Equity Clinic Patient Education

Equity Clinic

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Suction Abortion Procedure (<16 weeks)

Options Counseling

Dilation & Evacuation Procedure (>16 weeks)

Medication Abortion

Options Counseling

Patient Education VideosPlease be sure to unmute video volume!

Nearly half of all pregnancies in the United States are unintended

What are my options with an unintended pregnancy?

ParentAdoption

Continue

Title here

MedicationProcedure

Terminate

Title here

Parenthood

• Carrying pregnancy through birth
• Parenting the child

Adoption

• 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

Medication Abortion

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

• Takes 1-2 days to complete

Suction Abortion Procedure

• 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

Dilation and Evacuation 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

Thank you.Please call Equity Clinic at 224-350-2991 for any questions or concerns.

Medication Abortion

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Details About 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

You should not have a medication abortion if...

Ectopic pregnancy

IUD in place

Current steroid use

Chronic adrenal gland failure

Bleeding disorder or take blood thinners

Severe anemia

Allergy to mifepristone or misoprostol

What's the process?

May need ultrasound or blood tests

Appointment

At your appointment

Mifepristone

Misoprostol

24-48 hours later, buccally or vaginally

1-2 weeks later

Nurse Check-InPregnancy Test

What are the risks?

• 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%)

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

Numbers in red represent risk in a full term pregnancy

Pain Management

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

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

Normal

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 ill If any of these are happening, please call the office or seek emergency care

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

Thank you.Please call Equity Clinic at 224-350-2991 for any questions or concerns.

Suction Abortion Procedure (<16 weeks)

Patient Education VideosPlease be sure to unmute video volume!

Details About Suction Abortion Procedure

• 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

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.

What's the process?

Preparation

01

Pain medicineAntibiotics Pelvic exam

Anesthesia

02

Cervix cleanedLocal anesthesia injected

Dilation

03

Cervix dilated with instruments May require additional medication

Suction

04

Tissue removed

Examination

05

Tissue examined to ensure complete removal

What are the risks?

• 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%)

Numbers in red represent risk in a full term pregnancy

Pain Management

• 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

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

Normal

NOT Normal

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

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

Thank you.Please call Equity Clinic at 224-350-2991 for any questions or concerns.

Dilation & Evacuation Procedure (>16 weeks)

Patient Education VideosPlease be sure to unmute video volume!

Details About Dilation & Evacuation Procedure

• 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

What's the process?

05

04

03

01

02

Amniotic Fluid

Dilation

Anesthesia

Evacuation

Examination

Larger parts of the pregnancy removed with forceps and instruments

Visit #2 IV and local anesthesia Antibiotics

Visit #1 Pelvic exam Laminaria placement

Small parts of the pregnancy removed with suction

Tissue examined to ensure complete removal

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

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

What are the risks?

• 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%)

Numbers in red represent risk in a full term pregnancy

Pain Management

• 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

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

Normal

NOT Normal

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

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

Thank you.Please call Equity Clinic at 224-350-2991 for any questions or concerns.

Sources

• 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
• American College of Obstetricians and Gynecologists. (2017). Postpartum hemorrhage. ACOG | Clinical. Retrieved January 2023, from https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2017/10/postpartum-hemorrhage
• Bixby Center for Global Reproductive Health. (2019, April). Analysis of Medication Abortion Risk and the FDA report “Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018.” Advancing New Standards in Reproductive Health. Retrieved January 2023, from https://www.ansirh.org/sites/default/files/publications/files/mifepristone_safety_4-23-2019.pdf
• Boushra, M., &amp; Rahman, O. (2022). Postpartum infection. StatPearls. Retrieved January 2023, from https://www.ncbi.nlm.nih.gov/books/NBK560804/
• The Children's Hospital of Philadelphia. (2014, August 24). Postpartum hemorrhage. Children's Hospital of Philadelphia. Retrieved January 2023, from https://www.chop.edu/conditions-diseases/postpartum-hemorrhage#:~:text=About%201%20to%205%20percent,a%20half%20of%20a%20quart)
• Cooper, D., & Menefee, G. (2022, March 9). Dilation and Curettage - Statpearls. National Center for Biotechnology Information. Retrieved January 2023, from https://www.ncbi.nlm.nih.gov/books/NBK568791/
• GoodRx. (2022, June 27). How much does the abortion pill cost? GoodRx. Retrieved January, 2023, from https://www.goodrx.com/conditions/abortion/medication-abortion-pill-cost
• Hamilton, B. E., Martin, J. A., &amp; Osterman, M. J. K. (2022, May). Births: Provisional Data for 2021. National Center for Health Statistics.
• Induced abortion in the United States. Guttmacher Institute. (2022, August 24). Retrieved January, 2023, from https://www.guttmacher.org/fact-sheet/induced-abortion-united-states
• Ipas. (2017). Steps for Performing Manual Vacuum Aspiration (MVA) Using the Ipas MVA Plus® and Ipas EasyGrip® Cannulae.
• Knight, M., Tuffnell, D., Brocklehurst, P., Spark, P., &amp; Kurinczuk, J. (2010, May). Incidence and risk factors for amniotic-fluid embolism. Obstetrics and Gynecology. Retrieved January 2023, from https://pubmed.ncbi.nlm.nih.gov/20410762/
• Lohr, P. A. (2022, May 2). Cervical preparation with osmotic dilators. Innovating Education in Reproductive Health. Retrieved January 2023, from https://www.innovating-education.org/2022/03/cervical-preparation-with-osmotic-dilators/
• Lohr, P. A. (2022, May 2). Dilation and evacuation animation. Innovating Education in Reproductive Health. Retrieved January 2023, from https://www.innovating-education.org/2022/03/dilation-and-evacuation-animation/
• Malhotra, A., & Weinberger, S. (2022, October 3). Deep vein thrombosis in pregnancy: Epidemiology, pathogenesis, and diagnosis. UpToDate. Retrieved January 2023, from https://www.uptodate.com/contents/deep-vein-thrombosis-in-pregnancy-epidemiology-pathogenesis-and-diagnosis#:~:text=The%20overall%20incidence%20of%20venous,1%2D6%2C14%5D
• 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
• Springer Nature America, Inc. (2022, May 17). How Medication Abortion with RU-486/Mifepristone Works. Scientific American. Retrieved January, 2023, from https://www.scientificamerican.com/article/how-medication-abortion-with-ru-486-mifepristone-works/
• Steinauer, J., & Patil, R. (2023, January 27). Overview of Pregnancy Termination. UpToDate. Retrieved January 2023, from https://www.uptodate.com/contents/overview-of-pregnancy-termination?search=overview+of+pregnancy+termination&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
• Supermind Platforms, Inc. (2019, March 26). Types of adoption. MentalHelp.net. Retrieved January, 2023, from https://www.mentalhelp.net/adoption/types/
• Thurn, L., Wikman, A., Westgren, M., & Lindqvist, P. G. (2019, August 13). Incidence and risk factors of transfusion reactions in postpartum blood transfusions. Blood Advances. Retrieved January 2023, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6693016/#:~:text=Currently%2C%20up%20to%203%25%20of,effect%20on%20the%20immune%20system
• Williams, S. (2021, June 3). Uterine Aspiration Abortion - Ryan Curriculum. Innovating Education in Reproductive Health. Retrieved January 2023, from https://www.innovating-education.org/2021/06/uterine-aspiration-abortion-ryan-curriculum/