Equity Clinic Patient Education

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Equity Clinic

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Dilation & Evacuation Procedure (>16 weeks)

Suction Abortion Procedure (<16 weeks)

Medication Abortion

Options Counseling

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Options Counseling

Nearly half of all pregnancies in the United States are unintended

Terminate

MedicationProcedure

ParentAdoption

Continue

What are my options with an unintended pregnancy?

Title here

Title here

• Carrying pregnancy through birth
• Parenting the child

Parenthood

• Can be facilitated through:
• Agency
• Attorney
• Consultant
• Types
• Open - direct contact with adoptive parents
• Semi-open - contact with adoptive parents through agency
• Closed - no contact

Adoption

• Available up to 10 weeks
• Abortion occurs at wherever is safe for you
• Two medications - mifepristone and misoprostol

• Takes 1-2 days to complete

Medication Abortion

• Available up to 16 weeks
• Abortion occurs in the office
• Instruments are placed in the vagina and uterus to remove the pregnancy
• Takes 5-10 minutes to complete

Suction Abortion Procedure

• For pregnancies >16 weeks
• Abortion occurs in the office with two visits
• Placement of cervical dilators

• Removal of the pregnancy from the uterus

• Takes approximately 10 minutes to complete procedure

Dilation and Evacuation Procedure

Thank you.Please call Equity Clinic at224-350-2991 for any questions or concerns.

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Medication Abortion

• Abortion occurs wherever is safe for you
• You have control over timing, location
• May feel more natural - like a miscarriage
• No anesthesia or instrumentation
• Takes 1-2 days to complete
• Two medications - mifepristone and misoprostol

Details About Medication Abortion

Allergy to mifepristone or misoprostol

Severe anemia

Ectopic pregnancy

Chronic adrenal gland failure

Bleeding disorder or take blood thinners

IUD in place

Current steroid use

You should not have a medication abortion if...

What's the process?

1-2 weeks later

Nurse Check-InPregnancy Test

24-48 hours later, buccally or vaginally

Misoprostol

At your appointment

Mifepristone

May need ultrasound or blood tests

Appointment

Numbers in red represent risk in a full term pregnancy

Medication abortion is at least 15 times safer than a vaginal delivery at full term.

• Hemorrhage
• <1% need emergency treatment (1-5%)
• 0.1% require transfusion (3%)
• Ongoing pregnancy or incomplete abortion
• Dependent on how far in pregnancy you are
• No more than 5-10%
• May require more medicine or procedure
• Infection - 0.9% (5-7%)
• Death - 0.0003% (<0.02%)

What are the risks?

• Prescription for ibuprofen will be offered at appointment
• Nausea medicine is also available if desired

Pain Management

What should I expect to happen? What's not normal?

- Bleeding through 2 or more large pads for 2 hours straight- Not experiencing bleeding within 24 hours of misoprostol- Continued, severe pain more than 24 hours after misoprostol- Fever more than 24 hours after misoprostol- Feeling extremely illIf any of these are happening, please call the office or seek emergency care

NOT Normal

- Heavy bleeding - likely more than your period- Clots- Passage of pregnancy tissue- Cramping- Side effects of misoprostol: nausea, vomiting, fever, headache, diarrhea, dizziness

Normal

Thank you.Please call Equity Clinic at224-350-2991 for any questions or concerns.

Patient Education VideosPlease be sure to unmute video volume!

Suction Abortion Procedure (<16 weeks)

• Abortion occurs in the office
• Requires pelvic exam and instruments in the vagina and uterus
• Completed with device that uses gentle suction to empty uterus

• Takes 5-10 minutes to complete

• Less bleeding than medication abortion

Details About Suction Abortion Procedure

While there are no absolute contraindications for suction abortion procedure, there are some patients who would be safer to have their procedure done in a hospital than in a clinicYour individual risk factors will be reviewed at your appointment with your healthcare provider.

Tissue examined to ensure complete removal

05

Examination

Tissue removed

04

Suction

Cervix dilated with instrumentsMay require additional medication

03

Dilation

Cervix cleanedLocal anesthesia injected

02

Anesthesia

Pain medicineAntibioticsPelvic exam

01

Preparation

What's the process?

Numbers in red represent risk in a full term pregnancy

• Hemorrhage - <1% (1-5%)

• Infection - 0.5% (5-7%)
• Uterine perforation - <0.6%
• Cervix laceration - <0.1% (0.2%)
• Retained products of conception - <0.6% (1-3%)
• Death - <0.001% (<0.02%)

What are the risks?

• Oral pain medicine with ibuprofen and tylenol
• Local pain medicine: injections of lidocaine around the cervix

• Stronger medicines by mouth or by injection into muscle (arm, buttock) is available to help with both pain and anxiety
• May require that you have a ride home
• Should be ovrerall healthy
• Conscious sedation involves combination of anxiety and pain medication through your veins to make you very comfortable but not fully asleep
• Cause amnesia (help prevent you from remembering procedure)
• Requires that you have a ride home
• Should be overall healthy
• Available at an additional cost

Pain Management

What should I expect to happen after? What's not normal?

