Abstract
Background In North America, medical abortion using methotrexate and misoprostol has been extensively described. There is little information on medical abortion in young women and the problems inherent to this procedure. This paper describes medical abortion in women under 22 years old and problems encountered in follow up, especially differences between a private office and clinic setting. Method Healthy women Results In the clinic group, 1120 was completely lost to follow up and 6/19 had problems complying with the follow up protocol. In the private office, 35 eligible women were initially identified, 24 were offered medical abortion, 8 declined and 1/16 had compliance problems. Overall, 94% of women in both clinic and private office groups (19/19 & 14/16, respectively) had a successful medical termination. Two women required a suction curettage, one for an incomplete abortion and the other for an ongoing viable gestation. A mild postabortal endometritis occurred in one women in the clinic group. In both groups, a decrease of >80% in serum HCG by day 14 correlated with complete termination. Conclusion Medical abortion in early pregnancy using methotrexate and misoprostol is a viable and safe alternative to a surgical procedure in young women. Patient selection is paramount to avoid complications associated with noncompliance to protocol such as ongoing viable gestation and incomplete abortion. Because office·practice is referral-based, selection of appropriate candidates may be significantly easier to achieve, whereas clinic practice may need more rigorous selection criteria to ensure only women who can dedicate to follow up protocols are offered medical abortion.
Published Version
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