Medical abortion by mifpristone at home

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ESC Budapest Seminar 2003
Dr E. AUBENY, Paris FIAPAC
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Medical abortion by mifepristone at home ?
Present protocol of medical abortion by
mifepristone is
Efficacy rate 95.4
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Medical abortion by mifepristone at home ?

• Definition
• What is medical abortion at home ?
• It is the possibility to skip the visit to the
  hospital in order
• to take misoprostol (Cytotec), and take it at
  home
• This possibility would make medical abortion
  easier

Dr E. AUBENY - Fiapac Paris
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1- Is a non-hospitalisation after misoprostol
(Cytotec) possible from a medical point of
view?
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1983 - 1987 abortion by mifepristone only
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Since 1987 abortion by mifepristone
prostaglandins
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Why women stay at the hospital after
prostaglandins
FEAR
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Why women stay at the hospital after
prostaglandins

• Fear of prostaglandins (problem with
  sulprostone)

Replaced in 1992 by 400 µg misoprostol (Cytotec)
taken orally
? For 20 years, daily use all over the world to
prevent gastric ulcers when taking AINS
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Why women stay at the hospital after
prostaglandins

• Fear of prostaglandins

Misoprostol (Cytotec)
Suspicion towards misoprostol taken orally as a
drug for abortion is not justified
No need for a medical supervision in hospital
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Why women stay at the hospital after
prostaglandins

• Fear of haemorrhage at the time of expulsion

French and American trials show ? few
haemostatic aspirations 0.3
? late bleeding 10 to 15 days later
? few non-cataclysmic bleeding at the time of
expulsion
R. PEYRON, 1995 Spitz, 1999
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Why women stay at the hospital after
prostaglandins

• Fear of haemorrhage at the time of expulsion

Center Orthogénie Broussais few hemorrhages non
cataclysmic
Dagousset I non published
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Why women stay at the hospital after
prostaglandins

• Fear of haemorrhage at the time of expulsion

the 3-hour hospitalisation is not logical 40 of
women expel outside of the center
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Why women stay at the hospital after
prostaglandins

• Fear of haemorrhage at the time of expulsion

To summarise
? No more than one hour drive from the center
? Possibility to go to the centre day and night
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Why women stay at the hospital after
prostaglandins

• Fear of secondary effects

with 4OO µg misoprostol orally, they are
endurable
only 20 of non morphinic pain killers, they
can be taken at home
non frequent treatment, they that can be taken
at home
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Why women stay at the hospital after
prostaglandins
Fear of haemorrhage
Fear of secondary effects
Fear ofprostaglandins
To summarise, the French and U.S trials show from
a medical point of view that
Hospitalisation is not justified, neither by the
fear of prostaglandins,nor by fear of
haemorrhages, nor by fear of secondary effects
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Medical abortion by mifepristone at home ?
Foreign experiences go in the direction of
misoprostol at home
Ambulatory medical abortion
.
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Medical abortion by mifepristone at home ?
2 Is a non-hospitalisation after misoprostol
(Cytotec) possible from a
psychological point of view?
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Acceptability by women
French trial
?
?
120 women chose to go home
Dagousset I. and al, in press
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Medical abortion by mifepristone at home ?
Acceptability by women

• Results for 120 patients
• No major undesirable event
• Acceptance of the protocol 100
• Anxiety (valued by the number of phone calls)
• - 1 call 23 patients, 2 to 3 calls 3
  patients
• - no call 94 patients
• Use of pain killer 47 patients

98.5 of patients find the procedure
acceptable 77.5 of patients would recommend
it more privacy

Dr E. AUBENY - Paris, Fiapac
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3. Conclusion
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Conclusion
New possibility for women They must
be able to choose it
Dr.E. AUBENY - Paris, Fiapac