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Medical Abortion Study Guide Second Edition Medical Abortion Study Guide Disclaimer: The regularly updated Clinical Updates in Reproductive Health (www.ipas.org/clinicalupdates) provides Ipas’s most up-to-date clinical guidance, which supersedes any guidance that may differ in Ipas curricula or other materials. ISBN: 1-933095-46-6 © 2009, 2013 Ipas. Produced in the United States of America. Suggested citation: Ipas. (2013). Medical abortion study guide (second ed.) K. L. Turner (Ed.), Chapel Hill, NC: Ipas. Ipas is a nonprofit organization that works around the world to increase women’s ability to exercise their sexual and reproductive rights, especially the right to safe abortion. We seek to eliminate unsafe abortion and the resulting deaths and injuries and to expand women’s access to comprehensive abortion care, including contraception and related reproductive health information and care. We strive to foster a legal, policy and social environment supportive of women’s rights to make their own sexual and reproductive health decisions freely and safely. Ipas is a registered 501(c)(3) nonprofit organization. All contributions to Ipas are tax deductible to the full extent allowed by law. Cover photo credits: © Richard Lord Illustrations: Stephen C. Edgerton The illustrations and photographs used in this publication are for illustrative purposes only. No similarity to any actual person, living or dead, is intended. For more information or to donate to Ipas: Ipas P.O. Box 9990 Chapel Hill, NC 27515 USA 1-919-967-7052 [email protected] www.ipas.org Printed on recycled paper. Ipas Medical Abortion Study Guide Acknowledgments This second edition of Ipas’s Medical Abortion Study Guide was revised and updated by the following Ipas staff and consultants: Katherine L. Turner, USA, editor and lead reviewer Jennifer Soliman, USA, revision coordinator Lead revision team: Alice Mark, USA Amanda Huber, USA Bill Powell, USA Joan Healy, USA Technical reviewers: Alyson Hyman, USA Anna de Guzman, USA Nadia Shamsuddin, USA The following Ipas staff and colleagues provided valuable inputs:* Alison Edelman, USA Mary Fjerstad, USA Bhagawati Badal, Nepal Makgoale Magwentshu, South Africa Dalia Brahmi, USA Meena Kumari Shrestha, Nepal Deeb Shrestha Dangol, Nepal Prativa Koirala, Nepal Ganesh Bahadur Singh, Nepal Tarun Poudel, Nepal Kalpana Khadsaka, Nepal Manish Aryal, Nepal i Ipas Medical Abortion Study Guide We give thanks to Ipas staff who contributed to the development of the first edition: Alfonso Carrera, Mexico Makgoale Magwentshu, South Africa Alyson Hyman, USA Mary Fjerstad, USA Bill Powell, USA Mary-Jane Zondo, South Africa Cansas Mulligan, USA Marian Abernathy, USA Ganesh Shrestha, Nepal Nadia Shamsuddin, USA Indira Basnett, Nepal Phan Bich Thuy, Vietnam Jennie Orcutt, USA Robyn Sneeringer, USA Joachim Osur, Kenya Rodolfo Gómez Ponce de León, Joan Healy, USA Argentina Joseph Mills, Ghana Sangeeta Batra, India Josephine Addy, Ghana Sarah Packer, USA Karen Trueman, South Africa Sikiratu Kailani, Nigeria Kari Koita, Kenya Takele Geressu, Ethiopia Katherine L. Turner, USA Tiemoko Ouattara, Burkina Karen Padilla, Nicaragua Faso Laura Castleman, USA Traci Baird, USA We give our appreciation to the Swedish International Development Agency for contributing funding to the development of the first edition of this training package through a grant to Ipas. ii Ipas Medical Abortion Study Guide We would like to thank the following people for giving their time and expertise to the development of Ipas’s medical abortion training program:* Ali Samba, Ghana Lisa Memmel, USA Alison Edelman, USA Lisa Moreau, USA Anne Burke, USA Meera Ojha, Nepal Beth Kruse, USA Meera Upadhyay, Nepal Beverly Winikoff, USA Melanie Peña, USA Blami Dao, Burkina Faso Mitchell Creinin, USA Caitlin Shannon, USA Nitin Joglekar, India Chanda Karki, Nepal Nguyen Thi Nhu Ngoc,Vietnam Christina Wegs, USA Paige Layno-Winn, USA Danielle Hassoun, France Paul Blumenthal, USA Dalia Brahmi, USA Phillip Stubblefield, USA Fabian Rodriguez, Uruguay Pramila Pradha, Nepal George Huggins, USA Rodica Comendant, Moldova Hela Chelli, Tunisia Selma Hajri, Tunisia Helena Von Hertzen, Switzerland Shilu Aryal, Nepal Joe Taylor, Ghana Suchitra Dalvie, India Kusum Thapa, Nepal Swaraj Rajbhandari, Cambodia *The protocols and content in this publication do not necessarily reflect the views and opinions of each individual contributor. We give special thanks to the many colleague agencies who field tested the first edition of the training package: Nepal Training on Medical Abortion for Lead Trainers and the Family Health Division, Government of Nepal Africa Regional Training of Trainers on Medication Abortion and the Centre de Formation Internationale et de Recherche (CéFIR), Tunisia Cambodia Technical Working Group on Medical Abortion and the National Reproductive Health Program, Government of Cambodia South African Medical Abortion Curriculum Review Committee iii Ipas Medical Abortion Study Guide Table of contents Acknowledgements ...................................................................................................... i About the Medical Abortion Study Guide ..................................................................ix Clinical updates ............................................................................................................................ix Purpose .........................................................................................................................................ix Objectives .....................................................................................................................................ix Second edition ...............................................................................................................................x About the MA Training program .................................................................................xi Intended participants ...................................................................................................................xii Prerequisites ................................................................................................................................xii Duration of training program .......................................................................................................xii Module 1: Overview ..................................................................................................... 1 Introduction ...................................................................................................................................1 Abortion methods ..........................................................................................................................2 Access ............................................................................................................................................3 Acceptability ..................................................................................................................................4 Module 2A: Medical Abortion with Mifepristone and Misoprostol ............................ 7 Overview ........................................................................................................................................7 Eligibility ........................................................................................................................................9 Indication ..................................................................................................................................9 Contraindications .....................................................................................................................9 Precautions ...............................................................................................................................9 Ectopic pregnancy ...................................................................................................................... 10 Special considerations ................................................................................................................ 10 Young women ........................................................................................................................ 10 Asthma .................................................................................................................................. 10 HIV and AIDS ......................................................................................................................... 10 Breastfeeding ........................................................................................................................ 11 Sexually transmitted infections ............................................................................................. 11 Obesity .................................................................................................................................. 11 Multiple gestation ................................................................................................................. 11 Mifepristone and misoprostol regimens up to 13 weeks ........................................................... 11 iv Ipas Medical Abortion Study Guide Routes for taking medicines ....................................................................................................... 12 Mifepristone .......................................................................................................................... 12 Misoprostol ...........................................................................................................................
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