Medical strategy for abortions between 14 and 16 weeks of gestation

Objective. - To adapt the protocols for the management of voluntary termination of pregnancy following the new law extending the practice to 16 weeks of gestation. Material and method. - A systematic review of the literature in French and English concerning the management of patients requesting medically induced abortion was performed on PubMed, Cochrane Library and on the recommendations of international learned societies. Results. - The efficacy of the medical method is greater than 95% when the protocols are adapted to the gestational age. The combination of mifepristone and misoprostol currently represents the ''gold standard'' of drug-based management. Mifepristone 200 mg is sufficient, followed 24 to 48 hours later by misoprostol 800 mu g administered sublingually or buccally. After the first dose, 400 mu g should be administered every 3 hours buccally or sublingually until expulsion. Adverse effects (digestive and thermoregulatory disorders) during medical abortion are usually mild and short-lived. An anti-emetic treatment should be proposed as a prophylactic measure. For pain, ibuprofen is the analgesic treatment of choice, with the addition of level 2 analgesics if necessary. Conclusion. - Medical abortion is a safe and effective method up to 16 weeks of gestation, provided that the protocols, which differ according to gestational age, are respected. Women must be informed of the advantages and disadvantages of the methods according to the term and the side effects, which will allow them to choose the method that fits them best. (c) 2022 Elsevier Masson SAS. All rights reserved.