Ipas issues 2016 updates to clinical abortion guidance

New additions focus on fetal sex determination, reasons for second-trimester abortion, and why to stop sharp curettage

Wednesday, February 24, 2016

Clinical Updates in Reproductive Health

Ipas’s fourth annual publication of Clinical Updates in Reproductive Health continues to offer the most up-to-date, evidence-based recommendations on comprehensive abortion care—and three new topics were added in 2016.

The Clinical Updates include a broad spectrum of topics related to comprehensive abortion care, such as postabortion contraception, pain management, medical abortion regimens, and the safety of abortion for adolescent and young women. For abortion providers and trainers, the publication provides concise, easy-to-read answers to common clinical questions, such as:

  • What regimen of mifepristone and misoprostol should I use for second-trimester abortion?
  • What are the right medications to use for pain with vacuum aspiration?
  • When can I place an intrauterine device after a medical abortion?

“After making a thorough review of the published literature in 2015, we made no changes to our existing clinical guidance. Many new studies supported our existing guidance and demonstrated the safety and efficacy of abortion services provided by trained health-care professionals,” explains Dr. Alice Mark, Ipas senior clinical consultant and editor of the Clinical Updates. “The three new Updates address topics on which Ipas-trained providers and partners have told us they want more information to use during training or policy and advocacy work.”

While clinical and health-systems staff can use Clinical Updates to inform patient care and protocols, the streamlined summary of evidence is also useful for advocates and policymakers working to improve laws and policies related to women’s sexual and reproductive health.

New Updates in 2016

1. Replace sharp curettage with aspiration or medications (see page 6 in Clinical Updates)

 The recommendation that vacuum aspiration or medical abortion should replace sharp curettage (also known as dilatation and curettage or D&C) in the first and second trimesters aligns with guidance from the World Health Organization and the International Federation of Gynecology and Obstetrics.

 “Some providers or health systems may be hesitant to replace sharp curettage,” Mark says. “This Update offers compelling evidence that newer technologies are safer, less painful, easier and less expensive for women and providers—and gives support to enact a change that will benefit women.”


2. Identification of fetal sex via ultrasound
(see page 86 in Clinical Updates)

 This new Update presents key information on when fetal sex can be determined using ultrasound.

“The evidence is clear that the earliest gestation at which skilled technicians with advanced ultrasound equipment can tell whether a fetus is male or female is in the early second trimester,” Mark explains. “However, at this time, fetal sex determination is still not perfect. The summary of evidence we present explains the difficulties.”


3. Who has second-trimester abortions?
(see page 78 in Clinical Updates)

Although second-trimester abortion is rare, accounting for only 10 percent of all abortions worldwide, evidence shows women who need second-trimester abortions are more likely to be young, have late recognition of pregnancy, face financial or logistical barriers to care, or have medical complications.

“This Update can be used to encourage policymakers, health systems and providers to look closely at second-trimester abortion access—access that is often difficult for women to come by—and see who might need these life-saving services the most,” Mark says.

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Read and share the new Clinical Updates: www.ipas.org/clinicalupdates

Also available in Spanish: www.ipas.org/actualizacionesclinicas

For comments, questions or feedback on the Clinical Updates, please email clinicalaffairs@ipas.org

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