Wikipedia

Zubar da ciki na likita

Zubar da ciki na likita, Ya kasance shi ne wanda aka sani da zubar da ciki na magani ko zubar da ciki ba na tiyata, yana faruwa ne lokacin da ake amfani da kwayoyi ( magani ) don kawo zubar da ciki . Zubar da ciki na likitanci madadin tiyata ne kamar zubar da ciki kamar vacuum aspiration ko dilation da curettage . [1] Zubar da ciki na likitanci ya zama ruwan dare fiye da zubar da ciki na tiyata a mafi yawan wurare a fadin duniya.[2] [3].

An fi yin zubar da ciki na likitanci ta hanyar gudanar da haɗin magunguna guda biyu: mifepristone wanda ke biye da misoprostol . Wannan haɗin magunguna biyu ya fi tasiri fiye da sauran haɗin magunguna.[1] Lokacin da babu mifepristone, ana iya amfani da misoprostol kadai a wasu yanayi. [4]

Zubar da ciki na likita yana da lafiya kuma yana da tasiri a duk tsawon shekarun haihuwa, gami da na biyu da na uku na uku. [5] [6] [7] A Amurka, yawan mace-macen zubar da ciki na likitanci ya ragu da sau 14 idan aka kwatanta da yawan mace-macen haihuwa a lokacin haihuwa, kuma adadin manyan matsalolin da ke bukatar asibiti ko karin jini bai kai kashi 0.4 cikin dari ba. [8][9][10][11] Za a iya gudanar da zubar da ciki na likitanci lafiya a gida, ba tare da taimako ba, a cikin uku na farko. [12] A cikin uku na biyu da bayan haka, ana ba da shawarar shan magani na biyu a asibiti, ofishin mai bada sabis, ko wani wurin kula da lafiya. [12]

Tsarin magunguna

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200 MG na mifepristone da 800 μg misoprostol, tsarin da aka saba don zubar da ciki na farko na likita

Kasa da mako 12 ciki

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Don zubar da ciki na likitanci har zuwa ciki na tsawon makonni 12, adadin magungunan da aka ba da shawarar shine 200 milligrams na mifepristone ta baki, bayan kwana ɗaya zuwa biyu ta hanyar 800 micrograms na misoprostol a cikin kunci, a cikin farji, ko ƙarƙashin harshe. [13] Nasarar wannan haɗin maganin shine 96.6% ta hanyar ciki na makonni 10. [14]

Ya kamata a gudanar da Misoprostol 24 zuwa 48 hours bayan mifepristone; shan misoprostol kafin awanni 24 su wuce yana rage yuwuwar samun nasara. [10] Koyaya, wani bincike ya nuna cewa ana iya ɗaukar magungunan biyu lokaci guda tare da kusan inganci iri ɗaya. [15]

Don masu juna biyu bayan 9 makonni, allurai biyu na misoprostol (magani na biyu) yana sa maganin ya fi tasiri. [16] Daga makonni 10 zuwa 11 na ciki, Ƙungiyar Zubar da ciki ta Ƙasa ta ba da shawarar kashi na biyu na misoprostol (800 micrograms) sa'o'i hudu bayan kashi na farko. [17]

Bayan mai haƙuri ya ɗauki mifepristone, dole ne su kuma ba da misoprostol. Rashin shan misoprostol na iya haifar da ɗayan waɗannan sakamakon: za a iya ƙare tayin, amma ba a fitar da shi gaba ɗaya daga cikin mahaifa (wataƙila tare da zubar jini) kuma yana iya buƙatar aikin tiyata don cire tayin; ko kuma ana iya samun nasarar zubar da ciki da fitar da ciki; ko ciki na iya ci gaba da samun lafiyayyan tayin. Don waɗannan dalilai, yakamata a ɗauki misoprostol koyaushe bayan mifepristone. [18]

Idan ciki ya ƙunshi tagwaye, ana iya ba da shawarar mafi girman adadin mifepristone. [19]

Zubar da ciki na likitanci da kai

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A cikin uku na farko, zubar da ciki na likita da kansa yana samuwa ga marasa lafiya waɗanda suka fi son shan magungunan zubar da ciki a gida ba tare da kulawar likita kai tsaye ba (sabanin zubar da ciki na likita wanda mai badawa ke gudanarwa inda majiyyaci ke shan maganin zubar da ciki na biyu a gaban wanda ya horar da shi. ma'aikacin lafiya). [20] Shaidu daga gwaje-gwajen asibiti sun nuna zubar da ciki na likita da kai yana da tasiri kamar zubar da ciki da aka gudanar; duk da haka ana buƙatar ƙarin bincike don tabbatar da cewa aminci daidai yake. [21] [22]

Hanyar da ake amfani da ita don gudanar da magungunan biyu ya dogara da takamaiman magungunan da aka rubuta. Hanyar al'ada, don 200 MG mifepristone allunan, shine:[22] [23] [24] [25]

  1. Ɗauki kwamfutar hannu na mifepristone da baki
  2. Ɗaukar misoprostol tsakanin sa'o'i 24 zuwa 48 bayan mifepristone (umarnin da aka kawo tare da misoprostol za su ƙayyade yadda ake shan shi, kamar: tsakanin gumi da murfin ciki na kuncin baki, ko a ƙarƙashin harshe, ko a cikin farji ta hanyar yin amfani da shi. suppository na farji)
  3. Za a fitar da ciki ( embryo da placenta ) ta cikin farji a cikin sa'o'i 2 zuwa 24 bayan shan misoprostol, don haka majiyyaci ya kasance kusa da wuraren bayan gida a lokacin. Za a iya samun maƙarƙashiya, tashin zuciya da zubar jini yayin da ake fitar da ciki, da kuma bayan haka
  4. Don guje wa kamuwa da cuta, majiyyaci bai kamata ya yi amfani da tampons ko yin jima'i ba har tsawon makonni 2 zuwa 3
  5. Ya kamata majiyyaci ya tuntuɓi mai ba da su kwanaki 7 zuwa 14 bayan gudanarwar mifepristone don tabbatar da cewa ƙarshen ciki ya faru kuma don kimanta matakin jini.

