Early Options: Continuing Medical Education Information

Early Options - A Provider's Guide to Medical Abortion

Statement of Need
Intended Audience
Sponsorship
Accreditation
Educational Method
System Requirements
CME Credit
Commercial Support
Unlabeled/Unapproved Use
Faculty
Faculty Disclosure
Acknowledgement
Original Release Date
Current Review Date/Expiration Date
Module Overviews

Statement of Need:
It is estimated that about one in three American women will have an abortion by the time they reach age 45.¹ With the advent of new technologies enabling earlier diagnosis of pregnancy, many women who choose abortion are seeking early abortion services.

Women in several European countries and in China have had access to early medical abortion with mifepristone regimens for well over a decade, and in September 2000, the U.S. Food and Drug Administration granted final approval for mifepristone, used in combination with misoprostol, in the United States. As of 2005, mifepristone is licensed in more than 30 counties and has been used by millions of women.

The published literature regarding the safety, efficacy, side effects, and acceptability of various medical abortion regimens is extensive. In order to safely and effectively provide medical abortion services, and educate women about this option, health care professionals need accurate information about various aspects of providing medical abortion care, including patient counseling, medical abortion regimens, the management of side effects and complications, the role of ultrasound, hCG assays, and clinical assessment in estimating gestational age and assessing medical abortion outcomes, and administrative and service-delivery issues.

¹ Guttmacher Institute. State Facts About Abortion. 2003. http://www.guttmacher.org/statecenter/sfaa.html

Intended Audience:
This activity is intended for a wide range of clinicians involved in providing medical abortion care, or referring women for that care, including obstetricians and gynecologists, family physicians, adolescent medicine specialists, internists, pediatricians, emergency physicians, nurse practitioners, nurse-midwives, and physician assistants. Nurses, counselors, clinic or office administrators, and other allied health professionals will also benefit from the program.

Sponsorship:
This CME activity is sponsored by the National Abortion Federation (NAF).

Accreditation:
NAF is accredited by the ACCME to provide continuing medical education for physicians.

Educational Method:
This activity consists of this website and a post-test. The reader's knowledge is tested by the CME post-test at the end of each computer module.

Educational objectives are listed at the beginning of each of the five modules of this program.

System Requirements:
This activity is designed to run on any PC with Internet Explorer or Netscape Navigator. Downloading and playing the video clips requires Windows Media Player or equivalent media player. Transcripts of the videos are also provided.

CME Credit:
NAF designates this educational activity for a maximum of 5 hours in Category 1 credit towards the AMA's Physician Recognition Award. Each user should claim only those hours of credit that he/she actually spent going through the modules and completing the post-test. Instructions for obtaining CME credit are included on the online post-test forms.

Commercial Support:
The development of this program was supported in part through a program grant from The David and Lucile Packard Foundation and an unrestricted educational grant from Danco Laboratories.

Unlabeled/Unapproved Use:
In accordance with ACCME Essential Areas and ancillary policies, the user is advised that this CME activity contains references to unapproved uses of drugs. Unapproved uses of drugs will be clearly identified in the text.

Faculty:
Contributing Editors-in-Chief:
Maureen Paul, MD, MPH

• Chief Medical Officer, Planned Parenthood of New York City

Mitchell D. Creinin, MD

• Associate Professor, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine

• Director of Family Planning, University of Pittsburgh School of Medicine

• Director of Gynecologic Specialties, University of Pittsburgh School of Medicine

• Professor, Department of Epidemiology, University of Pittsburgh Graduate School of Public Health

Advisory Committee:
Vicki Breitbart, MSW, PhD

• Associate Vice President, Executive Office, Planned Parenthood of New York City

• Board Chair, National Abortion Federation

Suzanne T. Poppema, MD

• Associate Clinical Professor, University of Washington Family Medicine Department

• Director, International Medical Consulting

Eric Schaff, MD

• Clinical Assistant Professor, Department of Family Medicine, University of Buffalo

Coordinating Editors:
Laureen Tews, MPH (original version)

• National Abortion Federation

Laureen Tews, MPH, and Melissa Werner, MPH, MAT (2005 update)

• National Abortion Federation

Faculty Disclosure:
Drs. Creinin and Schaff serve as consultants for Danco Laboratories, LLC, for practitioners with emergency questions.

Acknowledgement:
The modules in this Web-based CME activity were adapted in whole or in part from several articles published in Am J Obstet Gynecol 2000;183:S1-S98, a NAF-sponsored journal supplement on medical abortion, with permission from Mosby, Inc.

Original Release Date
August 19, 2002

Current Review Date/Expiration Date:
Current Review Date: December 19, 2005
Expiration Date: December 19, 2008

Module Overviews:
Click on one of the links below to enter that CME module. We suggest that you proceed through the modules in order. However, you may select any of the following links:

Module 1 - Pharmacological Approaches to Early Abortion
This module covers safety and efficacy data for the FDA-approved mifepristone/misoprostol regimen, for evidence-based alternative, or off-label, mifepristone/misoprostol regimens, and for the methotrexate/misoprostol regimen. It also includes eligibility requirements for and contraindications to medical abortion with mifepristone/misoprostol, protocols for medical abortion with mifepristone/misoprostol, and expected side effects and possible complications.

Module 2 - Expected Side Effects and Management of Complications in Medical Abortion
This module discusses the expected side effects and management of complications of medical abortion.

Module 3 - Counseling for Medical Abortion
This module covers important counseling points for discussing differences between medical abortion and vacuum aspiration, components of telephone and office-based counseling for medical abortion, and the essential aspects of counseling throughout the abortion process.

Module 4 - The Role of Ultrasound, hCG Assays, and Clinical Assessment in Medical Abortion
This module deals with the sonographic signs of early intrauterine pregnancy, clinical, sonographic, and laboratory methods to estimate gestational age and assess medical abortion outcomes, sonographic findings pre- and post-medical abortion, and the use of ultrasonography in the diagnosis of abnormalities during early pregnancy.

Module 5 - Medical Abortion Service Delivery
This module covers the physical facility and clinic flow issues related to the provision of medical abortion services, staffing models for providing medical abortion, and administrative and regulatory issues to address when initiating and implementing medical abortion services.