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Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home

Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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Page 1: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

Dr E. AUBENY, Paris

FIAPAC

ESC Budapest Seminar 2003

Medical abortion by mifepristone at home ?

Page 2: 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 ?

Page 3: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 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

Page 4: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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?

Page 5: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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 %

Page 6: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 7: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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 ?

Page 8: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 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)

Page 9: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 10: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 11: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 12: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 13: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 14: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 15: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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

Page 16: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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 ?

Page 17: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 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 ?

Page 18: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 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

Page 19: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at 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

Page 20: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

Dr.E. AUBENY - Paris, Fiapac

Medical abortion by mifepristone at home ?

3. Conclusion

Page 21: Dr E. AUBENY, Paris FIAPAC ESC Budapest Seminar 2003 Medical abortion by mifepristone at home ?

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