Bayan sati 12 ciki

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Zubar da ciki na likita yana da lafiya kuma yana da tasiri a cikin na biyu da na uku.[5] [26] [27] [28] Hukumar Lafiya ta Duniya (WHO) ta ba da shawarar cewa zubar da ciki na likitanci da aka yi bayan makonni 12 na ciki, likita na gaba daya ko kwararren likita ne ya kula da shi (sabanin farkon watanni uku, inda majiyyaci zai iya shan magungunan a gida lafiya ba tare da kulawa ba). [12][13]

Don zubar da ciki na likita bayan makonni 12 na ciki, WHO ta ba da shawarar 200 MG na mifepristone ta baki ya biyo bayan kwana ɗaya zuwa biyu ta maimaita allurai na 400 μg misoprostol a ƙarƙashin harshe, a cikin kunci, ko a cikin farji. [29] Ya kamata a sha Misoprostol kowane sau 3 Sa'o'i har sai an sami nasarar zubar da ciki, ma'anar lokacin zubar da ciki bayan fara misoprostol shine sa'o'i 6-8, kuma kusan 94% zai zubar da ciki cikin sa'o'i 24 bayan fara misoprostol. [30] Lokacin da ba a samu mifepristone ba, ana iya amfani da misoprostol duk da cewa za a tsawaita lokacin zubar da ciki bayan fara misoprostol idan aka kwatanta da tsarin yin amfani da mifepristone da misoprostol. [31]

Madadin haɗin magunguna

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Haɗin mifepristone-misoprostol shine, ta zuwa yanzu, tsarin da aka fi ba da shawarar miyagun ƙwayoyi don zubar da ciki na likita, amma akwai sauran haɗin magunguna.

Misoprostol kadai, ba tare da mifepristone ba, ana iya amfani da shi a wasu yanayi don zubar da ciki na likita, har ma an nuna cewa ya yi nasara a cikin uku na biyu. [32] Misoprostol ya fi samuwa fiye da mifepristone, kuma ya fi sauƙi don adanawa da gudanarwa, don haka misoprostol ba tare da mifepristone na iya ba da shawara daga mai bada idan mifepristone ba ya samuwa.[4] Idan ana amfani da misoprostol ba tare da mifepristone ba, WHO ta ba da shawarar 800 μg na misoprostol a cikin kunci, ƙarƙashin harshe, ko a cikin farji.[13] Nasarar misoprostol kadai don kawo karshen ciki (93%) kusan iri daya ne da hadewar mifepristone-misoprostol (96%). Duk da haka, 15% na matan da ke amfani da misoprostol kadai suna buƙatar hanyar bin tsarin tiyata, wanda ya fi mahimmanci fiye da haɗin mifepristone-misoprostol. [33]

Gwaje-gwaje sun nuna cewa ana iya haɗawa da letrozole ko methotrexate a cikin tsarin mifepristone-misoprostol don inganta sakamako a cikin farkon watanni uku.[1] [34] [35]

Haɗin magungunan da ba kasafai ake amfani da shi ba don masu ciki na mahaifa shine methotrexate -misoprostol, wanda galibi ana keɓance shi don ciki na ectopic . [36] Ana ba da Methotrexate ko dai ta baki ko a cikin tsoka, sannan a biyo bayan misoprostol na farji bayan kwanaki 3-5.[17] Haɗin methotrexate yana samuwa ta cikin kwanaki 63. WHO ta ba da izinin haɗin methotrexate-misoprostol [37] amma yana bada shawarar haɗin mifepristone saboda methotrexate na iya zama teratogenic ga amfrayo a lokuta na zubar da ciki. Ana ɗaukar haɗin methotrexate-misoprostol mafi inganci fiye da misoprostol kadai.[37]

Contraindications

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Contraindications zuwa mifepristone an gaji porphyria, na kullum adrenal gazawar, da ectopic ciki. [38] [39] Wasu suna la'akari da na'urar intrauterine a wurin don zama mai hanawa kuma. [39] Wani rashin lafiyar da ya gabata ga mifepristone ko misoprostol shima sabani ne.[38]

Yawancin karatu sun cire matan da ke da matsanancin matsalolin likita kamar cututtukan zuciya da hanta ko kuma anemia mai tsanani.[39] Ana buƙatar taka tsantsan a cikin yanayi da yawa da suka haɗa da:[38]

  • amfani da corticosteroid na dogon lokaci;
  • rashin zubar jini;
  • anemia mai tsanani

A wasu lokuta, yana iya dacewa a tura mutanen da suka rigaya sun kamu da rashin lafiya zuwa ga mai ba da zubar da ciki na tushen asibiti. [40]

A madadin, wasu yanayi na likita na iya sa zubar da ciki na magani ya fi dacewa da zubar da ciki na tiyata kamar manyan fibroids na mahaifa, cututtukan mahaifa, ko tabo mai alaƙa da infibulation . [41] [42] [43]

Tasiri mara kyau

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Yawancin mata za su sami ciwon ciki da zubar jini fiye da lokacin haila.[39] Sauran illolin na iya haɗawa da tashin zuciya, amai, zazzabi, sanyi, zawo, ciwon kai, juwa, zafi ko walƙiya mai zafi. [44][45][15] Lokacin da aka yi amfani da shi a cikin farji, misoprostol yana ƙoƙarin samun ƙarancin sakamako masu illa.[1] Magungunan anti-inflammatory marasa steroidal irin su ibuprofen suna rage zafi tare da zubar da ciki na magani.

