MIFEPRISTONE PROTOCOL FOR MEDICATION ABORTION

Patient Eligibility
  1. Determine patient is pregnant (urine HCG).
  2. Options counseling
                    a. If wishes to continue pregnancy, initiate prenatal care.
                    b. If wishes termination, refer to appropriate provider ASAP.
  3. Determine gestational age (LMP, exam, sono needed only if indicated; see indications below)
  4. If over 8 weeks [or whatever gestational age you choose for your institution], needs aspiration procedure.
  5. If under or equal to your cutoff, offer medication abortion; if interested use protocol below.

Protocol for Mifepristone/Misoprostol Abortion
  1. Gestational age < 56 days [or whatever gestational age you choose for your institution].
  2. Hct/Hgb, Rh status on chart (will receive Rhogam if Rh negative).
  3. Phone number to contact patient on chart (use special medication abortion chart form). Be sure to confirm that she can receive calls from you at that number.
  4. Patient agreement/consent signed and put in chart.
  5. Patient given misoprostol (four 200 mcg tabs) with instructions to insert buccally (in mouth between cheek and gum) at home 24-48 hours after mifepristone taken in office. Lot number and expiration date logged on log sheet.
  6. Patient given prescription for pain medication (VicodinÆ -APAP 500 mg with hydrocodone 5mg- or similar medication and ibuprofen 400mg) with instructions for use.
  7. Patient instruction sheet, which includes beeper number and specific warning signs, reviewed with patient and then given to patient to take home.
  8. Patient given mifepristone 200 mg orally (by physician); lot number and expiration date logged on log sheet.
  9. Serum HCG ordered.
  10. Patient given follow-up appointment within one week, to assess completion
  11. If patient wants to start hormonal contraception, she can be given a prescription on the day she takes the mifepristone, to start at home as soon as she has had the abortion. She should also be given a prescription for Plan B.
  12. At return visit
                    Draw quantitative HCG levels.
                    Initiate appropriate contraception if she hasnít already started.
                    If patient still feels pregnant, and/or if HCG levels not falling, order sono ASAP
  13. If abortion not complete, and pregnancy viable, refer patient for suction ASAP.

Information for Medication Storage and Dispensing
Mifepristone and misoprostol available to dispense to patient in office. Patient will swallow mifepristone and take misoprostol for use at home.
Medication locked in cabinet.
Log kept for both medications, including
                Lot # and expiration date
                Patient name and chart #
                Contact phone information
                Date of administration
Mifepristone must be ordered directly from distributor.
Misoprostol ordered through your institutionsí process, to dispense in the office.

Indications for Sonography for Medication Abortion

Pre-abortion:
  1. Size/dates discrepancy
  2. Uncertain LMP (or no menses - after delivery, abortion, stopping hormonal contraception, etc)
  3. Adnexal mass or pain
  4. LMP at the end of a course of hormonal contraception
  5. Provider uncertainty with exam
  6. History of previous ectopic pregnancy

Post-abortion:
  1. History not consistent with successful medication abortion (no bleeding, no cramping)
  2. Woman still feels pregnant
  3. Serum Hcg not declining
  4. Provider uncertainty with history