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Medication management of early pregnancy loss and medication abortion has become increasingly common. Medication abortion now accounts for 60% of all abortions completed before 10 weeks’ gestation. Mifepristone (Mifeprex) and misoprostol (Cytotec) are safe and effective for outpatient treatment of early pregnancy loss for up to 84 days’ gestation and for medication abortion up to 77 days’ gestation. The most effective regimens include 200 mg of oral mifepristone followed by 800 mcg of misoprostol administered buccally or vaginally.
Feb 1, 2021 Issue
Screening for Cervical Intraepithelial Neoplasia with Patient-Collected HPV Samples [FPIN's Clinical Inquiries]
How useful are patient-collected human papillomavirus vaginal swabs as a screening test for cervical intraepithelial neoplasia?
Bleeding decreased over time for most women after the insertion of a levonorgestrel-releasing intrauterine system.
Vaginal, oral, and sublingual misoprostol in single doses of 600 to 800 mcg are equally effective for promoting completed abortion in patients with an incomplete first-trimester spontaneous abortion.
Jul 15, 2020 Issue
Screening for Bacterial Vaginosis in Pregnant Persons to Prevent Preterm Delivery: Recommendation Statement [U.S. Preventive Services Task Force]
The USPSTF recommends against screening for bacterial vaginosis in pregnant persons who are not at increased risk for preterm delivery.
Endometrial biopsy is a safe and efficient method to evaluate the endometrium. The biopsy is performed using a catheter that is inserted through the cervix into the uterine cavity. Cramping is a common adverse effect, and complications are rare. Patients should be referred for further evaluation if the procedure fails or an insufficient sample is obtained.
Topical lidocaine preparations including gels, creams, and sprays may modestly decrease pain with tenaculum placement but not during IUD insertion.
Misoprostol alone was associated with a nearly 80% success rate in the first trimester of pregnancy on meta-analysis.
Jul 1, 2019 Issue
Preventing Spontaneous Abortion with Progestin Therapy [Medicine by the Numbers]
The use of progestin therapy in women with recurrent pregnancy loss appears to reduce the incidence of spontaneous abortion, preterm labor, and stillbirth, and increase the rate of live birth. However, due to issues with the studies the authors were hesitant to give progestin their full support. Find out more.
Two percent of women will develop a Bartholin duct cyst or gland abscess in their lifetime, and physicians should be familiar with the range of treatment options. Find out which procedures are most effective, how to make a ring catheter in the office, and when to refer patients to a gynecologist for lesion excision.