Prior to arriving at the pharmacy for MIFE / MISO, people seeking abortion, hereinafter called "patients", will already have had a conversation with prescribers about medication abortion (MA) such as pregnancy options, eligibility, risks and efficacy[10].
When counselling patients, dispensers should provide a private space for counselling, ensure confidentiality and go over the key points below using an inclusive language[10]:
Ensure patients have the following before leaving[10]:
Ensure patients understand how to administer MIFE / MISO, how to manage side effects, and know when and how to seek care (see below).
Both MIFE and MISO are teratogenic and have been associated with fetal abnormalities. Once the MIFE / MISO treatment has been started, there is a risk of embryotoxicity if the pregnancy is not terminated[10].
If MISO is forgotten and > 48 hours have passed since MIFE: take MISO right away and inform the prescriber at follow-up[10].
In any case, if bleeding does not start within a few hours, contact a healthcare professional.
Ongoing pregnancy[6]: Ongoing pregnancy after medication abortion is uncommon and can be treated with another dose of MISO or with procedural abortion. Procedural abortion is recommended if cardiac activity is present 14 to 21 days after taking MISO.
Retained products of conception[6]: In the absence of ongoing pregnancy, retained products of conception can be managed by asking patients to wait for bleeding and cramping, offering them another dose of MISO, or providing them with or referring them for procedural abortion. Urgent procedural abortion is indicated in cases of heavy uncontrolled bleeding or retained products of conception associated with endometritis.
Symptoms of retained products include unexpected heavy/prolonged bleeding or cramping, and failure to have expected bleeding.
Post-abortion infections[6]: Treatment should be individualized and usually consists of broad-spectrum therapy. In mild cases, oral antibiotics can be used, but if infection is severe, patients should be hospitalized for treatment. Once patients start antibiotics, procedural abortion may be necessary to remove significant retained products of contraception.
Symptoms of Post-Abortion Infections
Toxic shock syndrome[6]: Toxic shock syndrome is associated with clostridium and Group A streptococcus. The majority of these infections are fulminant and rapidly progress to shock. Standard antibiotic therapy is not sufficient; thus, the treatment consists of supportive care, and empiric antibiotic treatment covering clostridial species and other organisms known to cause toxic shock, and surgical debridement, including possible hysterectomy.
Symptoms of Toxic Shock Syndrome
Patients are required to have a follow-up consultation with prescribers.
A follow-up with dispensers is optional and can take place 2 – 3 days after MISO administration. During the follow-up, dispensers can do the following[9,10]:
Emotional response after MA often vary. Some people feel relieved and positive and some have feelings of grief, sadness, or guilt while others have mixed feelings. These emotions are normal, and they may or may not be related to socioeconomic circumstances, the lack of social support, moral discomfort, and family conflict.
Patients can be supported by understanding that mixed emotions are normal and by exploring coping strategies and support. Useful resources include:
Due to rapid return to fertility following medication abortion (MA), patients should be advised to have a method for contraception at the earlier visits[6].
Patients seeking more information about contraception options can be referred to:
Below is a list of contraception options and special considerations: