Mifepristone and Misoprostol Overview
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Questions and Answers

What percentage of abortions completed before 10 weeks' gestation are medication abortions?

  • 30%
  • 70%
  • 60% (correct)
  • 50%

What is the role of mifepristone in a medication abortion regimen?

  • Causes cervical ripening
  • Regulates menstrual cycles
  • Acts as an anesthetic
  • Causes decidual necrosis and uterine contractions (correct)

Which medication is an analogue that contributes to cervical ripening during a medication abortion?

  • Mifeprex
  • Misoprostol (correct)
  • Methotrexate
  • Norgestrel

Before prescribing mifepristone and misoprostol, what should clinicians evaluate?

<p>Gestational age and contraindications (A)</p> Signup and view all the answers

What is the primary purpose of the combination of mifepristone and misoprostol in medication abortion?

<p>To induce uterine contractions and facilitate abortion (D)</p> Signup and view all the answers

What percentage of all abortions is accounted for by medication abortion?

<p>60% (B)</p> Signup and view all the answers

Which of the following conditions is concluded to not increase risk from medication abortion according to the 2018 review?

<p>Preterm birth (D)</p> Signup and view all the answers

Primary care clinicians are especially positioned to provide what service?

<p>Medication access (D)</p> Signup and view all the answers

What institution concluded that medication abortion does not increase the risk of certain health issues?

<p>National Academies of Sciences, Engineering, and Medicine (D)</p> Signup and view all the answers

What is one of the benefits of primary care clinicians in the context of patient care related to abortions?

<p>Wide geographic distribution (A)</p> Signup and view all the answers

In which setting can primary care clinicians prescribe the regimens discussed?

<p>Outpatient settings (D)</p> Signup and view all the answers

Which of the following health concerns is not associated with medication abortion?

<p>Chronic fatigue syndrome (D)</p> Signup and view all the answers

What aspect of patient care do primary care clinicians possess that aids in shared decision-making?

<p>Skills in shared decision-making (B)</p> Signup and view all the answers

What treatment is compared to misoprostol alone for early pregnancy failure?

<p>Mifepristone followed by misoprostol (B)</p> Signup and view all the answers

Which organization published the document regarding reproductive and sexual coercion?

<p>American College of Obstetricians and Gynecologists (D)</p> Signup and view all the answers

What is the primary focus of the report by Jones RK et al. released in September 2019?

<p>Abortion incidence and service availability (D)</p> Signup and view all the answers

What was the year of publication for the committee opinion on reproductive and sexual coercion?

<p>2013 (A)</p> Signup and view all the answers

What type of study was conducted by Biggs MA et al. about women's mental health regarding abortion?

<p>Prospective longitudinal cohort study (D)</p> Signup and view all the answers

What percentage reflects the need for unplanned uterine aspiration due to reasons other than ongoing pregnancy?

<p>1.8% to 4.2% (A)</p> Signup and view all the answers

What is the title of the study that addresses expectant management versus surgical evacuation in miscarriage?

<p>Expectant management versus surgical evacuation in first trimester miscarriage (C)</p> Signup and view all the answers

Which of the following treatments was evaluated in Wieringa-De Waard et al.'s study?

<p>Expectant management versus surgical evacuation (A)</p> Signup and view all the answers

Which condition has the highest percentage associated with it prior to medication abortion?

<p>Need for unplanned uterine aspiration (C)</p> Signup and view all the answers

What is the publication year for the study by Schreiber CA et al. on mifepristone pretreatment?

<p>2018 (C)</p> Signup and view all the answers

What is the reported risk of breast cancer associated with medication abortion?

<p>No increase (A)</p> Signup and view all the answers

What is the percentage range for the occurrence of pelvic infections associated with unplanned uterine aspiration?

<p>0.6% to 1.3% (B)</p> Signup and view all the answers

What is one method to confirm successful passage of pregnancy tissue after early pregnancy loss?

<p>Adequate decline in serial serum β-hCG levels (A)</p> Signup and view all the answers

What percentage reflects the occurrence of undiagnosed ectopic pregnancy?

<p>0.02% (A)</p> Signup and view all the answers

What long-term outcomes are similar for medication abortion compared to surgical management?

