dr e. aubeny, paris fiapac esc budapest seminar 2003 medical abortion by mifepristone at home ?
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Dr E. AUBENY, Paris
FIAPAC
ESC Budapest Seminar 2003
Medical abortion by mifepristone at home ?
Dr E. AUBENY - Fiapac Paris
Present protocol of medical abortion by mifepristone is :
D 1 : 600 mg mifepristone immediate departure from the center
Efficacy rate : 95.4 %
D 3 : 400 µg misoprostol 3 h. of medical supervision in the center
D 10 to 14 control visit
Medical abortion by mifepristone at home ?
Medical abortion by mifepristone at home ?
Definition
What is “medical abortion at home” ?
It is the possibility to skip the visit to the hospital in order
to take misoprostol (Cytotec), and take it at home
This possibility would make medical abortion easier
Dr E. AUBENY - Fiapac Paris
Dr E. AUBENY - Paris, Fiapac
Medical abortion by mifepristone at home ?
1- Is a non-hospitalisation after misoprostol (Cytotec) possible from a medical point of view?
Dr E. AUBENY - Paris ’ Fiapac
< 42 D.A.
1983 - 1987 : abortion by mifepristone only
Medical abortion by mifepristone at home ?
No hospitalisation
No medical problem
But efficacy rate of 80 %
Dr. E. AUBENY , Paris, Fiapac
Medical abortion by mifepristone at home ?
< 49 D.A.
Since 1987 : abortion by mifepristone + prostaglandins
Efficacy of 95.4 %
hospitalisation of 3 hours at the center
Dr E. AUBENY - Paris, Fiapac
Why women stay at the hospital after prostaglandins
FEAR
Prostaglandins
Secondary effects
Hemorrhages at expulsion
Are these fears justified after a 10-year
experience with misoprostol ?
Medical abortion by mifepristone at home ?
Dr E. AUBENY - Paris, Fiapac
Why women stay at the hospital after prostaglandins :
For 20 years, daily use all over the world to prevent gastric ulcers when
taking AINS
Replaced in 1992 by 400 µg misoprostol (Cytotec) taken orally
Medical abortion by mifepristone at home ?
Very large use worldwide for abortions
1 000 000 women have received mifépristone + misoprostol orally in France
No pharmacovigilance problem whatsoever
Fear of prostaglandins (problem with sulprostone)
Dr E. AUBENY - Paris, Fiapac
Why women stay at the hospital after prostaglandins :
Misoprostol (Cytotec)
Suspicion towards misoprostol taken orally
as a drug for abortion is not justified
Medical abortion by mifepristone at home ?
No need for a medical supervision in hospital
Fear of prostaglandins
Dr E. AUBENY , Paris, Fiapac
Why women stay at the hospital after prostaglandins :
late bleeding :10 to 15 days later
Medical abortion by mifepristone at home ?
few non-cataclysmic bleeding at the time of expulsion
French* and American** trials show :
few haemostatic aspirations : 0.3 %
Fear of haemorrhage at the time of expulsion
*R. PEYRON, 1995; **Spitz, 1999
Dr E. AUBENY , Paris, Fiapac
Why women stay at the hospital after prostaglandins :
I.V.G. Non-urgent aspirationwith mifepristone on the day
1997 1 081 3
1998 1 112 4
1999 1 212 4
Center Orthogénie Broussais : few hemorrhages non cataclysmic
Medical abortion by mifepristone at home ?
Fear of haemorrhage at the time of expulsion
*Dagousset I ; non published
38%
Patients who expel out of the hospital
Beyond the 3 hours
Dr E. AUBENY , Paris, Fiapac
Why women stay at the hospital after prostaglandins :
the 3-hour hospitalisation is not logical
40% of women expel outside of the center
60%
Patients who expel at the hospital
During the 3 hours
Medical abortion by mifepristone at home ?
2%
Before Misoprostol
Fear of haemorrhage at the time of expulsion
Dr E. AUBENY , Paris, Fiapac
Why women stay at the hospital after prostaglandins :
Few haemorrhages, non cataclysmic, less abundant than
spontaneous abortions which are not hospitalised
To summarise
Medical abortion by mifepristone at home ?
But precautions to be taken : No more than one hour drive from the center
Possibility to go to the centre day and night
Fear of haemorrhage at the time of expulsion
Dr E. AUBENY -, Paris, Fiapac
Why women stay at the hospital after prostaglandins :
pelvic pains :
with 4OO µg misoprostol orally, they are endurable
Medical abortion by mifepristone at home ?
only 20 % of non morphinic pain killers, they can be taken at home
digestion troubles :
non frequent treatment, they that can be taken at home
Fear of secondary effects
Dr.E. AUBENY -Paris, Fiapac
Why women stay at the hospital after prostaglandins :
Fear ofprostaglandins
Fear of
haemorrhage
Fear of secondary
effects
To summarise, the French and U.S trials show from a medical point of view that :
Medical abortion by mifepristone at home ?
Hospitalisation is not justified, neither by the fear of prostaglandins,nor by fear of haemorrhages, nor by fear of secondary effects
Dr E. AUBENY , Paris, Fiapac
Foreign experiences go in the direction of misoprostol at home
No problem whatsoever
In Guadeloupe (J. Bangou)
Publication about 100 cases without any problem
In reality, more than 1 000 cases Until 49 D.A.
Ambulatory medical abortion
In the U.S.A.
more than 80.000 cases now
until 56 D.A.
.
Medical abortion by mifepristone at home ?
Dr. E. AUBENY , Paris, Fiapac
2 – Is a non-hospitalisation after misoprostol (Cytotec)
possible from a psychological point of view?
Medical abortion by mifepristone at home ?
Dr E. AUBENY - Paris, Fiapac
Acceptability by women
French trial*
? ?Possibility to choose
Medical abortion by mifepristone at home ?
Dagousset I. and al, in press
120 women chose to go home
Medical abortion by mifepristone at home ?
Results for 120 patients :• No major undesirable event
• Acceptance of the protocol : 100 %
• Anxiety (valued by the number of phone calls)
- 1 call : 23 patients, 2 to 3 calls : 3 patients
- no call : 94 patients
• Use of pain killer : 47 patients
98.5% of patients find the procedure acceptable
77.5% of patients would recommend it : more privacy
Acceptability by women
Dr E. AUBENY - Paris, Fiapac
Dr.E. AUBENY - Paris, Fiapac
Medical abortion by mifepristone at home ?
3. Conclusion
Conclusion From a medical point of view
Until 49 D.A. with the present European protocol :mifépristone 600 mg + misoprostol 400 orallypossible to have misoprostol at home without any risk
Medical abortion by mifepristone at home ?
From a psychological point of view
The patient must be able to choose : hospitalisation or non-hospitalisation
In these cases, abortion at home is very well accepted
New possibility for women
They must be able to choose itDr.E. AUBENY - Paris, Fiapac
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