Chapter 36: Prenatal and Obstetric Care

ABORTION

Population

• – Women with incomplete abortion.

Recommendations

WHO 2018

• – Offer surgical or medical management vs. watchful waiting.

• – If patient <13-wk gestation elects medical management, give misoprostol 600 μg orally or 400 μg sublingually. Do not use vaginal misoprostol.

• – If patient ≥13-wk gestation elects medical management, give repeated doses of misoprostol 400 μg every 3 h sublingually, vaginally, or buccally.

Population

• – Women with intrauterine fetal demise between 14- and 28-wk gestation.

Recommendation

WHO 2018

• – Offer surgical or medical management vs. watchful waiting.

• – If patient elects medical management, give 200-mg mifepristone orally; 1–2 d later, give 400-μg misoprostol sublingually or vaginally, and repeat every 4–6 h. If mifepristone is not available or not preferred by the patient, give misoprostol 400 μg every 4–6 h as the initial treatment.

Population

• – Women who elect to induce an abortion.

Recommendations

WHO 2018

• – Options include vacuum aspiration (manual or electric), dilation, and evacuation or medical management.

• – For medical abortion, give mifepristone 200 mg once as initial dose. At least 24 h later, give misoprostol vaginally, sublingually, or buccally. If <12-wk gestation, use 800 μg. If ≥12-wk gestation, give 400 μg. If mifepristone is not available, use misoprostol as initial dose.

Source

• – Medical Management of Abortion. Geneva: World Health Organization; 2018. License: CC BY-NC-SA 3.0 IGO.

CONTRACEPTION