<p>Fertility rates and pregnancy outcomes (C)</p> Signup and view all the answers

Which condition is least likely to require transfusion based on the reported percentages?

<p>Hemorrhage requiring transfusion 0.03% to 0.6% (B)</p> Signup and view all the answers

What is the first medication administered in the FDA regimen for medication abortion up to 70 days’ gestation?

<p>Mifepristone (A)</p> Signup and view all the answers

Which of the following is an absolute contraindication for using Mifeprex?

<p>Allergy to mifepristone (B)</p> Signup and view all the answers

What is the recommended dose of misoprostol given after mifepristone in the FDA regimen?

<p>800 mcg (D)</p> Signup and view all the answers

Which condition is considered a relative contraindication in the context of medication abortion?

<p>Inability to access emergency services (A)</p> Signup and view all the answers

How many days past gestation does effectiveness of the regimen increase with an additional dose of misoprostol?

<p>Up to 77 days (D)</p> Signup and view all the answers

What procedure must be done with an intrauterine device before proceeding with medication abortion?

<p>Remove it (A)</p> Signup and view all the answers

What must be ordered from the manufacturer before dispensing mifepristone to a patient?

<p>A prescription (D)</p> Signup and view all the answers

Which of the following is NOT an absolute contraindication for medication abortion?

<p>Mild hypertension (A)</p> Signup and view all the answers

Which medication is indicated for safe use in outpatient settings by primary care clinicians?

<p>Mifepristone and misoprostol (B)</p> Signup and view all the answers

What is required to confirm gestational age prior to a medication abortion?

<p>Menstrual dating or ultrasonography (C)</p> Signup and view all the answers

What is the most effective regimen for managing early pregnancy loss?

<p>Mifepristone 200 mg followed by misoprostol 800 mcg (A)</p> Signup and view all the answers

What is the recommended regimen for medication abortion up to 70 days' gestation?

<p>Mifepristone then misoprostol vaginally (D)</p> Signup and view all the answers

What should be done to increase the effectiveness of medication abortion?

<p>Administer a second dose of misoprostol (B)</p> Signup and view all the answers

How is completed early pregnancy loss or abortion confirmed?

<p>Monitoring beta hCG levels and ultrasonography (A)</p> Signup and view all the answers

Which of the following evidence ratings indicates good-quality patient-oriented evidence?

<p>Rating A (C)</p> Signup and view all the answers

When should ultrasonography be performed prior to medication abortion?

<p>If gesta-tional age cannot be confirmed or risk of ectopic pregnancy (D)</p> Signup and view all the answers

What is recommended for patients at 71 to 77 days' gestation after the initial dose?

<p>A second dose of misoprostol is recommended (C)</p> Signup and view all the answers

What clinical recommendation has a rating of C?

<p>The safety of mifepristone and misoprostol use (A)</p> Signup and view all the answers

Flashcards

Medication Abortion

A type of abortion where medication is used to end a pregnancy.

Mifepristone

A drug used in medication abortions that blocks the hormone progesterone. It causes tissue breakdown in the uterus.

Misoprostol

A medication used in medication abortions that causes the cervix to soften and the uterus to contract.

Gestational Age

The period of time a pregnancy has lasted, measured from the first day of the last menstrual period.

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Contraindications

Factors that make a medical procedure or treatment unsafe for a specific patient.

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Medication Abortion Prevalence

Medication abortion accounts for a majority of abortions in the early stages of pregnancy.

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Role of Primary Care in Medication Abortion

Primary care clinicians are well-suited to provide medication abortion services due to their accessibility, expertise in decision-making, and medication dispensing.

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Safety of Medication Abortion

Medication abortion does not increase the risk of breast cancer, mental health problems, infertility, pregnancy loss, or preterm birth.

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Safety and Acceptability of Medication Abortion

Medication abortion is a safe and acceptable option for patients and can be prescribed by primary care clinicians.

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National Academies Review of Medication Abortion

A 2018 review by the National Academies of Sciences, Engineering, and Medicine concluded that medication abortion is safe and does not have the negative health effects often associated with it.

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Access to Medication Abortion

Patients can access medication abortion services in their communities through primary care clinicians.

