Medical Termination of Pregnancy Protocol

First Trimester (≤9 weeks gestation)

• The American College of Obstetricians and Gynecologists recommends medical termination using mifepristone 200 mg orally followed by misoprostol 800 μg vaginally 24-48 hours later, achieving 95% complete abortion rates 1

Surgical Alternative

• Prophylactic antibiotics are mandatory to reduce infection risk from 5-20% to 1.3% 2

Second Trimester (14-24 weeks gestation)

• Dilation and evacuation (D&E) is the safest procedure for second-trimester termination and should be performed in a hospital setting by experienced providers under sedation or general anesthesia 1, 2, 3
• Hemorrhage rate is 9.1% with D&E compared to 28.3% with medical methods 1, 2, 3
• Infection rate is 1.3% with D&E compared to 23.9% with medical methods 1, 2, 3

Essential Post-Procedure Care (All Methods)

• Antibiotic prophylaxis is required to prevent post-abortal endometritis (occurs in 5-20% without antibiotics) 1, 2, 3
• Anti-D immunoglobulin is required for all Rh-negative women to prevent alloimmunization 1, 2, 3

Critical Counseling Points

• Counseling must be performed expeditiously to optimize choices and outcomes, as delays directly impact success rates and complication risks 1
• Contraception counseling should address safety, effectiveness, accessibility, affordability, and acceptability of full range of options 4, 5

Common Pitfalls to Avoid

• Never delay counseling or procedure - timing directly impacts success rates and complication risks 1
• Never use prostaglandin F compounds in medical termination - they cause adverse hemodynamic effects 2, 3
• Never omit antibiotic prophylaxis - infection rates increase from 1.3% to 5-20% 1, 2
• Never forget anti-D immunoglobulin in Rh-negative women 1, 2, 3