Medical abortion in primary care

Early medical abortion is a safe, cost effective and acceptable alternative to surgical abortion.It offers privacy and autonomy and can be provided by general practitioners who have completed an online training module.Abortion can be induced with mifepristone and misoprostol up to nine weeks of gestation.Apart from anticoagulation and severe anaemia, there are few contraindications and precautions for medical abortion.Obtaining informed consent requires the provision of information on expected effects, adverse effects and complications.The woman must know when to present to an emergency department.Follow-up must be arranged to ensure the abortion is complete.A serum human chorionic gonadotropin concentration or a low-sensitivity urine pregnancy test is used to confirm completion.Most contraceptive methods can be started immediately following medical abortion.If an intrauterine device is preferred, it should be inserted after confirming the abortion is complete. Medical abortion in primary careworker or mental health nurse.For women without contraindications to either medical or surgical abortion the relative advantages and disadvantages of both methods should be discussed (Box 1).When feasible, the chosen method should be offered or facilitated.Contraceptive options are important to raise before an abortion.This includes discussing long-acting reversible contraceptive methods.Support for clinicians providing, or considering providing, medical abortion in primary care is available through the Australian Contraception and Abortion Primary Care Practitioner Support Network (AusCAPPS). PrecautionsSpecialist advice is required for women with severe anaemia, ischaemic heart disease and severe renal or respiratory disease.Due to the antiglucocorticoid effects of mifepristone, specialist advice is needed for those with asthma that is difficult to control.This is because there may be no effect if the patient needs