Early Abortion Options

Two Early Abortion methods are available:
(a) the medication abortion from 5 - 7 wks LMP using RU-486 (Mifeprex) and misoprostol (Cytotec)
(b) the Early Vacuum Aspiration ( "E-V-A" ) from 3 - 7 wks LMP. This early mini-suction curettage is used in conjunction with three methods of assuring complete termination of the pregnancy and proactively searching for early ectopic pregnancy. Immediate pre and post suction vaginal ultrasound, stereo microscopy of the aspirate, and in a few selected cases, days 1 and 2 quantitative hCG (blood pregnancy test).

EVA is preferred by most women seeking an early abortion because:
a) EVA will efficiently complete the abortion in a matter of minutes - in a single office visit - and entail less time lost from work and other activities than the medical abortion, which takes several days or even weeks.
b) the rate of failed abortion is zero when a gestational sac is visible on the ultrasound. An ultrasound is performed before and after the suction - while the patient is still on the operating table - to instantly verify the success of the procedure and prevent abortion failures. Most (95%) patients will be reasured prior to leaving the clinic that they are no longer pregnant and did not have an ectopic pregnancy. In comparison, medical abortion has a 5-8% failure rate which are usually discovered late by repeat ultrasound, in 7 - 14 days.
c) EVA provides more certainty to the question of an undiagnosed, early ectopic pregnancy because there is tissue available for immediate gross and microscopic examination to identify the villi (pregnancy tissue) in the aspirate which is the gold standard. Villi are identified in 100% of cases that have a visible gestational sac on ultrasound; and in 95% of the cases that have no gestational sac on ultrasound. Finding villi identifies an intrauterine pregnancy, which practically excludes the diagnosis of an ectopic pregnancy because the coexistence of an intrauterine and extrauterine pregnancy is very rare, about1 in 30,000. Medical abortion carries a higher probability of missing an ectopic pregnancy because it relies only on the ultrasound, which in a very early pregnancy is not specific.
For example, ectopic pregnancy may be accompanied by an intrauterine decidual reaction that may mimic the appearance of an early gestational sac; and similar images may be present in the non pregnant patient in infections, myomas and bleeding disorders.
d) EVA can be performed a full two weeks earlier than a medical abortion even when a gestational sac is not found on ultrasound - as long as there is a positive pregnancy test. This allows to proactive search for a possible ectopic pregnancy; and may expedite diagnosing it at an early stage, when drug treatment is possible and emergency surgery and complications may be avoided. In comparison, the medical abortion must be cancelled if a visible gestational sac is not found on ultrasound.
e) Patients experience less bleeding, pain and anxiety; and recover faster after an EVA. EVA is performed under intravenous sedation to enhance the patient's comfort and decrease her recollection of the events surrounding the procedure. The actual operating time is less than two minutes, which should not be a surprise considering the small amount of tissue that needs to be removed. For example, the size of a 5 wks fetus is 1-2mm; at 6 wks, its size is 5 - 6 mm which is like a
grain of rice