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What follow-up care is required when having a medication abortion?
The medication abortion process varies in length depending on both the regimen and the protocol. For all regimens, the medication abortion process requires at least two clinic visits in the United States. The following table lists the most commonly used protocol for each of the medical abortion regimens.
Day 1 (Clinic): A clinician counsels the woman, takes a medical history and performs an exam and lab tests.
The woman takes the mifepristone orally and is given misoprostol to administer at home.Day 2-4 (Home): Misoprostol is self-administered vaginally at home. Nearly 2/3 of women will have a complete abortion within four hours of the misoprostol administration; 90% of women will have a complete abortion within 24 hours of misoprostol administration.
Day 7-14 (Clinic): Patient returns to the clinic for follow-up and a clinician assesses for the completion of the abortion. If the abortion is incomplete (2%-5% of cases), the clinician will discuss treatment options with the patients. These options include waiting and re-evaluating, administering additional misoprostol, or performing an aspiration abortion.
Day 1 (Clinic): A clinician counsels the woman, takes a medical history and performs an exam and lab tests. Methotrexate is administered either orally or intramuscularly and the woman is given misoprostol to administer at home.Day 3-7 (Home): Misoprostol is self-administered vaginally at home.
Day 8 (Clinic): A clinician performs a vaginal ultrasound to determine if the abortion is complete.
Approximately 75% of women will have had a complete abortion and no further visits are required.
If the abortion is incomplete and no cardiac activity is detected on ultrasound, the woman is given additional misoprostol and returns to the clinic on Day 28-45. Approximately 15%-20% of women will complete the abortion process over the next three weeks.
If cardiac activity is detected, additional misoprostol is given and the woman returns on Day 15.Day 15 (Clinic, if necessary): The patient is assessed for continued pregnancy. If cardiac activity is detected, a surgical termination is performed. If no cardiac activity is detected, the woman is asked to return in three weeks.
Day 28-45 (Clinic, if necessary): The patient is assessed for continued pregnancy. If the abortion is incomplete (5% of cases), an aspiration termination is performed.
There is currently no standard protocol for the misoprostol-only regimen. However, a review of recent studies demonstrates that serial vaginal administration of moistened misoprostol results in completion rates of 85%-90%. The length of time required for complete abortion varies by regimen and ranges from one day to two weeks.Review of recent studies on the misoprostol-only regimen.
If you have questions about medication abortion, please visit our page on frequently asked questions.