Spontaneous abortion Management

Grand Rounds 51513

Jamie Peregrine R2 WCGME OBGYN

Objectives

bull Differentiate between abnormal pregnancies ectopic vs missedincompletecomplete abortion

bull Know where to look for management of spontaneous abortions

bull Review management of threatened and incomplete abortions

bull Discuss birth control options after abortion

Common presentations of abnormal pregnancies

bull 9w0d by LMP VBx4d no IUP by TVS UPREG+

ndash quant 20000 48 hours later 18000

bull 9w0d by LMP VB x4d live IUP measures 8w5d by TVS w subchorionic hemorrhage gt50

bull 9w0d by LMP VBx4d abd pn amp back cramps live IUP 8w5d by TVS cervix 2cm w bleeding

bull 11w0d by LMP routine PNC absent cardiac activity IUP 8w5d by TVS cervix closed

Resources

bull Williams OB 23rd edition

ndash Ch 9 Abortion

ndash pp 220-223

bull Creasy MFM 6th edition

ndash Ch 33 Embryonic and Fetal Demise

ndash pp 627 1 paragraph

Resources continued

bull UpToDate

bull ACOG practice bulletins

ndash No 94 Medical management of ectopic pregnancy

ndash No 67 Medical management of abortion

bull RCOG NICE clinical guideline

ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage

bull Dec 2012 (281 pp)

Threatened abortion

bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain

bull 20-25 of early pregnancies

bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy

bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab

Threatened abortion management

bull Cochrane reviewed RCTs and found insufficient evidence to recommend

ndash Bedrest

ndash HCG

ndash Vitamin supplementation

ndash Tocolyticsbeta-agonists

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Objectives

bull Differentiate between abnormal pregnancies ectopic vs missedincompletecomplete abortion

bull Know where to look for management of spontaneous abortions

bull Review management of threatened and incomplete abortions

bull Discuss birth control options after abortion

Common presentations of abnormal pregnancies

bull 9w0d by LMP VBx4d no IUP by TVS UPREG+

ndash quant 20000 48 hours later 18000

bull 9w0d by LMP VB x4d live IUP measures 8w5d by TVS w subchorionic hemorrhage gt50

bull 9w0d by LMP VBx4d abd pn amp back cramps live IUP 8w5d by TVS cervix 2cm w bleeding

bull 11w0d by LMP routine PNC absent cardiac activity IUP 8w5d by TVS cervix closed

Resources

bull Williams OB 23rd edition

ndash Ch 9 Abortion

ndash pp 220-223

bull Creasy MFM 6th edition

ndash Ch 33 Embryonic and Fetal Demise

ndash pp 627 1 paragraph

Resources continued

bull UpToDate

bull ACOG practice bulletins

ndash No 94 Medical management of ectopic pregnancy

ndash No 67 Medical management of abortion

bull RCOG NICE clinical guideline

ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage

bull Dec 2012 (281 pp)

Threatened abortion

bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain

bull 20-25 of early pregnancies

bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy

bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab

Threatened abortion management

bull Cochrane reviewed RCTs and found insufficient evidence to recommend

ndash Bedrest

ndash HCG

ndash Vitamin supplementation

ndash Tocolyticsbeta-agonists

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Common presentations of abnormal pregnancies

bull 9w0d by LMP VBx4d no IUP by TVS UPREG+

ndash quant 20000 48 hours later 18000

bull 9w0d by LMP VB x4d live IUP measures 8w5d by TVS w subchorionic hemorrhage gt50

bull 9w0d by LMP VBx4d abd pn amp back cramps live IUP 8w5d by TVS cervix 2cm w bleeding

bull 11w0d by LMP routine PNC absent cardiac activity IUP 8w5d by TVS cervix closed

Resources

bull Williams OB 23rd edition

ndash Ch 9 Abortion

ndash pp 220-223

bull Creasy MFM 6th edition

ndash Ch 33 Embryonic and Fetal Demise

ndash pp 627 1 paragraph

Resources continued

bull UpToDate

bull ACOG practice bulletins

ndash No 94 Medical management of ectopic pregnancy

ndash No 67 Medical management of abortion

bull RCOG NICE clinical guideline

ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage

bull Dec 2012 (281 pp)

Threatened abortion

bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain

bull 20-25 of early pregnancies

bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy

bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab

Threatened abortion management

bull Cochrane reviewed RCTs and found insufficient evidence to recommend

ndash Bedrest

ndash HCG

ndash Vitamin supplementation

ndash Tocolyticsbeta-agonists

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Resources

bull Williams OB 23rd edition

ndash Ch 9 Abortion

ndash pp 220-223

bull Creasy MFM 6th edition

ndash Ch 33 Embryonic and Fetal Demise

ndash pp 627 1 paragraph

Resources continued

bull UpToDate

bull ACOG practice bulletins

ndash No 94 Medical management of ectopic pregnancy

ndash No 67 Medical management of abortion

bull RCOG NICE clinical guideline

ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage

bull Dec 2012 (281 pp)