Alamomin da ke buƙatar kulawar gaggawa

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  • Zubar da jini mai nauyi (isasshen jini da za a jiƙa ta pads guda huɗu a cikin awanni 2) [46]
  • Ciwon ciki, tashin zuciya, amai, zawo, zazzabi fiye da awanni 24 bayan shan mifepristone [46]
  • Zazzabi na 38 °C (100.4 °F) ko sama sama da awanni 4 [46]

Matsalolin da ke ƙarƙashin ciki na makonni 10 ba kasafai ba ne; bisa ga manyan bita guda biyu, zubar da jini da ake buƙatar ƙarin jini ya faru a cikin 0.03-0.6% na mata da kuma kamuwa da cuta mai tsanani a cikin 0.01-0.5%.[10][15] Saboda cuta ba ta da wuya bayan magani zubar da ciki, Kwalejin Ba'amurke na Amurka da 'yan wasan' ', al'arin iyali, da kuma Naf ba su bayar da shawarar amfani da maganin rigakafin yau da kullun ba. [47][17] Wasu lokuta da ba kasafai ake samun mace-mace daga cutar sankarau mai guba ta clostridial sun faru bayan zubar da ciki na likita. [48]

Bita na tsari na 2013 wanda ya haɗa da mata 45,000 waɗanda suka yi amfani da 200 mg mifepristone tare da haɗin misoprostol ya gano cewa ƙasa da 0.4% yana da matsala mai tsanani da ke buƙatar asibiti (0.3%) da/ko ƙarin jini (0.1%).[10][49]

Gudanar da zubar jini

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Zubar da jinin al'ada gabaɗaya yana raguwa a hankali sama da makonni biyu bayan zubar da ciki na likitanci, amma a lokuta daban-daban hange na iya ɗaukar kwanaki 45. [50] Ana iya yin la'akari da aikin tiyata na gaggawa ko na likita don tsawaita zubar jini dangane da yadda majiyyaci ke ji da kuma idan jinin yana da alama yana samun sauki. Gabaɗaya, ƙasa da 1% na mutanen da suka zubar da ciki dole ne su sami sabis na gaggawa don zubar da jini mai yawa, kuma kusan 0.1% na buƙatar ƙarin jini . [51] [52] [53] Za a fitar da ragowar samfuran cikin ciki yayin zubar jini na farji na gaba. Duk da haka, ana iya yin aikin tiyata a kan buƙatar mace, idan zubar da jini ya yi nauyi ko tsawo, ko kuma ya haifar da anemia, ko kuma idan akwai shaidar endometritis . [51]

Tsaro

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A duniya, mutanen da za su iya yin ciki suna fuskantar haɗari ga lafiyarsu saboda manyan ƙalubalen samun amintaccen sabis na zubar da ciki. [54] [55] [56] [57] Waɗannan munanan sakamako sun taso ne daga ƙaƙƙarfan ƙa'idodin zubar da ciki, tsarin kiwon lafiya marasa inganci, ƙarancin ƙwararrun ƙwararrun ƙwararrun kiwon lafiya, ƙaƙƙarfar ƙaƙƙarfan ƙaƙƙarfan ƙaƙƙarfan ayyuka a yankuna masu nisa. [58][37] Bugu da kari, a cikin kasashe masu karamin karfi da matsakaitan kudin shiga inda aka ba da izinin zubar da ciki bisa ka'ida, ana samun adadi mai yawa na zubar da ciki mara inganci. Kimanin mata miliyan 7 ne ke kwance a asibitoci a duk shekara a wadannan wuraren sakamakon matsalolin da ke tasowa daga zubar da ciki mara kyau. Zubar da ciki mara lafiya ana danganta shi da kashi 4.7% zuwa 13.2% na mace-macen mata masu juna biyu a kowace shekara, tare da kiyasin kudaden da ake kashewa don magance matsalolinsa ya kai dala miliyan 553.[37][59] Abubuwa da yawa suna ba da gudummawa ga waɗannan haɗarin kiwon lafiya da suka haɗa da rashin ilimi game da zaɓin da ake da su, mabanbantan ra'ayoyin masu ba da lafiya game da zubar da ciki, ƙarancin ƙwararrun ma'aikata don amintaccen sabis na zubar da ciki, ƙarancin sirri da sirri, da ayyukan da suka gaza biyan buƙatu.[60]

A Amurka, wani rahoton FDA ya bayyana cewa daga cikin mata miliyan 3.7 da suka zubar da cikin da magani tsakanin shekarar 2000 zuwa 2018, 24 sun mutu bayan haka, 11 daga cikin wadanda suka mutu ba su da alaka da zubar da ciki, ciki har da shan kwayoyi, kisa, da kuma kashe kansa.[15][16] Lokacin da ba a la'akari da mutuwar mutane 11 da ba su da alaƙa, adadin mace-mace na zubar da ciki shine rabin adadin mace-macen zubar da ciki gaba ɗaya.[1][15] Ciki har da duk mace-mace a cikin binciken, bayanan sun nuna cewa yawan mace-mace na zubar da ciki na magani ya kusan daidai da zubar da ciki gaba daya, wanda ya kai sau 14 kasa da adadin mace-macen haihuwa na haihuwa, sannan kuma kasa da adadin mace-macen Penicillin da Viagra . [8] [9] Ƙungiyoyin kiwon lafiya na duniya kamar WHO sun nuna cewa zubar da ciki na likita yana da aminci har ma a cikin na biyu da na uku na uku,[5][26][27][28] amma damar yin amfani da waɗannan ayyuka na shari'a yana canzawa akai-akai a Amurka da kuma a duniya.

Teratogenicity da ci gaba da ciki

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Kafin shan magani don zubar da ciki, ya kamata a shawarci mutane game da yiwuwar illar misoprostol idan zubar da ciki bai yi nasara ba. Idan ciki ya ci gaba bayan yin amfani da mifepristone da misoprostol, an ba da shawarar a nemi kulawar likita don tattauna zaɓuɓɓukan ciki, tare da cikakken tattaunawa game da haɗari da fa'idodi ga kowane. Babu wata shaida na mifepristone da ke haifar da lahani na haihuwa, [61] amma misoprostol, lokacin da aka yi amfani da shi a cikin farkon watanni na farko, zai iya zama teratogenic kuma ya haifar da cututtuka na haihuwa kamar lahani na hannu, tare da ko ba tare da ciwo na Möbius ba (shanyewar fuska). [62]

