Abortion
Medical termination of intrauterine pregnancyf can be managed with medication or through a procedure involving uterine aspiration.2
Management with medication typically involves a combination of mifepristone and misoprostol. Mifepristone 200 mg is approved by FDA, in a regimen with misoprostol, for the medical termination of pregnancy through 70 days of gestation. The Mifepristone Risk Evaluation and Mitigation Strategy (REMS) Program sets out requirements that must be followed for the use of mifepristone for medical termination of early intrauterine pregnancy.147 In some circumstances, uterine aspiration may be appropriate for termination of an intrauterine pregnancy, including for reasons of patient preference or when medically indicated (such as for those patients with contraindications to mifepristone or misoprostol). Persons desiring medication or procedural services for termination of pregnancy should receive referrals to timely care. The provider should assess each person’s need and desire for social support and refer them to appropriate counseling or supportive services upon request (Exhibit 12).
Exhibit 12. Practical Tips for Discussing a Pregnancy Test Result
Before delivering the result.
Understand that some people may not wish to process or even talk with health care providers about their pregnancy test result, and this is completely acceptable. Although people will often want partners, loved ones, family members, or others to be part of the subsequent discussion, it is good practice to relay this information to the person alone first, giving them an opportunity to share any sensitive information and inform the clinician about preferences regarding sharing.
Be clear and use a neutral tone.
"Your urine pregnancy test today is positive. That means you are pregnant."
Pause for patient response.
"Would you like a few minutes alone, or would you like me to stay here with you?"
Seek understanding, and pay attention to verbal and nonverbal responses.
Ask open-ended questions: "What thoughts or feelings are coming up for you right now?"
Validate and normalize.
"It's normal to experience and go through several emotions as you are processing this information."
For positive pregnancy tests, offer to share pregnancy options.
"Let me know how I can be most helpful to you. We can discuss any options you are interested in hearing about, including options for continuing or ending your pregnancy, or you can take time to think things over on your own."
Source: Adapted from Reproductive Health Access Project and Provide.
Some patients may utilize telehealth services for medical abortion, using FDA-approved mifepristone, dispensed consistent with the Mifepristone REMS Program, which includes dispensing through a certified pharmacy either in person or via mail order. Providers should be prepared to provide post-abortion care, including management of side effects or complications.148 Post-abortion care includes an assessment of signs and symptoms of ongoing pregnancy and/or incomplete abortion; the need for contraceptive, fertility, or STI services; and, if needed, a focused physical examination to assess any complaints.148 Providers can refer to WHO guidelines for comprehensive recommendations.