Overview

A state-of-the-art report on the use of pharmaceutical agents and other non-invasive methods for the medical termination of pregnancy. Addressed to service managers, the report draws together a wealth of recent findings useful in evaluating the safety, efficacy, cost-effectiveness and acceptability of medical methods, whether currently in use or undergoing clinical trials. Information on established surgical procedures for abortion is also provided to facilitate comparisons and balanced decisions. While noting that the prevention of unwanted pregnancies remains the first public health priority, the report aims to help health care personnel providing legal abortion services to determine whether these newer medical methods can improve the management of abortion in specific patient groups and in different resource settings. Over 250 references to the literature are included. The report has eight sections. The first, on the demography of abortion, explores the many factors that contribute to unwanted pregnancies and influence abortion rates. Section two, on mechanisms for medical abortion, explains how pharmaceutical agents act to interrupt the pregnancy process and cause the pregnancy to end. Of particular value is a review of some 18 agents categorized as prostaglandins; antiprogestogens, including mifepristone; epostane; oxytocin; hypertonic agents; ethacridine lactate; hydrophilic cervical dilators; and cervical ripening devices. Each is profiled in terms of its mechanisms of action, efficacy, side-effects and safety, mode of administration, and advantages and disadvantages when compared with other medical and surgical methods. Against this background, the main part of the report provides detailed information on the current or potential place of medical methods for abortion at up to 9 weeks of gestation, at 9-14 weeks of gestation, and after 14 weeks of gestation. In each section, conclusions and recommendations identify methods of choice and their most acceptable alternatives, summarize procedures that can enhance safety, and point out factors that should be considered when selecting a method for routine use. Needs for further research are also identified. Subsequent sections discuss the complications of abortion and measures for their prevention, and review findings from several recent studies of the acceptability - to both women and service providers - of medical abortion. The final section provides a guide to the introduction of medical abortion as a routine clinical service.

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