Ilimin harhada magunguna

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Mifepristone yana toshe hormone progesterone, [63] [64] yana haifar da rufin mahaifa zuwa bakin ciki, yana hana amfrayo daga liƙawa zuwa bangon mahaifa don girma. Methotrexate, wanda ake amfani da shi a wasu lokuta maimakon mifepristone, yana dakatar da nama na cytotrophoblastic daga girma da zama mahaifa mai aiki, sashin da ke ba da abinci mai gina jiki ga tayin mai tasowa. [65] Misoprostol, prostaglandin na roba, yana sa mahaifa ya yi karo da kuma fitar da tayin ta cikin farji. [66] Letrozole shine mai hana aromatase wanda ke hana haɓakar estrogen kuma yana ƙarfafa kwai. Binciken da aka yi kwanan nan ya ba da shawarar yin amfani da letrozole kafin misoprostol ko mifepristone don fara zubar da ciki na likita zai iya inganta ingantaccen magani kuma ya rage buƙatar ayyukan tiyata. [67]

Yaduwa

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Country Percentage
Spain 25% in 2021[68]
Netherlands 34% in 2021[69]
Italy 35% in 2020[70]
Canada 37% in 2021[71]
Belgium 38% in 2021[72]
Germany 39% in 2022[73]
New Zealand 46% in 2021[74]
United States 63% in 2023[75]
Portugal 68% in 2021[76]
Slovenia 72% in 2019[77]
France 76% in 2021[78]
Switzerland 80% in 2021[79]
Denmark 83% in 2021[80]
England and Wales 87% in 2021[81]
Iceland 87% in 2021[82]
Estonia 91% in 2021[83]
Norway 95% in 2022[84]
Sweden 96% in 2021[85]
Finland 98% in 2021[86]
Scotland 99% in 2021[87]

Wani binciken Cibiyar Guttmacher na duk sanannun masu ba da zubar da ciki a Amurka ya gano cewa zubar da ciki na likita ya kai kashi 53% na duk zubar da ciki a cikin 2020. [88] Wannan ƙidayar ba ta haɗa da zubar da ciki da kai ba . [88]

A asibitocin Planned Parenthood a Amurka, zubar da ciki na likita ya kai 32% na zubar da ciki na farko a cikin 2008, [89] 35% na duk zubar da ciki a 2010 da 43% na duk zubar da ciki a 2014.[90]

A cikin 2009, tsarin zubar da ciki na likita ta amfani da mifepristone a hade tare da analog na prostaglandin sune mafi yawan hanyoyin da ake amfani da su don haifar da zubar da ciki na biyu a Kanada, yawancin Turai, China da Indiya;[2] ya bambanta da Amurka, inda 96% na zubar da ciki na biyu-trimester an yi ta tiyata ta hanyar dilation da fitarwa.[91]

Tarihi

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Masu binciken Sweden sun fara gwada yiwuwar zubar da ciki a cikin 1965. A cikin 1968, likitan Sweden Lars Engström ya buga takarda kan gwaji na asibiti, wanda aka gudanar a asibitin mata na Asibitin Karolinska a Stockholm, na fili na F6103 akan matan Sweden masu ciki da nufin haifar da zubar da ciki. Ita ce gwajin asibiti na farko na kwayar zubar da ciki da za a gudanar a Sweden.[92] Takardar, wanda aka fara mai suna The Swedish zubar da ciki Pill, an sake masa suna zuwa The Swedish Postconception Pill, saboda ƙananan adadin zubar da ciki da aka haifar da ya faru a cikin yawan mutanen da aka gwada. Bayan waɗannan yunƙurin ba su yi nasara ba tare da F6103, masu bincike guda ɗaya sun yi ƙoƙari su nemo kwayar zubar da ciki tare da prostaglandins, suna yin amfani da yawan masana kimiyya na prostaglandin da ke aiki a Sweden a lokacin; Daga karshe an ba su lambar yabo ta Nobel a fannin Physiology a shekarar 1982 saboda aikinsu. [93]

Zubar da ciki na likita ya zama hanyar samun nasarar zubar da ciki tare da samun prostaglandin analogs a cikin 1970s da antiprogestogen mifepristone (wanda aka fi sani da RU-486) [94] a cikin 1980s.[2][95] [96] An fara amincewa da Mifepristone don amfani a China da Faransa a 1988, a Burtaniya a 1991, a Sweden a 1992, a Austria, Belgium, Denmark, Finland, Georgia, Jamus, Girka, Iceland, Isra'ila, Lichtenstein, Luxembourg, Netherlands, Rasha, Spain, da Switzerland a 1999, a Norway, Taiwan, Tunisia, da Amurka a 2000, da kuma a cikin ƙarin ƙasashe 70 daga 2001 zuwa 2023. [97]

A shekara ta 2000, FDA ta Amurka ta amince da mifepristone don zubar da ciki ta hanyar kwanakin 49 na ciki. [98] A cikin 2016, FDA ta Amurka ta sabunta alamar mifepristone don tallafawa amfani ta cikin kwanaki 70 na ciki.[46]

Samun damar zubar da ciki na likita

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Duka kwayoyi – Mifepristone da misoprostol – Ba a rufe ta da haƙƙin mallaka na miyagun ƙwayoyi, don haka ana samun su azaman magungunan gama-gari .

Samuwar ma'auni

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Abubuwan da ake buƙata don takardar sayan magani sun bambanta tsakanin ƙasashe. Kasashe da yawa suna samar da magungunan zubar da ciki na likita akan kantuna, ba tare da takardar sayan magani ba, kamar China, Indiya, da sauransu. [99] Wasu ƙasashe suna buƙatar takardar magani (Kanada, yawancin Yammacin Turai, Amurka, da sauransu). [99] Wasu ƙasashe suna buƙatar takardar sayan magani amma basu da hankali game da aiwatar da wannan buƙatun (Rasha, Brazil, da sauransu). [99]

Samun damar wayar tarho

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Telehealth ya haɗa da samun damar yin amfani da sabis na likita wanda mutum zai iya yi a gida, ba tare da kai-tsaye zuwa asibiti ko ofisoshin samarwa ba. Mutanen da suka yi amfani da rahoton kiwon lafiya na wayar tarho sun gamsu da damar da yake bayarwa ga ayyukan zubar da ciki. [100] [101] Koyaya, waɗanda zasu iya buƙatar sabis ɗin (waɗanda ke kurkuku, ba a gida, ko kuma masu ƙarancin kuɗi) galibi ana hana su shiga. [102]

