Skip to main content Accessibility help
×
Hostname: page-component-7479d7b7d-qs9v7 Total loading time: 0 Render date: 2024-07-15T21:41:21.925Z Has data issue: false hasContentIssue false

Chapter 22 - Management of Unintended Pregnancy

from Section 4 - Contraception and STIs

Published online by Cambridge University Press:  24 November 2021

Tahir Mahmood
Affiliation:
Victoria Hospital, Kirkcaldy
Charles Savona-Ventura
Affiliation:
University of Malta, Malta
Ioannis Messinis
Affiliation:
University of Thessaly, Greece
Sambit Mukhopadhyay
Affiliation:
Norfolk & Norwich University Hospital, UK
Get access

Summary

Unintended pregnancy is common. It is estimated that one in three pregnancies end in abortion. Management of unintended pregnancy, in the form of surgical and medical abortion, is an essential part of reproductive healthcare and fundamental for training in obstetrics and gynaecology. Comprehensive abortion care includes provision of accurate information on methods of abortion, provision of abortion and post-abortion care.

This chapter will provide background on the prevalence of abortion, pre-abortion assessment, methods of abortion, post-abortion contraception and management of abortion-related complications.

Type
Chapter
Information
Publisher: Cambridge University Press
Print publication year: 2021

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Oppegaard, KS. Position statement from the European Board and College of Obstetrics & Gynaecology (EBCOG): medical abortion. 2015. Available at www.ebcog.org/single-post/2016/05/09/position-paper-medical-abortion.Google Scholar
Sedgh, G, Bearak, J, Singh, S, et al. Abortion incidence between 1990 and 2014: global, regional, and subregional levels and trends. Lancet 2016;388:258267.Google Scholar
Singh, S, Remez, L, Sedgh, G, Kwok, L, Onda, T. Abortion Worldwide 2017: Uneven Progress and Unequal Access. New York: Guttmacher Institute, 2018. Available at www.guttmacher.org/report/abortion-worldwide-2017.Google Scholar
Raymond, EG, Grossman, D, Weaver, MA, Toti, S, Winikoff, B. Mortality of induced abortion, other outpatient surgical procedures and common activities in the United States. Contraception 2014;90:476479.Google Scholar
Raymond, EG, Grimes, DA. The comparative safety of legal induced abortion and childbirth in the United States. Obstet Gynecol 2012;119:215219.CrossRefGoogle ScholarPubMed
World Health Organization. Preventing unsafe abortion fact sheet. 2018. Available at www.who.int/news-room/fact-sheets/detail/preventing-unsafe-abortion.Google Scholar
Ganatra, B, Gerdts, C, Rossier, C, et al. Global, regional, and subregional classification of abortions by safety, 2010–14: estimates from a Bayesian hierarchical model. Lancet 2017;390:23722381.Google Scholar
Faúndes, A, Shah, IH. Evidence supporting broader access to safe legal abortion. Int J Gynecol Obstet 2015;131(Suppl. 1):S56S59.CrossRefGoogle ScholarPubMed
Mendez, JE. Twenty years of anti-abortion law in Poland. Federation for Women and Family Planning, 2013. Available at http://en.federa.org.pl/20-years-anti-abortion-law.Google Scholar
Hirvonen, E. Polish Abortion Tourism. Vantaa: Laurea University of Applied Sciences, 2017.Google Scholar
Exelgyn. European abortion data. 2019. Available at https://abort-report.eu/europe.Google Scholar
Cameron, ST, Glasier, A. Identifying women in need of further discussion about the decision to have an abortion and eventual outcome. Contraception 2013;88:128132.CrossRefGoogle ScholarPubMed
Bartlett, LA, Berg, CJ, Shulman, HB, et al. Risk factors for legal induced abortion-related mortality in the United States. Obstet Gynecol 2004;103:729737.Google Scholar
Scotland Information Services Division. Termination of Pregnancy Year Ending December 2017. Edinburgh: NHS National Services Scotland, 2018.Google Scholar
