL
In order to improve accessibility to safe abortion where in settings where provision of abortion is not against the law, medical abortion with 200 mg oral mifepristone followed by 800 μg vaginal misoprostol 1–3 days later should be considered in preference to vacuum aspiration for pregnancies of up to 9 weeks' gestation. This method of abortion is effective and generally cheaper than surgical abortion as it can potentially be administered as an out-patient procedure. The delivery of the service is less skill-dependent compared with the surgical method. Moreover, it is safer as it avoids the need for an anaesthetic and avoids the risk of surgical complications such as cervical laceration and uterine perforation. Adequate follow-up is required in order to ensure that complete abortion is achieved.
AT HOME OR IN THE COMMUNITY
This document should be cited as: Chien P and Thomson M. Medical versus surgical methods for first trimester termination of pregnancy: RHL practical aspects (last revised: 15 December 2006). The WHO Reproductive Health Library; Geneva: World Health Organization.