Clinic-zuwa asibiti

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A cikin wannan ƙirar, mai bada sabis yana tattaunawa da majiyyaci da ke wani rukunin yanar gizo ta amfani da taron bidiyo na asibiti-zuwa asibiti don ba da zubar da ciki na magani. An gabatar da wannan ta Planned Parenthood na Heartland a Iowa don ba da damar majiyyaci a wata cibiyar kiwon lafiya don sadarwa ta ingantaccen bidiyo tare da mai ba da lafiya a wani wurin. [103] Wannan samfurin ya faɗaɗa zuwa wasu Shirye-shiryen Iyaye a cikin jihohi da yawa da sauran asibitocin da ke ba da kulawar zubar da ciki. [103]

Samun kai tsaye zuwa ga marasa lafiya

gyara sashe

Tsarin kai tsaye-zuwa-haƙuri yana ba da damar zubar da ciki na magani ba tare da ziyarar asibiti ta cikin mutum ba. Maimakon ziyarar asibiti a cikin mutum, majiyyaci yana karɓar shawarwari da umarni daga mai ba da zubar da ciki ta hanyar taron bidiyo. Mara lafiya na iya kasancewa a kowane wuri, gami da gidansu. Ana aika magungunan da ake buƙata don zubar da ciki kai tsaye zuwa ga majiyyaci. Wannan samfuri ne, da ake kira TelAbortion ko rashin gwajin magani zubar da ciki (tsohon zubar da ciki na magani ba tare da taɓawa ba), wanda Ayyukan Lafiya na Gynuity ke gwadawa da yin nazari, tare da izini na musamman daga Hukumar Abinci da Magunguna ta Amurka (FDA). [104] An nuna wannan samfurin yana da aminci, inganci, inganci, kuma mai gamsarwa.[104] [105] [106] Ana iya tabbatar da cikakkiyar zubar da ciki ta hanyar tantancewa ta wayar tarho. [107]

Tasirin COVID-19

gyara sashe

Cutar ta COVID-19 ta kalubalanci masu tsara manufofin kiwon lafiya a duk duniya wanda ya haifar da tasirin kai tsaye da kai tsaye kan samun lafiyar haihuwa. [108] [109] Babban raguwar samuwa da isar da mahimmancin kula da lafiyar jima'i, gami da zubar da ciki mai aminci, a tsakanin cutar ta COVID-19 ta haifar da karuwar rikice-rikice da asarar rayuka yayin daukar ciki. [110] [111]

Masu ciki sun nemi samun zubar da ciki na likita fiye da zubar da ciki na tiyata a lokacin bala'in, kuma sun gwammace ikon yin zubar da ciki na likita a gida ta hanyar sabis na kiwon lafiya. [112] [113] [114] [115] [116] [117] Bayanai sun nuna cewa karuwar amfani da telemedicine don ayyukan zubar da ciki a wannan lokacin ya kasance sakamakon tsoron COVID-19, rage ikon tafiya, umarnin zama a gida, babban ɓoyewa, da kwanciyar hankali na kulawar gida. [118] [119] Wannan bayanan sun goyi bayan aminci da inganci na sabis na zubar da ciki na telehealth, kuma sun nuna karuwar bukatar sa. Tsanani da adadin rikice-rikice bayan sabis na zubar da ciki na telehealth ya yi ƙasa, yana kwatanta ƙimar rikicewar zubar da ciki na gabaɗaya, gami da waɗanda aka yi a cikin asibitoci ko wasu wuraren kiwon lafiya.[106]

Amurka

gyara sashe

A cikin Amurka, kowane kantin magani na iya cika takardun magani na mifepristone - kan layi ko bulo-da-turmi - wanda ya sami takaddun shaida na musamman. [120] An aiwatar da wannan tsarin na ɗan lokaci a cikin Dec 2021, kuma Hukumar Abinci da Magunguna ta Amurka (FDA) ta kammala shi a cikin Janairu 2023. [121] [122]

Daga 2011 har zuwa 2021, ana buƙatar mace ta ziyarci mai ba da lafiya a cikin mutum (a asibiti ko ofis) kuma ta karɓi mifepristone kai tsaye daga mai badawa. [123] FDA ta cire buƙatun ziyartar asibiti don karɓar maganin a cikin Disamba 2021, yayin bala'in COVID-19 . A karkashin sabbin dokokin, ana iya samun takardar sayan magani ta hanyar wayar tarho (kiran waya ko taron bidiyo tare da mai ba da lafiya), sannan a cika shi a kowane kantin magani da aka tabbatar. [124] [125] [126] A lokaci guda FDA ta cire abin da ake buƙata don ziyarar cikin mutum, sun ƙara da buƙatu cewa rarraba magunguna su kasance "sharaɗi", wanda ke buƙatar kantin magani ya sami izini na musamman don ba da magungunan. – bukatu da FDA ta gindaya akan magunguna 40 kawai daga cikin fiye da 19,000 da take gudanarwa. [127]

Magani na biyu da ake amfani da shi wajen zubar da ciki na likita, misoprostol, an fi amfani da shi don magance ciwon ciki, kuma ba a taɓa fuskantar ƙayyadaddun ƙayyadaddun mifepristone ba, kuma koyaushe ana samun su daga kantin magani tare da takardar sayan magani.[ana buƙatar hujja]

FDA ba ta ba da izinin yin amfani da mifepristone don zubar da ciki na likita ba bayan kwanaki 70, ba kamar sauran ƙasashe ba, waɗanda ke ba da izinin zubar da ciki na likita a cikin na biyu trimester har ma da na uku trimester.[124] [128]

Wasu jihohi sun zartar da dokokin da suka hana masu samar da bincike bincikar mace ta hanyar wayar tarho ko taron bidiyo, maimakon haka suna buƙatar matar ta kai ziyarar kai tsaye ga mai ba da magani don samun takardar sayan magani. [129][130]

A yawancin jihohi, ana iya aikawa da magungunan zubar da ciki daga kantin magani ga majiyyaci ta hanyar wasiku, amma wasu jihohi sun zartar da dokar da ta haramta hakan, kuma suna buƙatar samun magungunan daga kantin magani ko mai badawa a cikin mutum.[131][132]

 
Amincewa da Hoto: Ted Eytan - 2022.06.24 Roe v Wade Ya Juye - SCOTUS, Washington, DC Amurka 175 143208.

