The Society of Family Planning has released two clinical recommendations for medication abortion between 14 0/7 and 27 6/7 weeks of gestation and the management of hemorrhage at the time of abortion. Here’s more information on updated regimens and interventions. The Society of Family Planning will present these recommendations in more detail at the 2023 Annual Meeting beginning on October 28th through October 30th in Seattle, Washington.
The Society of Family Planning has recently released two new clinical updates for medication abortion between 14 0/7 and 27 6/7 weeks of gestation and the management of hemorrhage at the time of abortion. The recommendation for medication abortion was jointly developed with the Society for Maternal-Fetal Medicine and reviews relevant literature to provide evidence-based recommendations for medication abortion within this gestational age range with a focus on mifepristone-misoprostol and misoprostol-only regimens. Additional details include:
- The Society of Family Planning regularly develops evidence-based clinical guidance based on existing medical literature and best practice. Rh testing and administration are no longer recommended prior to 12 weeks gestation for patients undergoing spontaneous, medication, or procedural abortion.
- Medication regimen recommendations include:
- Mifepristone 200 milligrams orally 24 to 48 hours before misoprostol, followed by misoprostol 400 micrograms every three hours vaginally, sublingually, or buccally for medication abortion between 14 0/7 and 23 6/7 weeks of gestation.
- When mifepristone 200 milligrams orally is not available 24 to 48 hours prior to the first misoprostol dose, the recommendation is to administer mifepristone and vaginal misoprostol simultaneously.
- If mifepristone is unavailable, the recommendation is misoprostol 400 micrograms vaginally, sublingually, or buccally every three hours for medication abortion between 14 6/7 and 23 6/7 weeks of gestation.
- For medication abortion between 24 0/7 and 27 6/7 weeks of gestation the recommendation is mifepristone 200 milligrams plus misoprostol 200 micrograms vaginally or buccally every three hours.
- If mifepristone is unavailable, the recommendation is misoprostol 200 micrograms vaginally or buccally every three hours for medication abortion between 24 0/7 and 27 6/7 weeks of gestation.
- Oxytocin-based regimens are not recommended for medication abortion unless misoprostol with or without mifepristone is unavailable or contraindicated.
- Hemorrhage after abortion is rare, occurring in fewer than one percent of abortions, but associated morbidity may be significant. The Society of Family Planning recommends preoperative identification of women at high risk of hemorrhage, as well as the development of an organized approach to treatment. Further studies are needed on prophylactic use of uterotonic medication, intraoperative ultrasound, and optimal delivery of the placenta after second-trimester medical abortion.
- Medication abortion may be preferred when lithotomy position is not possible or in patients with extreme obesity. Limited data suggest that women treated with anticoagulation therapy bleed more than other women during surgical abortion, although this additional bleeding may be clinically unimportant. The decision to temporarily discontinue anticoagulation therapy will depend on the agent used and the underlying risk of thrombosis.
The Society of Family Planning will review these new clinical recommendations in detail at the 2023 Annual Meeting beginning on October 28th – October 30th in Seattle, Washington.
References
Clinical guidance. Society of Family Planning. September 27, 2023. Accessed October 23, 2023. https://societyfp.org/clinical-guidance/.
Home. Society of Family Planning. October 20, 2023. Accessed October 23, 2023. https://societyfp.org/.
Contraception. Accessed October 23, 2023. https://www.contraceptionjournal.org/content/sfp_guidelines.
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