Care for Women Choosing Medication Abortion

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

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But do physician-only laws that prevent NPs from providing aspiration abortion also preclude providing medication abortion? Borgmann and Jones and Jones and Haller reviewed states' physician-only laws to see whether they apply to providers of medication abortion.6,7 In some cases, it can be argued that when it comes to medication abortion, more recent laws granting prescriptive authority to APCs supersede physician-only restrictions. This argument can be advanced through both legal cases and state legislation, such as the new California law. In other states, legal research is needed to establish support for the provision of medical abortion by NPs. The Abortion Access Project (http://www.abortionaccess.org) and Clinicians for Choice (http://www.cliniciansforchoice.org) are two of the organizations working to expand the role of APCs in abortion care.

* Pharmacology of Mifepristone-Misoprostol

Mifepristone induces abortion by blocking the action of progesterone, a hormone that maintains pregnancy. Mifepristone is used in combination with the prostaglandin analogue misoprostol, which stimulates uterine contractions.

The FDA-approved labeling for mifepristone includes a "standard" protocol for medication abortion consisting of 600 mg of mifepristone, followed 2 days later by a 400 meg dose of oral misoprostol given at a second clinic visit, to terminate pregnancies of up to 49 days gestation. Subsequent studies have demonstrated that: 200 mg of mifepristone is equally effective; vaginal use of misoprostol can improve efficacy at up to 63 days gestation; misoprostol need not be given at precisely 48 hours after mifepristone; and misoprostol can be safely self-administered by the patient. These findings led to the development of an "evidence-based regimen" now used by most providers (see Table: "Comparison of Mifepristone Regimens").8-17

* Case 1: Patient Counseling-

Medication and Aspiration Abortion

Your 19-year-old primary care patient comes in for pregnancy testing because her period did not begin as expected last week. Her pregnancy test is positive, and it has been 40 days since the first day of her last menstrual period (LMP). The pregnancy was unintended and your patient would like information about her options. In addition to informing her that she can choose to continue her pregnancy to term and either become a mother or place her child up for adoption, you tell her about her options for pregnancy termination. What are the key features of medication and aspiration abortion for early pregnancy termination? What are the key differences?

Both medication and aspiration abortion are safe and effective methods of pregnancy termination. Women choosing medication abortion and women choosing aspiration abortion both have high rates of satisfaction.18-21 Some women perceive medication abortion to be less invasive and more "natural" than aspiration abortion because instruments are not inserted into the uterus. Taking medication at home may provide a greater sense of privacy and control over the process, compared to having an aspiration procedure performed in a clinic.