Sha'awar magungunan zubar da ciki a Amurka ta kai matsayi mafi girma a cikin 2022, bayan da Kotun Koli ta Amurka ta yi watsi da daftarin Dobbs v. Jackson Women's Health Organisation wanda zai soke hukuncin Roe v. Wade na 1973 ta yanar gizo. [133] Sha'awa ta kasance mafi girma a jihohin da ke da ƙarin hani kan samun zubar da ciki. [133] Masu fafutukar zabar zabi a Amurka sun binciko hanyoyin da za a samar da zubar da ciki na likita, musamman a jihohin da ke da iyaka, tare da amfani da albarkatun kafofin watsa labarun don wannan dalili. [134] [135] [136] [137]

Dangane da takunkumin zubar da ciki da wasu jihohi suka sanya bayan hukuncin Dobbs na shari'a, kungiyoyi da yawa da ke ba da sabis na kiwon lafiya na sadarwa da suka shafi zubar da ciki na likita, irin su Plan C da Hey Jane, sun ga karuwar tambayoyi da amfani. [138] [139] [140] [141] [142]

A watan Maris na 2023, Gwamna Mark Gordon na Wyoming ya sanya hannu kan wata doka da ta haramta amfani da kwayoyin zubar da ciki a cikin jihar, wanda ya zama jihar Amurka ta farko da ta haramta zubar da ciki daban-daban daga hana duk ayyukan zubar da ciki. Sabuwar dokar, wacce ta fara aiki a watan Yuli 2023, ta haramta "rubutun magani, rarrabawa, rarrabawa, siyarwa, ko amfani da kowane magani" don samun ko zubar da ciki. [143] Wadanda suka karya doka, ban da mai juna biyu, ana iya tuhumar su da aikata wani laifi kuma za su iya fuskantar tarar dala 9,000 da kuma daurin watanni shida a gidan yari.[144] Wasu jihohi goma sha hudu sun kafa dokar hana zubar da ciki bargo da suka hada da zubar da ciki na likitanci, duk da haka, kuma jihohi goma sha biyar sun riga sun takaita amfani da wadannan magunguna. [145]

A cikin Maris 2024, wasu manyan sarƙoƙi na kantin magani, irin su CVS da Walgreens, sun karɓi takaddun shaida daga FDA don ba da mifepristone kuma suna shirin ba da shi don siyarwa a cikin jihohin da ke da doka. [146] A cikin waɗancan jihohin, matan da ke neman zubar da ciki za su ziyarci ma’aikatan kiwon lafiya don samun takardar magani, amma za su iya siyan maganin a wani kantin magani da aka ƙware, maimakon buƙatar jiki ta karɓi ta kai tsaye daga asibiti, asibiti, ko kiwon lafiya. mai bayarwa. [146]

Al'umma da al'adu

gyara sashe

Hukumar ta WHO ta tabbatar da cewa ya kamata dokoki da manufofi su goyi bayan samun damar mutane don samun kulawar da aka amince da su ta hanyar shaida, gami da zubar da ciki. [147] [148]

Rigimar "juyawa".

gyara sashe

Wasu kungiyoyin hana zubar da ciki suna da'awar cewa marasa lafiya da suka canza ra'ayinsu game da zubar da ciki bayan shan mifepristone na iya "juya" zubar da ciki ta hanyar gudanar da progesterone (kuma ba gudanar da misoprostol ba). [149][150] Tun daga shekarar 2022, babu wata kwakkwarar hujja ta kimiyya cewa za a iya juya tasirin mifepristone ta wannan hanyar. [151] [152] [153] Duk da haka, jihohi da yawa a Amurka suna buƙatar masu samar da zubar da ciki ba na tiyata ba waɗanda ke amfani da mifepristone don gaya wa marasa lafiya cewa juyawa zaɓi ne. [154] A cikin 2019, masu bincike sun ƙaddamar da ƙaramin gwaji na abin da ake kira tsarin "juyawa" ta amfani da mifepristone wanda ke biye da progesterone ko placebo. [155] [156] An dakatar da binciken ne bayan da mata 12 suka yi rajista sannan uku sun samu mummunan zubar jini a cikin farji. Sakamakon ya haifar da damuwa mai tsanani game da amfani da mifepristone ba tare da bin misoprostol ba. [157]

Ilimin tattalin arziki

gyara sashe

A cikin Amurka, a cikin 2009, farashin da aka caje don zubar da ciki na likita har zuwa makonni tara na ciki shine US$490, kashi huɗu sama da $470 na al'ada da ake cajin zubar da ciki a cikin makonni goma. [158] A Amurka, a cikin 2008, kashi 57% na matan da suka zubar da ciki sun biya su daga aljihu .[158]

A cikin Afrilu 2013, gwamnatin Ostiraliya ta fara aikin tantancewa don yanke shawarar ko za a lissafta mifepristone (RU486) da misoprostol akan Tsarin Amfanin Magunguna na ƙasar (PBS). [159] A cikin Yuni 2013, Ministan Lafiya na Ostiraliya ya sanar da cewa Gwamnatin Ostiraliya ta amince da jerin sunayen mifepristone da misoprostol akan PBS don ƙarewar likita a farkon ciki daidai da shawarar Kwamitin Shawarwari na Amfanin Magunguna . [160] Lissafi akan PBS sun fara a watan Agusta 2013. [161] [162]