Ingham, R, Lee, E, Clements, SJ, Stone, N. Reasons for second trimester abortions in England and Wales. Reprod Health Matters 2008;16(31 Suppl.):1829.Google Scholar
World Health Organization. Clinical Practice Handbook for Safe Abortion. Geneva: World Health Organization, 2014.Google Scholar
Baird, DT, Rodger, M, Cameron, IT, Roberts, I. Prostaglandins and antigestagens for the interruption of early pregnancy. J Reprod Fertil Suppl 1988;36:173179.Google Scholar
Spitz, IM, Bardin, CW, Benton, L, Robbins, A. Early pregnancy termination with mifepristone and misoprostol in the United States. N Engl J Med 1998;338:12411247.Google Scholar
Penney, G. Treatment of pain during medical abortion. Contraception 2006;74:4547.Google Scholar
Fiala, C, Safar, P, Bygdeman, M, Gemzell-Danielsson, K. Verifying the effectiveness of medical abortion: ultrasound versus hCG testing. Eur J Obst Gynecol Reprod Biol 2003;109:190195.Google Scholar
Pohjoranta, E, Suhonen, S, Heikinheimo, O. Attendance at post-abortal follow-up visits is low: can the risks of non-attendance be identified? Acta Obstet Gynecol Scand 2011;90:543546.Google Scholar
Ashok, PW, Templeton, A, Wagaarachchi, PT, Flett, GM. Midtrimester medical termination of pregnancy: a review of 1002 consecutive cases. Contraception 2004;69:5158.Google Scholar
Ngoc, NTN, Shochet, T, Raghavan, S, et al. Mifepristone and misoprostol compared with misoprostol alone for second-trimester abortion: a randomized controlled trial. Obstet Gynecol 2011;118:601608.Google Scholar
Gerdts, C, Jayaweera, RT, Baum, SE, Hudaya, I. Second-trimester medication abortion outside the clinic setting: an analysis of electronic client records from a safe abortion hotline in Indonesia. BMJ Sex Reprod Health 2018;44:286291.Google Scholar
Fiala, C, Swahn, ML, Stephansson, O, Gemzell-Danielsson, K. The effect of non-steroidal anti-inflammatory drugs on medical abortion with mifepristone and misoprostol at 13–22 weeks gestation. Hum Reprod 2005;20:30723077.Google Scholar
International Federation of Gynecology and Obstetrics. Consensus statement on uterine evacuation. 2011.Google Scholar
Sääv, I, Kopp Kallner, H, Fiala, C, Gemzell-Danielsson, K. Sublingual versus vaginal misoprostol for cervical dilatation 1 or 3 h prior to surgical abortion: a double-blinded RCT. Hum Reprod 2015;30:13141322.Google Scholar
Shaw, KA, Lerma, K, Shaw, JG, et al. Preoperative effects of mifepristone for dilation and evacuation after 19 weeks of gestation: a randomised controlled trial. BJOG 2017;124:19731981.Google Scholar
Low, N, Mueller, M, Van Vliet, H, Kapp, N. Perioperative antibiotics to prevent infection after first‐trimester abortion. Cochrane Database Syst Rev 2012;3:CD005217.Google Scholar
Sääv, I, Stephansson, O, Gemzell-Danielsson, K. Early versus delayed insertion of intrauterine contraception after medical abortion: a randomized controlled trial. PLoS One 2012;7:e48948.Google Scholar
Faculty of Sexual and Reproductive Healthcare. Clinical Guideline: contraception after pregnancy. January 2017.Google Scholar
Hognert, H, Kopp Kallner, H, Cameron, S, et al. Immediate versus delayed insertion of an etonogestrel releasing implant at medical abortion: a randomized controlled equivalence trial. Hum Reprod 2016;31:24842490.Google Scholar
Royal College of Obstetricians and Gynaecologists. The care of women requesting induced abortion. Evidence-based Clinical Guideline No. 7. 2011.Google Scholar
Pridmore, BR, Chambers, DG. Uterine perforation during surgical abortion: a review of diagnosis, management and prevention. Aust N Z J Obstet Gynaecol 1999;39:349353.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure [email protected] is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×