spontaneous abortion: management - kusm-w … of ectopic pregnancy and miscarriage •dec 2012 ......
TRANSCRIPT
Spontaneous abortion Management
Grand Rounds 51513
Jamie Peregrine R2 WCGME OBGYN
Objectives
bull Differentiate between abnormal pregnancies ectopic vs missedincompletecomplete abortion
bull Know where to look for management of spontaneous abortions
bull Review management of threatened and incomplete abortions
bull Discuss birth control options after abortion
Common presentations of abnormal pregnancies
bull 9w0d by LMP VBx4d no IUP by TVS UPREG+
ndash quant 20000 48 hours later 18000
bull 9w0d by LMP VB x4d live IUP measures 8w5d by TVS w subchorionic hemorrhage gt50
bull 9w0d by LMP VBx4d abd pn amp back cramps live IUP 8w5d by TVS cervix 2cm w bleeding
bull 11w0d by LMP routine PNC absent cardiac activity IUP 8w5d by TVS cervix closed
Resources
bull Williams OB 23rd edition
ndash Ch 9 Abortion
ndash pp 220-223
bull Creasy MFM 6th edition
ndash Ch 33 Embryonic and Fetal Demise
ndash pp 627 1 paragraph
Resources continued
bull UpToDate
bull ACOG practice bulletins
ndash No 94 Medical management of ectopic pregnancy
ndash No 67 Medical management of abortion
bull RCOG NICE clinical guideline
ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage
bull Dec 2012 (281 pp)
Threatened abortion
bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain
bull 20-25 of early pregnancies
bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy
bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab
Threatened abortion management
bull Cochrane reviewed RCTs and found insufficient evidence to recommend
ndash Bedrest
ndash HCG
ndash Vitamin supplementation
ndash Tocolyticsbeta-agonists
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Objectives
bull Differentiate between abnormal pregnancies ectopic vs missedincompletecomplete abortion
bull Know where to look for management of spontaneous abortions
bull Review management of threatened and incomplete abortions
bull Discuss birth control options after abortion
Common presentations of abnormal pregnancies
bull 9w0d by LMP VBx4d no IUP by TVS UPREG+
ndash quant 20000 48 hours later 18000
bull 9w0d by LMP VB x4d live IUP measures 8w5d by TVS w subchorionic hemorrhage gt50
bull 9w0d by LMP VBx4d abd pn amp back cramps live IUP 8w5d by TVS cervix 2cm w bleeding
bull 11w0d by LMP routine PNC absent cardiac activity IUP 8w5d by TVS cervix closed
Resources
bull Williams OB 23rd edition
ndash Ch 9 Abortion
ndash pp 220-223
bull Creasy MFM 6th edition
ndash Ch 33 Embryonic and Fetal Demise
ndash pp 627 1 paragraph
Resources continued
bull UpToDate
bull ACOG practice bulletins
ndash No 94 Medical management of ectopic pregnancy
ndash No 67 Medical management of abortion
bull RCOG NICE clinical guideline
ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage
bull Dec 2012 (281 pp)
Threatened abortion
bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain
bull 20-25 of early pregnancies
bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy
bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab
Threatened abortion management
bull Cochrane reviewed RCTs and found insufficient evidence to recommend
ndash Bedrest
ndash HCG
ndash Vitamin supplementation
ndash Tocolyticsbeta-agonists
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Common presentations of abnormal pregnancies
bull 9w0d by LMP VBx4d no IUP by TVS UPREG+
ndash quant 20000 48 hours later 18000
bull 9w0d by LMP VB x4d live IUP measures 8w5d by TVS w subchorionic hemorrhage gt50
bull 9w0d by LMP VBx4d abd pn amp back cramps live IUP 8w5d by TVS cervix 2cm w bleeding
bull 11w0d by LMP routine PNC absent cardiac activity IUP 8w5d by TVS cervix closed
Resources
bull Williams OB 23rd edition
ndash Ch 9 Abortion
ndash pp 220-223
bull Creasy MFM 6th edition
ndash Ch 33 Embryonic and Fetal Demise
ndash pp 627 1 paragraph
Resources continued
bull UpToDate
bull ACOG practice bulletins
ndash No 94 Medical management of ectopic pregnancy
ndash No 67 Medical management of abortion
bull RCOG NICE clinical guideline
ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage
bull Dec 2012 (281 pp)
Threatened abortion
bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain
bull 20-25 of early pregnancies
bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy
bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab
Threatened abortion management
bull Cochrane reviewed RCTs and found insufficient evidence to recommend
ndash Bedrest
ndash HCG
ndash Vitamin supplementation
ndash Tocolyticsbeta-agonists
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Resources
bull Williams OB 23rd edition
ndash Ch 9 Abortion
ndash pp 220-223
bull Creasy MFM 6th edition
ndash Ch 33 Embryonic and Fetal Demise
ndash pp 627 1 paragraph
Resources continued
bull UpToDate
bull ACOG practice bulletins
ndash No 94 Medical management of ectopic pregnancy
ndash No 67 Medical management of abortion
bull RCOG NICE clinical guideline
ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage
bull Dec 2012 (281 pp)
