User:Lookwhatimook/Medical abortion

Telemedicine Abortion article Ms. Magazine https://msmagazine.com/2020/03/26/telemedicine-abortion-what-it-is-and-why-we-need-it-now-more-than-ever/

Guttmacher TeleAbortion summary

https://www.guttmacher.org/gpr/2019/05/improving-access-abortion-telehealth

PPFA summary of Obstetrics and Gynecology study 2019

https://www.plannedparenthood.org/about-us/newsroom/press-releases/new-multi-state-study-shows-telemedicine-abortion-is-as-safe-and-effective-as-in-person-care

"Traditionally, the administration of mifepristone has been as an in-person clinic visit, but based on accumulated evidence [47-49], the American College of Obstetricians and Gynecologists [50] and the National Abortion Federation [51] support alternative approaches to evaluation, counseling, and medication provision, including elimination of the in-person initial visit for many patients. Alternatives that have been investigated or implemented include telemedicine services [52], postal mail delivery of mifepristone and misoprostol [53], and/or direct pharmacy dispensation [42,54]. In places in the United States where telemedicine is utilized for medication abortion, the service resembles the in-person process but can be performed in remote clinics through videoconference and remote ability to unlock drawers that contain the medications once counseling is complete. A survey of 600 women using this service at Planned Parenthood of the Heartland in Iowa demonstrated comparable clinical outcomes to those of in-person visits and excellent satisfaction in 94 percent of patients [55]. A retrospective cohort study of over 5000 women receiving either telemedicine (n = 738) or traditional (n = 5214) medication abortion through four United States health centers reported similar mean gestational ages between the groups but lower rates of follow-up within 45 days for the telemedicine patients (60.3 versus 76.9 percent, respectively) [49]. In countries where mifepristone/misoprostol abortion medications are available directly, abortion provision happens at substantially earlier gestations [54,56,57]."

Through 12 weeks gestation[ edit]
This is an option for people with gestations through 77 DAYS. Mifepristone 200 mg is taken and followed by misoprostol 800 mcg IN THE CHEECK, vaginally, or UNDER THE TONGUE 24 to 48 hours later. The early first-trimester medical abortion regimen (200 mg of oral mifepristone, followed 24–48 hours later by 800 mcg of buccal misoprostol) currently used by Planned Parenthood clinics in the United States since April 2006 is 98.3% effective through 59 days' gestation.

Though not a first line choice, a methotrexate/misoprostol combination regimen is appropriate. Methotrexate is given either orally or intramuscularly, followed by vaginal misoprostol 3–5 days later. This is an appropriate option for gestations through 63 days. Per the WHO, a methotrexate-misoprostol regimen can also be used; but is not recommended as methotrexate may be teratogenic to the fetus in cases of incomplete abortion. However, this combination is considered more effective than misoprostol alone.

Is it worth going into timing of buccal(24-48h) vs. vaginal miso (0-72h)? per NAF protocol YES

I think we should remove the section on methotrexate as now Canada is using mifepristone and WHO specifically recommeds against MTX.

Shaw KA, Topp NJ, Shaw JG, Blumenthal PD. Mifepristone-misoprostol dosing interval and effect on induction abortion times: a systematic review. Obstet Gynecol. 2013;121(6):1335–1347. doi:10.1097/AOG.0b013e3182932f37

NAF CPG: https://prochoice.org/education-and-advocacy/cpg/

NAF 2020 Clinical Policy Guidelines

up to 12wk ref

Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI. Medical abortion in the late first trimester: a systematic review. Contraception. 2019;99(2):77–86. doi:10.1016/j.contraception.2018.11.002

Misoprostol, a different kind of medication (instead A PROSTAGLANDIN ANALOGUE), causes the uterus to contract and expel the embryo through the vagina

Raymond EG, Harrison MS, Weaver MA. Efficacy of misoprostol alone for first-trimester medical abortion: a systematic review. Obstet Gynecol. 2019;133(1):137–147.

TO DO

Update Infobox -- There's a 2016 MMWR https://www.cdc.gov/mmwr/volumes/68/ss/ss6811a1.htm I think we increase to 31$ (27.9+3.4%) for US

Add of REMS restrictions

Edit the reversal section so it's shorter