Medicaltermination of pregnancy

In: Contraception · 2013 · pp. 181–191 · doi:10.1017/cbo9781107323469.022 · W1578411246
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This chapter outlines the clinical protocols and outcomes for early medical abortion, specifically focusing on regimens administered up to 63 days of gestation. It highlights that the combination of mifepristone and misoprostol achieves complete abortion rates between 95% and 99%, with side effects primarily consisting of pain and vaginal bleeding similar to spontaneous miscarriage. The text also notes that mifepristone levels in breast milk are negligible after a single dose and emphasizes the public health risks associated with unsafe abortion procedures globally. Relevance to endometriosis: The paper does not explicitly discuss endometriosis or adenomyosis; it was included in the corpus via a keyword match in the upstream search index.

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Abstract

This chapter presents a case study of a 42 year old female (Alison), who suffered from heavy painful periods. Alison's situation is far from unusual for this age group, where the risk of relationship breakdown is high. It is apparent that Alison's first priority is a highly effective contraceptive method. However, she requires much more from her method: effective control of bleeding and dysmenorrhoea; restoration of menstrual predictability and/or amenorrhoea. A bimanual examination for Alison is undertaken to assess for uterine enlargement (fibroids, adenomyosis), uterine mobility and adnexal masses and/or tenderness. Alison was advised about how the levonorgestrel-releasing intrauterine system (LNG-IUS) works by profound endometrial glandular and stromal suppression, cervical mucus changes and a foreign body effect within the endometrium. Progestogen-only pills (POPs) would be an option for Alison if she has contraindications to taking oestrogens.
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Contraception Buy print or eBook [Opens in a new window] A Casebook from Menarche to Menopause - Contraception - Contraception - Copyright page - Contents - List of contributors - Foreword - Preface - 1 Whatwomen want from their contraceptives… and what we can offer - 2 Mythsand misconceptions about sex and con(tra)ception - 3 Thehistory of contraception - 4 Physiologyof the menstrual cycle and natural family planning - 5 Theoestrogen component of currently used steroidal contraceptives - 6 Therisk of oestrogens in contraceptives - 7 Progestogensused in contraceptives - 8 Thecontraceptive consultation - 9 Menarcheand associated problems - 10 Adolescence:contraception in the teenage years - 11 Contraceptionin the20-somethings - 12 Contraception in the 30-somethings - 13 Contraceptionin the 40-somethings - 14 Contraception in the50-somethings - 15 Whatis the risk of cancer with hormonal contraception? - 16 Newdevelopments in female sterilization - 17 Malesterilization - 18 Emergency contraception - 19 Sexuallytransmissible infections and pelvic pain: what you really need to know - 20 Medicaltermination of pregnancy - 21 Surgicaltermination of pregnancy - 22 Primary care treatment of subfertility and what every health professional needs to know about assisted reproductive technology - 23 Sexualassault - 24 Future developments incontraception - Index Published online by Cambridge University Press: 05 August 2013 Edited in consultation with Book contents - Contraception - Contraception - Copyright page - Contents - List of contributors - Foreword - Preface - 1 Whatwomen want from their contraceptives… and what we can offer - 2 Mythsand misconceptions about sex and con(tra)ception - 3 Thehistory of contraception - 4 Physiologyof the menstrual cycle and natural family planning - 5 Theoestrogen component of currently used steroidal contraceptives - 6 Therisk of oestrogens in contraceptives - 7 Progestogensused in contraceptives - 8 Thecontraceptive consultation - 9 Menarcheand associated problems - 10 Adolescence:contraception in the teenage years - 11 Contraceptionin the20-somethings - 12 Contraception in the 30-somethings - 13 Contraceptionin the 40-somethings - 14 Contraception in the50-somethings - 15 Whatis the risk of cancer with hormonal contraception? - 16 Newdevelopments in female sterilization - 17 Malesterilization - 18 Emergency contraception - 19 Sexuallytransmissible infections and pelvic pain: what you really need to know - 20 Medicaltermination of pregnancy - 21 Surgicaltermination of pregnancy - 22 Primary care treatment of subfertility and what every health professional needs to know about assisted reproductive technology - 23 Sexualassault - 24 Future developments incontraception - Index This chapter provides basic information on regimens recommended for early medical abortion up to 63 days of gestation. Mifepristone is the only anti-progestin approved for the induction of abortion. The levels of mifepristone found in breast milk from lactating women following the intake of a single dose of 200 mg are low or immeasurable. The combined regimen of mifepristone and misoprostol has success rates, measured as complete abortion without the need for surgical intervention or additional drug administration, of 95-99%. The side effects of medical abortion are similar to those experienced with miscarriage, with the most frequently reported adverse events being pain (caused by uterine contractions) and vaginal bleeding. Postponing contraception is associated with the highest rate of repeat abortion. Globally, approximately 13% of all maternal deaths are due to complications of unsafe abortion and the proportion of unsafe abortion increases. - Type - Chapter - Information - ContraceptionA Casebook from Menarche to Menopause, pp. 181 - 191Publisher: Cambridge University PressPrint publication year: 2013 Accessibility compliance for the HTML of this chapter is currently unknown and may be updated in the future. To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle. Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply. Find out more about the Kindle Personal Document Service. - Medicaltermination of pregnancy - - Book: Contraception - Online publication: 05 August 2013 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox. - Medicaltermination of pregnancy - - Book: Contraception - Online publication: 05 August 2013 To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive. - Medicaltermination of pregnancy - - Book: Contraception - Online publication: 05 August 2013

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