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Shared Decision-Making in Medication Abortion

Primary care clinicians are skilled in shared decision-making, which is essential for counseling patients about medication abortion.

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Absolute contraindications

Conditions that absolutely prevent the use of mifepristone and misoprostol for medication abortion.

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Adrenal insufficiency

A condition where the adrenal glands are not producing enough hormones.

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Allergy to mifepristone or misoprostol

A severe allergic reaction to either mifepristone or misoprostol.

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Chronic systemic glucocorticoid use

Long-term use of medications that suppress the adrenal glands.

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Confirmed or suspected ectopic pregnancy

A pregnancy that develops outside of the uterus.

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Hemodynamic instability

A state of unstable vital signs (e.g., low blood pressure, rapid heart rate).

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Hemorrhagic disorder or current anticoagulant use

A condition where the blood is not clotting properly.

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Inherited porphyrias

A group of genetic disorders that affect the production of heme.

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Misoprostol-Only Abortion

A type of medication abortion involving only misoprostol, used for ending pregnancies early in the first trimester.

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Uterine Aspiration

A procedure to remove the contents of the uterus due to an incomplete miscarriage or pregnancy loss.

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Need for Unplanned Uterine Aspiration

The risk of a woman needing a surgical procedure (uterine aspiration) after a medication abortion, due to incomplete expulsion of pregnancy tissue.

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Hemorrhage Requiring Transfusion

A potential complication of medication abortions, involving bleeding that requires a blood transfusion.

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Pelvic Infection

A possible complication of medication abortions, involving an infection of the reproductive organs.

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Ongoing Pregnancy

A possible complication of medication abortion, involving an ongoing pregnancy despite the medication.

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Undiagnosed Ectopic Pregnancy

A potential complication of medication abortion, involving the fertilized egg implanting outside the uterus.

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Medical abortion

A type of abortion that is done using medication, rather than surgery.

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Longitudinal study

A study that follows a group of people over time to see how their health changes.

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Randomized controlled trial (RCT)

A type of study where participants are randomly assigned to different groups to compare the effects of different treatments.

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Reproductive coercion

A situation where a person is pressured or forced into having sex.

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Surgical abortion

A type of abortion that is done by a healthcare professional using a surgical procedure.

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Medication Abortion in Primary Care

Mifepristone (Mifeprex) and misoprostol (Cytotec) can be safely prescribed by primary care clinicians in the outpatient setting.

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Confirming Gestational Age

Gestational age should be confirmed through menstrual dating or ultrasonography before medication abortion.

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Ultrasound for Medication Abortion

Ultrasonography is required for patients at risk of ectopic pregnancy, or if gestational age can't be confirmed clinically.

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Best Regimen for Pregnancy Loss

The most effective regimen for medication management of early pregnancy loss involves mifepristone followed by misoprostol, rather than misoprostol alone.

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Medication Abortion Up to 70 Days

The recommended regimen for medication abortion up to 70 days gestation is mifepristone followed by misoprostol, administered either buccally or vaginally.

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Second Dose of Misoprostol

A second dose of misoprostol 4 hours after the first is recommended for pregnancies between 71 and 77 days, and considered for those between 64 and 70 days.

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Confirming Completion of Medication Abortion

Completed early pregnancy loss or abortion can be confirmed through clinical history, serum beta human chorionic gonadotropin (hCG) levels, ultrasonography, or a negative pregnancy test.

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Evidence for Medication Abortion Regimens

A systematic review of using mifepristone and misoprostol buccally and individual randomized controlled trials of using misoprostol vaginally demonstrated the effectiveness of these regimens.

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National Academies Guideline on Abortion Care

The National Academies of Sciences, Engineering, and Medicine released a consensus guideline on the safety and quality of abortion care, supporting medication abortion in the outpatient setting.

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Evidence for Gestational Age Confirmation

Consistent results from two prospective case series and a retrospective review provide evidence for the use of menstrual dating or ultrasonography to confirm gestational age before medication abortion.