Threatened abortion

bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain

bull 20-25 of early pregnancies

bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy

bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab

Threatened abortion management

bull Cochrane reviewed RCTs and found insufficient evidence to recommend

ndash Bedrest

ndash HCG

ndash Vitamin supplementation

ndash Tocolyticsbeta-agonists

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Resources continued

bull UpToDate

bull ACOG practice bulletins

ndash No 94 Medical management of ectopic pregnancy

ndash No 67 Medical management of abortion

bull RCOG NICE clinical guideline

ndash Diagnosis and initial management in early pregnancy of ectopic pregnancy and miscarriage

bull Dec 2012 (281 pp)

Threatened abortion

bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain

bull 20-25 of early pregnancies

bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy

bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab

Threatened abortion management

bull Cochrane reviewed RCTs and found insufficient evidence to recommend

ndash Bedrest

ndash HCG

ndash Vitamin supplementation

ndash Tocolyticsbeta-agonists

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Threatened abortion

bull Bleeding through a closed cervical os first frac12 of pregnancy +- pain

bull 20-25 of early pregnancies

bull 50 of all threatened abs end in abortion but 90-96 of pregnancies with fetal cardiac activity amp VB at 7-11 weeks will result in ongoing pregnancy

bull Managed expectantly until resolution dx nonviable pregnancy or progress to inevitable incomplete or complete Sab

Threatened abortion management

bull Cochrane reviewed RCTs and found insufficient evidence to recommend

ndash Bedrest

ndash HCG

ndash Vitamin supplementation

ndash Tocolyticsbeta-agonists

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Threatened abortion management

bull Cochrane reviewed RCTs and found insufficient evidence to recommend

ndash Bedrest

ndash HCG

ndash Vitamin supplementation

ndash Tocolyticsbeta-agonists

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Threatened abortion management

bull Meta-analysis showed lower miscarriage with progestin compared with placebo or none (RR 053 95 CI 035-079) ndash 4 studies 2 oral 2 vaginal 1 good study (the only one which did show

significant difference by itself) vaginal subgroup analysis CI crossed 1 ndash Regimens

bull PO dydrogesterone (Duphaston) 10 mg bid continued until 1 week after bleeding stopped

bull PV 25 mg progesterone bid cont until 14 d after bleeding stopped bull PV 90 mg progesterone (Crinone 8) daily x 5d bull PO dydrogesterone 40 mg then 10 mg bid treatment cont until 16 weeks

bull RCOG guidelines find it probably cost effective to treat but find insufficient evidence to treat based on quality of data lack of long-term safety data

bull Dydrogesterone not available in US

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Spontaneous abortion

bull Non-induced loss of pregnancy before 20 weeks lt500 g (WHO)

bull 8-20 of clinically recognized pregnancies

bull 13-36 of all pregnancies

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Expectant vs active tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Risk of Ashermanrsquos increases from 8 with 1st or 2nd DampC to 30 with 3rd

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Medical vs surgical tx of Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec PV vs placebo missed ab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec PV vs placebo missed ab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

RU-486 vs placebo missed ab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec+RU-486 vs RU-486 missed ab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec Dose missed ab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

SL cyotec x1 or longer missed ab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

SL cyotec x1 or longer missed ab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

SL Cytotec x1 or more missed ab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

PO vs SL missed ab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

PO vs SL missed ab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

PO vs SL missed ab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

SL vs PV missed ab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

SL vs PV missed ab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

SL vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

PO vs PV missed ab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

PO vs PV missed ab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

PO vs PV missed ab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec PV vs placebo incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Dose of PO cytotec incomplete

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Dose of PO cytotec incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec PO vs PV incomplete

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec PO vs PV incomplete

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec PO vs SL incomplete

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Cytotec PO vs SL incomplete

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Rhogam

bull Sab yes as many as 5 become isoimmunized without it

bull Threatened abortion controversial

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Contraception post-Sab

bull Gaffield ME Kapp N Ravi A Use of combined oral contraceptives post abortion Contraception 2009 Oct80(4)355-62 doi 101016jcontraception200904005 Epub 2009 Jun 4

bull Systematic review 7 articles identified 1 involving spontaneous ab Quality of data not great Immediate COCs didnrsquot increase bleeding after induced abortion in 1st trimester Coagulation parameters increased compared to copper IUD control Clinical significance unknown Increase VTE not reported

bull WHO and CDC Medical Eligibility Criteria for Contraceptive Use ndash COCs Depo IUDs no restriction after induced abortion ndash IUD no restriction after 1st trimester induced or spontaneous abortion ndash Non-IUD methods no restriction in GTN (decreasing or persistently

elevated HCG) ndash Otherwise doesnrsquot specify safety of contraception immediately post-

Sab

Use single dose of 800 mcg dose vaginally or sublingually