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20 April 2004 | Volume 140 Issue 8 | Pages 620-626
Internists care for many women who have had abortions and many who will seek abortions in the future. Each year, about 2% of all women of reproductive age have an abortion. Women having abortions tend to be young, white, unmarried, and early in pregnancy. Most abortions are done by suction curettage under local anesthesia in a freestanding clinic. However, medical abortion is growing in popularity as a nonsurgical alternative. The regimen approved by the U.S. Food and Drug Administration specifies mifepristone, 600 mg orally, followed 2 days later by misoprostol, 400 µg orally (within 49 days from last menses). Recent studies have recommended alternative approaches, such as mifepristone, 200 mg orally, followed in 1 to 3 days by misoprostol, 800 µg vaginally (up to 63 days). Medical abortion can be provided by a broader variety of physicians than can surgical abortion. The overall case-fatality rate for abortion is less than 1 death per 100 000 procedures. Infection, hemorrhage, acute hematometra, and retained tissue are among the more common complications. Referral back to the original abortion provider for management is advisable. Overall, induced abortion does not lead to late sequelae, either medical or psychiatric. Of importance, no link exists between induced abortion and later breast cancer. For physicians who are asked to help with a referral, the National Abortion Federation and Planned Parenthood Federation of America have helpful Web sites and networks of high-quality clinics. The cost of abortion (currently about $372 at 10 weeks) has decreased in recent decades. Provision of ongoing contraception and encouragement of emergency contraception can reduce unintended pregnancies and the need for abortion.
Author and Article Information
From University of North Carolina School of Medicine, Chapel Hill, North Carolina, and University of Pittsburgh School of Medicine, Magee-Womens Research Institute, Pittsburgh, Pennsylvania.
Potential Financial Conflicts of Interest:Employment: D.A. Grimes, M.D. Creinin; Consultancies: M.D. Creinin (Danco Laboratories); Expert testimony: D.A. Grimes.
Requests for Single Reprints: David A. Grimes, MD, Department of Obstetrics and Gynecology, CB #7570, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7570.
Current Author Addresses: Dr. Grimes: Department of Obstetrics and Gynecology, CB #7570, University of North Carolina School of Medicine, Chapel Hill, NC 27599-7570.
Dr. Creinin: Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Magee-Womens Research Institute, 300 Halket Street, Pittsburgh, PA 15213-3108. REVIEW
Induced Abortion: An Overview for Internists
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