Safe abortion: technical and policy guidance for health systems

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World Health Organization

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Safe abortion: technical and policy guidance for health systems

Recommendations

Vacuum aspiration is the recommended technique of surgical abortion for pregnancies of up to 12 to 14 weeks of gestation. The procedure should not be routinely completed by sharp curettage. Dilatation and sharp curettage (D&C), if still practised, should be replaced by vacuum aspiration.

For pregnancies of gestational age up to 9 weeks (63 days) The recommended method for medical abortion is mifepristone followed 1 to 2 days later by misoprostol

For pregnancies of gestational age over 12 weeks (84 days) The recommended method for medical abortion is 200 mg mifepristone administered orally followed 36 to 48 hours later by repeated doses of misoprostol.

Where mifepristone is not available. For pregnancies of gestational age over 12 weeks (84 days) The recommended method of medical abortion is 400 μg of misoprostol administered vaginally or sublingually, repeated every 3 hours for up to five doses

Prior to surgical abortion, cervical preparation is recommended for all women with a pregnancy over 12 to 14 weeks of gestation. Its use may be considered for women with a pregnancy of any gestational age

Recommendations for care preceding induced abortion. All women undergoing dilatation and evacuation (D&E) with a pregnancy over 14 weeks of gestation should receive cervical preparation prior to the procedure.

Recommendations for care preceding induced abortion. The recommended methods of cervical preparation prior to dilatation and evacuation (D&E) after 14 weeks of gestation are osmotic dilators or misoprostol.

Use of routine pre-abortion ultrasound scanning is not necessary.

All women having surgical abortion, regardless of their risk of pelvic inflammatory infection, should receive appropriate prophylactic antibiotics pre- or peri-operatively.

For women having medical abortion, routine use of prophylactic antibiotics is not recommended.

All women should be routinely offered pain medication (e.g. non-steroidal anti-inflammatory drugs) during both medical and surgical abortions. General anaesthesia is not recommended routinely for vacuum aspiration abortion or dilatation and evacuation (D&E).

There is no medical need for a routine follow-up visit following uncomplicated surgical abortion or medical abortion using mifepristone followed by misoprostol. However, women should be advised that additional services are available to them if needed or desired.