Contraindications and Considerations for Medical Termination of Pregnancy

Absolute Contraindications

• Severe cardiovascular disease, especially pulmonary arterial hypertension, is a contraindication for medical termination of pregnancy, and pregnancy termination in these patients should be performed surgically in centers with cardiac surgery capabilities 1, 2

Relative Contraindications

• Severe liver or kidney disease may alter drug metabolism and clearance, and requires careful consideration in patients undergoing medical termination of pregnancy 3

Method-Specific Considerations

• Dilation and evacuation (D&E) is the safest procedure in both first and second trimesters, with lower rates of hemorrhage and infection 2, 4
• Prostaglandin E1 (misoprostol) or E2 can be used if surgical evacuation is not feasible, but prostaglandin F compounds should be avoided as they can increase pulmonary arterial pressure and decrease coronary perfusion 2

Special Populations

• Patients with pulmonary arterial hypertension should have pregnancy termination as early as possible, preferably in the first trimester, and high-risk patients should be managed in centers with on-site cardiac surgery 1, 2, 4
• Patients with end-stage renal disease are at increased risk of bleeding, fluid and electrolyte imbalances, and infection, and surgical evacuation may be preferred over medical termination 3

Post-Procedure Care

• Antibiotic prophylaxis is recommended to prevent post-abortal endometritis, which occurs in 5-20% of women not given antibiotics 2, 5
• Rh-negative women should receive anti-D immunoglobulin to prevent alloimmunization 5

Important Considerations

• First trimester termination is safest and should be performed in hospital rather than outpatient settings for high-risk patients 2
• Method selection should be based on gestational age, provider expertise, facility capabilities, and patient's medical conditions 4, 5