Threatened abortion
bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain
bull 20-25 of early pregnancies
bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy
bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab
Threatened abortion management
bull Cochrane reviewed RCTs and found insufficient evidence to recommend
ndash Bedrest
ndash HCG
ndash Vitamin supplementation
ndash Tocolyticsbeta-agonists
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Resources continued
bull UpToDate
bull ACOG practice bulletins
ndash No 94 Medical management of ectopic pregnancy
ndash No 67 Medical management of abortion
bull RCOG NICE clinical guideline
ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage
bull Dec 2012 (281 pp)
Threatened abortion
bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain
bull 20-25 of early pregnancies
bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy
bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab
Threatened abortion management
bull Cochrane reviewed RCTs and found insufficient evidence to recommend
ndash Bedrest
ndash HCG
ndash Vitamin supplementation
ndash Tocolyticsbeta-agonists
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Threatened abortion
bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain
bull 20-25 of early pregnancies
bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy
bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab
Threatened abortion management
bull Cochrane reviewed RCTs and found insufficient evidence to recommend
ndash Bedrest
ndash HCG
ndash Vitamin supplementation
ndash Tocolyticsbeta-agonists
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Threatened abortion management
bull Cochrane reviewed RCTs and found insufficient evidence to recommend
ndash Bedrest
ndash HCG
ndash Vitamin supplementation
ndash Tocolyticsbeta-agonists
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Threatened abortion management
bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show
significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens
bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped
bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks
bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data
bull Dydrogesterone not available in US
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Spontaneous abortion
bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)
bull 8-20 of clinically recognized pregnancies
bull 13-36 of all pregnancies
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Expectant vs active tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Medical vs surgical tx of Sab
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec PV vs placebo missed ab
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec PV vs placebo missed ab
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
RU-486 vs placebo missed ab
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec+RU-486 vs RU-486 missed ab
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec Dose missed ab
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
SL cyotec x1 or longer missed ab
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
SL cyotec x1 or longer missed ab
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
SL Cytotec x1 or more missed ab
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
PO vs SL missed ab
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
PO vs SL missed ab
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
PO vs SL missed ab
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
SL vs PV missed ab
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
SL vs PV missed ab
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
SL vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
PO vs PV missed ab
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
PO vs PV missed ab
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
PO vs PV missed ab
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec PV vs placebo incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Dose of PO cytotec incomplete
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Dose of PO cytotec incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec PO vs PV incomplete
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec PO vs PV incomplete
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec PO vs SL incomplete
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Cytotec PO vs SL incomplete
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Rhogam
bull Sab yes as many as 5 become isoimmunized without it
bull Threatened abortion controversial
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Contraception post-Sab
bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4
bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported
bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently
elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-
Sab
Use single dose of 800 mcg dose vaginally or sublingually
Use single dose of 800 mcg dose vaginally or sublingually