Manazarta

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  1. ↑ 1.0 1.1 1.2 1.3 1.4 Zhang J, Zhou K, Shan D, Luo X (May 2022). "Medical methods for first trimester abortion". The Cochrane Database of Systematic Reviews. 2022 (5): CD002855. doi:10.1002/14651858.CD002855.pub5. PMC 9128719 Check |pmc= value (help). PMID 35608608 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 Kapp N, von Hertzen H (2009). "Medical methods to induce abortion in the second trimester". In Paul M, Lichtenberg ES, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD (eds.). Management of unintended and abnormal pregnancy : comprehensive abortion care. Oxford: Wiley-Blackwell. pp. 178–192. ISBN 978-1-4051-7696-5.
  3. ↑ "Medication Abortion Now Accounts for More Than Half of All US Abortions". Guttmacher Institute. December 1, 2022. Retrieved April 16, 2023.
  4. ↑ 4.0 4.1 Langer BR, Peter C, Firtion C, David E, Haberstich R (2004). "Second and third medical termination of pregnancy with misoprostol without mifepristone". Fetal Diagnosis and Therapy. 19 (3): 266–270. doi:10.1159/000076709. PMID 15067238. S2CID 25706987.
  5. ↑ 5.0 5.1 5.2 Vlad S, Boucoiran I, St-Pierre ÉR, Ferreira E (June 2022). "Mifepristone-Misoprostol Use for Second- and Third-Trimester Medical Termination of Pregnancy in a Canadian Tertiary Care Centre". Journal of Obstetrics and Gynaecology Canada. 44 (6): 683–689. doi:10.1016/j.jogc.2021.12.010. PMID 35114381 Check |pmid= value (help). S2CID 246505706 Check |s2cid= value (help).
  6. ↑ Whitehouse K, Brant A, Fonhus MS, Lavelanet A, Ganatra B (2020). "Medical regimens for abortion at 12 weeks and above: a systematic review and meta-analysis". Contraception. 2: 100037. doi:10.1016/j.conx.2020.100037. PMC 7484538. PMID 32954250.
  7. ↑ Cumpston M, Li T, Page MJ, Chandler J, Welch VA, Higgins JP, Thomas J (October 2019). "Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions". The Cochrane Database of Systematic Reviews. 10 (10): ED000142. doi:10.1002/14651858.ED000142. PMC 10284251 Check |pmc= value (help). PMID 31643080.
  8. ↑ 8.0 8.1 "Analysis of Medication Abortion Risk and the FDA report - "Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018"" (PDF). Bixby Center for Global Reproductive Health. April 1, 2019. The mortality rate for women known to have had a live-born infant is 8.8 per 100,000 live births, which is about 14 times higher than the mortality rate associated with medication abortion. Other medications that are commonly prescribed or administered in outpatient settings also have risks, including a small risk of death. Penicillin causes a fatal anaphylactic reaction at a rate of 2 deaths per 100,000 patients administered the drug. Phosphodiesterase type-5 inhibitors, which are used for erectile dysfunction and include Viagra, have a fatality rate of 4 deaths per 100,000 users. These risks are several times higher than the risk of death with medication abortion.
  9. ↑ 9.0 9.1 "Mifepristone U.S. Post-Marketing Adverse Events Summary through 12/31/2018". Food and Drug Administration. December 31, 2018.
  10. ↑ 10.0 10.1 10.2 10.3 Raymond EG, Shannon C, Weaver MA, Winikoff B (January 2013). "First-trimester medical abortion with mifepristone 200 mg and misoprostol: a systematic review". Contraception. 87 (1): 26–37. doi:10.1016/j.contraception.2012.06.011. PMID 22898359.
  11. ↑ Cite error: Invalid <ref> tag; no text was provided for refs named NYT_2022-08-07
  12. ↑ 12.0 12.1 12.2 "Self-management Recommendation 50: Self-management of medical abortion in whole or in part at gestational ages < 12 weeks (3.6.2) - Abortion care guideline". WHO Department of Sexual and Reproductive Health and Research. November 19, 2021. Retrieved June 30, 2022.
  13. ↑ 13.0 13.1 13.2 Abortion Care Guideline. Geneva: World Health Organization (WHO). 2022. ISBN 9789240039483.
  14. ↑ Chen MJ, Creinin MD (July 2015). "Mifepristone With Buccal Misoprostol for Medical Abortion: A Systematic Review". Obstetrics and Gynecology. 126 (1): 12–21. doi:10.1097/AOG.0000000000000897. PMID 26241251. S2CID 20800109.
  15. ↑ 15.0 15.1 15.2 15.3 15.4 Creinin MD, Schreiber CA, Bednarek P, Lintu H, Wagner MS, Meyn LA (April 2007). "Mifepristone and misoprostol administered simultaneously versus 24 hours apart for abortion: a randomized controlled trial". Obstetrics and Gynecology. 109 (4): 885–894. doi:10.1097/01.AOG.0000258298.35143.d2. PMID 17400850. S2CID 43298827.
  16. ↑ 16.0 16.1 Kapp N, Eckersberger E, Lavelanet A, Rodriguez MI (February 2019). "Medical abortion in the late first trimester: a systematic review". Contraception. 99 (2): 77–86. doi:10.1016/j.contraception.2018.11.002. PMC 6367561. PMID 30444970.
  17. ↑ 17.0 17.1 17.2 "NAF Clinical Policy Guidelines". National Abortion Federation. Retrieved April 10, 2020.
  18. ↑ Creinin MD, Hou MY, Dalton L, Steward R, Chen MJ (January 2020). "Mifepristone Antagonization With Progesterone to Prevent Medical Abortion: A Randomized Controlled Trial". Obstetrics and Gynecology. 135 (1): 158–165. doi:10.1097/AOG.0000000000003620. PMID 31809439. S2CID 208813409. Patients in early pregnancy who use only mifepristone may be at high risk of significant hemorrhage.
  19. ↑ Sørensen EC, Iversen OE, Bjørge L (March 2005). "Failed medical termination of twin pregnancy with mifepristone: a case report". Contraception. 71 (3): 231–233. doi:10.1016/j.contraception.2004.09.002. PMID 15722075.