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Study Notes

Mifepristone and Misoprostol for Early Pregnancy Loss and Medication Abortion

  • Medication regimens using mifepristone and misoprostol are safe and effective for outpatient treatment of early pregnancy loss (up to 84 days) and medication abortion (up to 77 days).
  • Gestational age is determined using ultrasonography or menstrual history. Ultrasonography is needed if gestational dating is uncertain or if there are risk factors for ectopic pregnancy.
  • The most effective regimens combine 200 mg of oral mifepristone (progesterone receptor antagonist) followed by 800 mcg of misoprostol (prostaglandin E₁ analogue) administered buccally or vaginally.
  • Cramping and bleeding are common side effects, lasting an average of 9-16 days.
  • Misoprostol side effects (e.g., low-grade fever, GI symptoms) are manageable with NSAIDs or antiemetics.
  • Rare complications include ongoing pregnancy, infection, hemorrhage, undiagnosed ectopic pregnancy, and the need for uterine aspiration.
  • Medical management of early pregnancy loss and abortion has increased since FDA approval of mifepristone (2000).
  • Medication abortion now accounts for 60% of abortions before 10 weeks.
  • Medication regimens combine mifepristone (decidual necrosis, uterine contractions) and misoprostol (cervical ripening, uterine contractions).
  • Primary care providers are well-suited to counsel patients and provide medication; they have broad reach, skills in shared decision-making, and ongoing patient relationships.
  • Before prescribing mifepristone and misoprostol, clinicians must determine gestational age, evaluate contraindications, counsel patients on management options, and consider lab testing.
  • The National Academies of Sciences, Engineering, and Medicine state that medication abortion does not increase the risk of breast cancer, mental health problems, infertility, pregnancy loss, or preterm birth.

Key Recommendations for Practice

  • Mifepristone (Mifeprex) and misoprostol (Cytotec) are safe for use by primary care clinicians.
  • Menstrual dating or ultrasonography is needed to determine gestational age before medication abortion procedure. Ultrasonography is especially important for high-risk patients or those with uncertain gestational age.
  • The most effective regimen for early pregnancy loss management is 200 mg oral mifepristone, followed 24-48 hours later by 800 mcg vaginal misoprostol.
  • For medication abortion (up to 70 days), 200 mg oral mifepristone followed by 800 mcg buccal misoprostol 24-48 hours later, or 800 mcg vaginal misoprostol (0-72 hours later) is the recommended regimen.
  • For greater effectiveness of medication abortion (71-77 days gestation), a second 800 mcg dose of misoprostol is recommended four hours after the first dose.
  • Following treatment, early pregnancy loss completion is confirmed by clinical history, a decrease in serum beta-hCG levels (80% decline from baseline) or ultrasonography.

Regimens for Early Pregnancy Loss

  • 200 mg mifepristone, followed by 800 mcg vaginal misoprostol 24-48 hours later, is the most effective regimen for early pregnancy loss.
  • Misoprostol alone can be used if mifepristone is unavailable; however, it has lower efficacy.

Regimens for Medication Abortion

  • The FDA regimen for medication abortion up to 70 days is 200 mg mifepristone followed by 800 mcg buccal misoprostol 24 to 48 hours later.
  • Evidence-based regimens demonstrate safety and effectiveness up to 77 days (with an increased effectiveness using additional misoprostol dose at 64-77 days).
  • Using vaginal misoprostol (0-72 hrs) is as effective as the buccal method.

Contraindications

  • Absolute: Adrenal insufficiency, allergy to mifepristone/misoprostol, confirmed/suspected ectopic pregnancy, hemodynamic instability, hemorrhagic disorder or current anticoagulant use (except aspirin), inherited porphyrias, intrauterine device (must be removed).
  • Relative: Hemoglobin less than 10 g/dL, inability to access emergency services or follow up.
  • Patients must be counseled about all management options (expectant management, medication, aspiration).
  • Patients should be informed of risks and benefits of each choice.
  • Patients need autonomy during the decision-making process.

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Mifepristone and Misoprostol for Early Pregnancy Loss and Medication Abortion PDF

Description

This quiz covers the safety and effectiveness of using mifepristone and misoprostol for early pregnancy loss and medication abortion. It includes information on recommended regimens, side effects, and complications. Understanding gestational dating and its importance in treatment is also emphasized.

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