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Outcomes of very early medical and surgical abortion: correlates of success and role of tissue evaluation

Maureen Baldwin, MD MPH, Oregon Health & Science University

Project abstract

Clinical uncertainty prior to the visualization of an intrauterine pregnancy (IUP) on ultrasound results in delayed care, prolonged follow-up, and costly unnecessary interventions during both abortion care and the workup of first trimester bleeding. Protocols exist for very early abortion, but there is uncertainty regarding the comparative effectiveness of medical or surgical abortion.

We aim to evaluate the outcomes of medical and surgical very early abortion <42 days (including prior to ultrasound visualization of IUP), and to compare these between types of abortion and by GA (<42 days versus 42-48 days). To this end, we propose an observational cohort study of all women seeking medical and surgical abortion <49 days gestation at two Planned Parenthood affiliates over 12 months.

We will assess potential factors associated with need for further intervention.
Additionally, because improved detection of chorionic villi is a strategy to rule out ectopic pregnancy among women with early abortion without a visible IUP, we will pilot a novel method for detection of trophoblastic tissue in uterine aspirate using molecular biology approaches to identify unique gene expression patterns associated with intrauterine and ectopic pregnancy.

The goal of this study is to improve the care of women seeking early abortion through more timely and efficient provision of services. The knowledge gained by this study will help to inform national protocols and techniques for clinic-based medical and surgical treatment of very early abortion, provide evidence for safety of current protocols, and improve the care of women during the workup of ectopic pregnancy.

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