Skip to main content Accessibility help
×
Home
  • Print publication year: 2013
  • Online publication date: August 2013

20 - Medicaltermination of pregnancy

Summary

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.

Related content

Powered by UNSILO

References

1. Fiala C, Gemzell-Danielsson K. Review on medical abortion using mifepristone in combination with a prostaglandin analogue. Contraception 2006; 74(1): 66–86.
2. Gynuity Health Projects. http://gynuity.org/ (accessed 19 March 2013).
3. Moreau C, Trussell J, Desfreres J, et al. Medical vs surgical abortion: the importance of women's choice. Contraception 2011; 84(3): 224–9.
4. The National Board of Health and Welfare. Official Statistics of Sweden: induced abortions [in Swedish]. http://www.socialstyrelsen.se/ (accessed 19 March 2013).
5.World Health Organization. Safe Abortion: technical and policy guidance for health systems. Geneva, Switzerland: WHO, 2012.
6. Tang OS, Gemzell-Danielsson K, Ho PC. Misoprostol: pharmacokinetic profiles, effects on the uterus and side effects. Int J Gynaecol Obstet 2007; 99 (Suppl 2): 160–7.
7. International Federation of Gynecology and Obstetrics. http://www.figo.org (accessed 19 March 2013).
8. European Medicines Agency. http://www.ema.europa.eu/ema/ (accessed 19 March 2013).
9. Sääv I, Fiala C, Hämäläinen JM, et al. Medical abortion in lactating women – low levels of mifepristone in breast milk. Acta Obstet Gynecol Scand 2010; 89(5): 618–22.
10. Rowlands S. Misinformation on abortion. Eur J Contracept Reprod Health Care 2011; 16(4): 233–40.
11. Fiala C, Fux M, Gemzell Danielsson K. Rh-prophylaxis in early abortion. Acta Obstet Gynecol Scand 2003; 82(10): 892–903.
12. Hamoda H, Ashok PW, Flett GM, et al. Analgesia requirements and predictors of analgesia use for women undergoing medical abortion up to 22 weeks of gestation. BJOG 2004; 111(9): 996–1000.
13. Fiala C, Swahn ML, Stephansson O, et al. The effect of non-steroidal anti-inflammatory drugs (NSAIDs) on medical abortion with mifepristone and misoprostol. Hum Reprod 2005; 20(11): 3072–7.
14. Cameron ST, Glasier A, Dewart H, et al. Telephone follow-up and self-performed urine pregnancy testing after early medical abortion: a service evaluation. Contraception 2012; 86(1): 67–73.
15. Sääv I, Stephansson O, Gemzell-Damielsson K. Early versus delayed insertion of intrauterine contraception after medical abortion – a randomized controlled trial. PLosOne 2012; 7(11): e48948.
16. Women on Web. http://www.womenonweb.org/ (accessed 19 March 2013).
17. Gomperts RJ, Jelinska K, Davies S, et al. Using telemedicine for termination of pregnancy with mifepristone and misoprostol in settings where there is no access to safe services. BJOG 2008; 115(9): 1171–5.