Care for Women Choosing Medication Abortion

Nurse Practitioner, Oct 2004 by Taylor, Diana, Hwang, Ann C, Stewart, Felicia H

If the ultrasound of the patient had showed cardiac activity, she would have had an unsuccessful medication abortion with continuing pregnancy. This rare outcome is generally treated with uterine aspiration to terminate the pregnancy. Should the patient decline this procedure, the teratogenicity of the drugs used in medication abortion becomes important. Although mifepristone is likely not teratogenic, there have been case reports of fetal abnormalities following misoprostol use.31 Whether this is a causal relationship is not known, but a woman who has a continuing pregnancy after medication abortion treatment should be carefully counseled about the potential risks to the fetus should she decide against uterine aspiration to terminate the pregnancy.

* Next Steps

Fielding, Lee, and Schaff reviewed professional considerations for providing mifepristone-induced abortion, including legal restrictions, reimbursement, and staffing issues.32 A CME-accredited training course, available from http://www.earlyoptions.org/online_cme_default.asp, provides additional clinical information. This training provides the NP with the knowledge necessary for providing medication abortions, including:

* clinical competency in prescribing PDA-approved and evidence-based medication abortion protocols;

* clinical management and counseling essentials across the abortion process; and

* the role of ultrasonography, both pre- and post-medication abortion.

For the millions of women each year who face unintended pregnancy, NPs can be a critical source of support and information.33 There also is increasing recognition of the NP as an appropriate provider of abortion care. Integrating abortion care into primary care helps to normalize it as an essential component of reproductive healthcare. Providers have described how rewarding it is to help their patients through a difficult time, and patients appreciate being able to receive abortion care from their primary care clinicians. Providing abortion care in the primary care context also facilitates better follow-up treatment and continuity of care. Medication abortion offers NPs a new opportunity to expand women's reproductive healthcare, by providing patients with a safe and effective means of pregnancy termination within a primary care setting.

REFERENCES

1. Henshaw SK: Unintended pregnancy in the United States. Fam Plan Perspect 1998;30(1):24-9, 46.

2. Hcnshaw SK, Finer LB: The accessibility of abortion services in the United States, 2001. Perspect Sex Rcprod Health 2003;35(1):16-24.

3. Hausknecht R: Mifcpristone and misoprostol for early medical abortion; 18 months' experience in the United States. Contraception 2003;67(6):463-5.

4. Snyder U: Medical abortion in family practice: a newsmaker interview with Linda Princ, MD. Medscape. August 11, 2003.

5. Grumbach K, Hart LG, Mertz E, et al.: Who is caring for the underserved? A comparison of primary care physicians and nonphysician clinicians in California and Washington. Ann Fam Med 2003;(2):97-104.