National Women's Health Organization

Appointments

Call us in advance to make an appointment. The toll-free 800 number is answered Monday through Friday from 8:00am until 4:00pm EST. Please bring any special problems to the attention of the phone counselor. If the appointment has to be canceled for any reason, please let us know at least a day in advance.

The Cost

To ensure confidentiality we do not send bills. Fees are all-inclusive and include pre- and post-RU-486 counseling, laboratory studies, physician's fee, and a post-op exam. Full payment must be made on the first visit of the RU-486 in the form of money orders, cashier's check, ATM Card, American Express, Mastercard, VISA, Discover, or cash. The credit card owner must be present to sign the sales receipt if a credit card is used. For collection reasons, we do not accept personal checks. We accept direct payment from many insurance companies. The fees below are all subject to change.

Low-cost medical abortions with RU486 / Mifepristone (Mifeprex) are performed at these NWHO centers:

Protocols

ELIGIBLE PATIENTS:

1) Must be in overall good health, and will be advised not to proceed with Mifeprex if:

·  It has been more than 56 days(8 weeks) since her last period began.

·  The patient has current severe anemia Hemoglobin < 10 (hematocrit less than 30);

·  The patient currently has an intrauterine device (IUD) in place;

·  The patient has a pregnancy outside of the uterus;

·  The patient has contraindications to a surgical abortion;

·  The patient has problems with her adrenal glands (chronic adrenal failure);

·  The patient has a bleeding problem;

·  The patient takes any medication to thin her blood;

·  The patient takes any steroid medicines;

·  The patient cannot return for the mandatory follow up visit;

·  The patient cannot easily get emergency help in 2 weeks after taking Mifeprex;

·  The patient is allergic to Mifepristone, Misoprostol

1) Although there is no data available on the effects of Mifepristone and Misoprostol while breastfeeding, it is prudent to advise patients to discontinue breastfeeding for 72 hours after the Misoprostol is taken.

COUNSELING, EDUCATION, AND INFORMED CONSENT include:

1. Discussion of the decision to have an abortion and assurance that the decision is patient’s own;
2. Discussion of non-surgical and surgical alternatives and the risks and benefits of each, as well as consent for surgery if and when it is recommended by the doctor;
3. Discussion of the known side effects and possible complications of Mifepristone and Misoprostol; explanation that both Mifepristone and Misoprostol can cause serious fetal anomalies, so that once Mifeprex has been administered, the abortion must be completed either medically or surgically.
4. Discussion of the amount of time involved the requirement of three visits, and the failure rate of Mifeprex-induced abortions resulting in the need for surgical abortion; patients should also be advised that if the pregnancy is not fully expelled from the uterus it could cause infection or other complications.
5. Discussion of the patient’s choice of alternative treatment of Mifeprex, how the alternative treatment differs from the FDA approved regimen, and her option to choose the FDA approved regimen if she desires and meets the criteria.
6. Discussion of the amount of pain experienced by previous patients and the use of pain medications.
7. Discussion of the amount of bleeding associated with the abortion process and, in particular, the size of the clots and embryo and the possibility of observing the embryo at home; also a discussion of what post medication symptoms are normal and the parameters for calling the clinic.
8. Availability of contraception and contraceptive counseling;
9. A review of the consent form;

MEDICAL HISTORY AND PHYSICAL EXAMINATION

Includes a thorough medical and obstetrical history, including history of allergies and all current patient medications; pelvic examination, and pertinent physical examination base-line blood pressure.

ULTRASOUND

1. Trans-vaginal ultrasound and/or abdominal ultrasound should be used to confirm gestational age. Document ultrasound examination (gestational sac, embryonic pole, presence of cardiac activity, or yolk sac) for the medical records before administering Mifeprex.
2. As soon as the embryonic pole is visible, use this measurement instead of gestational sac measurement.
3. If an intrauterine sac is not present, this could indicate early intrauterine pregnancy or ectopic pregnancy (or miscarriage if patient has bleeding). If the patient is at a high risk for ectopic pregnancy, give her precautions for ectopic pregnancy signs and re-evaluate in one week. If the patient is not at a high risk for ectopic pregnancy, simply schedule the patient for a re-evaluation in one week.

LAB WORK

MEDICATION AND FOLLOW UP

Day 1:

·  Mifepristone 200 mg orally (one 200-mg tablet) Patient will be given 2 Misoprostol (400mcg) tablets to take home to be taken orally 48 hours after the first visit. The patient will be called to remind them to take the Misoprostol pills.

·  RH Immune globulin for RH negative patients.

·  Provide patient with adequate analgesic information and prescription as directed by M.D.

DAY 14:

Obtain patient history and perform trans-vaginal ultrasound or abdominal ultrasound.

·  If gestational sac is absent, treatment is completed.

·  If gestational sac is still present, perform surgical aspiration.

·  If gestational sac is still present without cardiac activity, follow up in approximately 3 weeks or re-administer Misoprostol.

CONCLUSION OF TREATMENT:

When an ultrasound confirms expulsion of the gestational sac, the abortion has been completed. The patient should receive follow up instructions to include information about expected length of bleeding, increased heavy bleeding (which may indicate an incomplete abortion), birth control counseling and prescription if desired by patient, and other pertinent medical information.

Alternative Treatment Information

Before reviewing this document, please read the Mifeprex Medication Guide (in the green booklet which will be given you) carefully. This document you are reading now describes the alternative Mifeprex medical abortion procedure used at this facility. The alternative procedure differs from the one you read about in the Mifeprex Medication Guide. Because clinics have performed medical abortion research through clinical trials preformed across the country, scientific evidence allows the provider to alter the medication dose

Read this information carefully before taking the Mifeprex and Misoprostol. It will help you understand how the treatment works. If you wish, you may choose to follow the FDA advised regimen. Please be aware that this protocol requires an increased fee.

ALTERNATIVE TREATMENT PLANS FOR MIFEPREX (MIFEPRISTONE)

In research studies, other ways of using Mifepristone and Misoprostol for medical abortion have been shown to be equally safe and effective as the regimen advised by the Food and Drug Administration (FDA) We offer the following alternative for using Mifeprex:

Medication Dosing Changes:

1. A lower dose of 200mg of Mifeprex (one pill) will be used instead of the 600mg (three pills) dose recommended on the package. The lower dose has been shown to be equally effective and less expensive.

2. The dose of Misoprostol will be 400mcg (2 pills) and is taken orally. The combination of 200mcg of Mifeprex (Mifepristone) by mouth and 400mcg of Misoprostol orally has been shown to:

·  Cause less nausea and vomiting

·  Be acceptable to women

·  Be equally effective at ending early pregnancy.

Post Op Information