- Bleeding through 2 or more large pads for 2 hours straight- Continued, severe pain- Feeling extremely illIf any of these are happening, please call the office or seek emergency care

NOT Normal

- Pressure or light tugging during procedure- Cramping- Light bleeding for up to 7 days- Irregular spotting for a few weeks

Normal

Thank you.Please call Equity Clinic at224-350-2991 for any questions or concerns.

Patient Education VideosPlease be sure to unmute video volume!

Dilation & Evacuation Procedure (>16 weeks)

• Abortion occurs in the office with two visits
• First visit is placement of cervical dilators and takes a few minutes

• Second visit removes the pregnancy from the uterus with suction and long forceps in approximately 10 minutes

• Requires pelvic exam and instruments in the vagina and uterus

Details About Dilation & Evacuation Procedure

Tissue examined to ensure complete removal

05

Examination

Larger parts of the pregnancy removed with forceps and instruments

04

Evacuation

Small parts of the pregnancy removed with suction

03

Amniotic Fluid

Visit #2IV and local anesthesiaAntibiotics

02

Anesthesia

Visit #1Pelvic examLaminaria placement

01

Dilation

What's the process?

Depending on how far along in pregnancy you are, may require additional medication to soften and dilate cervix

The most important step of the procedure is softening and dilating the cervix

Numbers in red represent risk in a full term pregnancy

• Hemorrhage
• 2.5% of patients have increased bleeding due to uterus not returning to normal size

• 0.1-0.6% require transfusion (3%)

• Infection - 0.1-4% (5-7%)
• Retained products of conception - <1% (1-3%)
• Cervical laceration - 3.3% (0.2%)

• Uterine perforation - 0.2-0.5%

• Blood clot or amniotic fluid in lungs - 0.01%

• Death - <0.009% (<0.02%)

What are the risks?

• Oral pain medicine with ibuprofen and tylenol
• Local pain medicine: injections of lidocaine around the cervix
• Stronger medicines by mouth or by injection into muscle (arm, buttock) are available to help with both pain and anxiety
• May require that you have a ride home
• Should be ovrerall healthy
• Conscious sedation involves combination of anxiety and pain medication through your veins to make you very comfortable but not fully asleep
• Cause amnesia (help prevent you from remembering procedure)
• Requires that you have a ride home
• Should be overall healthy

Pain Management

What should I expect to happen after? What's not normal?

- Bleeding through 2 or more large pads for 2 hours straight- Feeling extremely ill- Continued, severe painIf any of these are happening, please call the office or seek emergency care

NOT Normal

- Pressure or light tugging during procedure- Cramping- Light bleeding for up to 7 days- Irregular spotting for a few weeks

Normal

Thank you.Please call Equity Clinic at224-350-2991 for any questions or concerns.

• American College of Obstetricians and Gynecologists. (2020, August 14). Medication Abortion Up to 70 Days of Gestation. ACOG Clinical. Retrieved January 2023, from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/10/medication-abortion-up-to-70-days-of-gestation
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• Ipas. (2017). Steps for Performing Manual Vacuum Aspiration (MVA) Using the Ipas MVA Plus® and Ipas EasyGrip® Cannulae.
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• Parikh, R., Brotzman, S., & Anasti, J. N. (2006, April). Cervical lacerations: Some surprising facts. Obstetrics &amp; Gynecology. Retrieved January 2023, from https://journals.lww.com/greenjournal/Fulltext/2006/04001/Cervical_Lacerations__Some_Surprising_Facts.153.aspx#:~:text=We%20noted%2032%20cervical%20lacerations,%25%20CI%201.5%E2%80%936.7)
• Perlman, N. C., & Carusi, D. A. (2019, October 7). Retained placenta after vaginal delivery: Risk factors and management. International Journal of Women's Health. Retrieved January 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6789409/
• Planned Parenthood Federation of America, Inc. (n.d.). Ectopic Pregnancy. Retrieved January 2023, from https://www.plannedparenthood.org/learn/pregnancy/ectopic-pregnancy

• Raymond, E. G., & Grimes, D. A. (2012). The comparative safety of legal induced abortion and childbirth in the United States. Obstetrics &amp; Gynecology, 119(6), 1271–1272. https://doi.org/10.1097/aog.0b013e318258c833
• Reproductive Health Access Project. (2022, March). Early Abortion Options.
• Reproductive Health Access Project. (2017, August). Options Counseling: Management of Unintended Pregnancy.
• Shih, G., & Wallace, R. (2023, January 4). First-trimester pregnancy termination: Uterine aspiration. UpToDate. Retrieved January 2023, from https://www.uptodate.com/contents/first-trimester-pregnancy-termination-uterine-aspiration?search=first+trimester+pregnancy+termination&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2
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