  20. ↑ "Self-management Recommendation 50: Self-management of medical abortion in whole or in part at gestational ages < 12 weeks (3.6.2) - Abortion care guideline". WHO Department of Sexual and Reproductive Health and Research. November 19, 2021. Retrieved June 30, 2022.
  21. ↑ Gambir K, Kim C, Necastro KA, Ganatra B, Ngo TD (March 2020). "Self-administered versus provider-administered medical abortion". The Cochrane Database of Systematic Reviews. 2020 (3): CD013181. doi:10.1002/14651858.CD013181.pub2. PMC 7062143. PMID 32150279.
  22. ↑ 22.0 22.1 Schmidt-Hansen M, Pandey A, Lohr PA, Nevill M, Taylor P, Hasler E, Cameron S (April 2021). "Expulsion at home for early medical abortion: A systematic review with meta-analyses". Acta Obstetricia et Gynecologica Scandinavica. 100 (4): 727–735. doi:10.1111/aogs.14025. PMID 33063314. S2CID 222819835.
  23. ↑ "Mifepristone and misoprostol: Recommended regimen". Ipas. January 30, 2020. Retrieved June 30, 2022.
  24. ↑ "Mifeprex (mifepristone) Information". U.S. Food and Drug Administration (FDA). February 7, 2022.
  25. ↑ "Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin, Number 225". Obstetrics and Gynecology. 136 (4): e31–e47. October 2020. doi:10.1097/AOG.0000000000004082. PMID 32804884.
  26. ↑ 26.0 26.1 Safe abortion: technical and policy guidance for health systems-2nd ed. Italy: World Health Organization (WHO). 2012. p. 42. ISBN 9789241548434.
  27. ↑ 27.0 27.1 Gómez Ponce de León R, Wing DA (April 2009). "Misoprostol for termination of pregnancy with intrauterine fetal demise in the second and third trimester of pregnancy - a systematic review". Contraception. 79 (4): 259–271. doi:10.1016/j.contraception.2008.10.009. PMID 19272495.
  28. ↑ 28.0 28.1 Mendilcioglu I, Simsek M, Seker PE, Erbay O, Zorlu CG, Trak B (November 2002). "Misoprostol in second and early third trimester for termination of pregnancies with fetal anomalies". International Journal of Gynaecology and Obstetrics. 79 (2): 131–135. doi:10.1016/s0020-7292(02)00224-2. PMID 12427397. S2CID 44373757.
  29. ↑ Borgatta L, Kapp N (July 2011). "Clinical guidelines. Labor induction abortion in the second trimester". Contraception. 84 (1): 4–18. doi:10.1016/j.contraception.2011.02.005. PMID 21664506.
  30. ↑ Borgatta L, Kapp N (July 2011). "Clinical guidelines. Labor induction abortion in the second trimester". Contraception. 84 (1): 4–18. doi:10.1016/j.contraception.2011.02.005. PMID 21664506.
  31. ↑ Perritt JB, Burke A, Edelman AB (September 2013). "Interruption of nonviable pregnancies of 24-28 weeks' gestation using medical methods: release date June 2013 SFP guideline #20133". Contraception. 88 (3): 341–349. doi:10.1016/j.contraception.2013.05.001. PMID 23756114.
  32. ↑ "ACOG Practice Bulletin No. 135: Second-trimester abortion". Obstetrics and Gynecology. 121 (6): 1394–1406. June 2013. doi:10.1097/01.AOG.0000431056.79334.cc. PMID 23812485. S2CID 205384119.
  33. ↑ Raymond EG, Harrison MS, Weaver MA (January 2019). "Efficacy of Misoprostol Alone for First-Trimester Medical Abortion: A Systematic Review". Obstetrics and Gynecology. 133 (1): 137–147. doi:10.1097/AOG.0000000000003017. PMC 6309472. PMID 30531568.
  34. ↑ Zhuo Y, Cainuo S, Chen Y, Sun B (May 2021). "The efficacy of letrozole supplementation for medical abortion: a meta-analysis of randomized controlled trials". The Journal of Maternal-Fetal & Neonatal Medicine. 34 (9): 1501–1507. doi:10.1080/14767058.2019.1638899. PMID 31257957. S2CID 195764644.
  35. ↑ Yeung TW, Lee VC, Ng EH, Ho PC (December 2012). "A pilot study on the use of a 7-day course of letrozole followed by misoprostol for the termination of early pregnancy up to 63 days". Contraception. 86 (6): 763–769. doi:10.1016/j.contraception.2012.05.009. PMID 22717187.
  36. ↑ "Medical abortion". Mayo Clinic. Retrieved July 10, 2022.
  37. ↑ 37.0 37.1 37.2 37.3 "Methotrexate and Misoprostol for Abortion". Women's Health. WebMD. Archived from the original on February 27, 2015.
  38. ↑ 38.0 38.1 38.2 International Consensus Conference on Non-surgical (Medical) Abortion in Early First Trimester on Issues Related to Regimens and Service Delivery (2006). Frequently asked clinical questions about medical abortion (PDF). Geneva: World Health Organization (WHO). ISBN 978-92-4-159484-4. Archived from the original (PDF) on January 17, 2009.
  39. ↑ 39.0 39.1 39.2 39.3 "Medical management of first-trimester abortion". Contraception. American College of Obstetricians and Gynecologists; Society of Family Planning. 89 (3): 148–161. March 2014. doi:10.1016/j.contraception.2014.01.016. PMID 24795934.
  40. ↑ Guiahi M, Davis A (December 2012). "First-trimester abortion in women with medical conditions: release date October 2012 SFP guideline #20122". Contraception. 86 (6): 622–630. doi:10.1016/j.contraception.2012.09.001. PMID 23039921. S2CID 21464833.
  41. ↑ Mark K, Bragg B, Chawla K, Hladky K (November 2016). "Medical abortion in women with large uterine fibroids: a case series". Contraception. 94 (5): 572–574. doi:10.1016/j.contraception.2016.07.016. PMID 27471029.
  42. ↑ Goldthwaite LM, Teal SB (October 2014). "Controversies in family planning: pregnancy termination in women with uterine anatomic abnormalities". Contraception. 90 (4): 460–463. doi:10.1016/j.contraception.2014.05.007. PMID 24958107.
  43. ↑ Mistry H, Jha S (May 11, 2015). "Pregnancy with a pinhole introitus: A report of two cases and a review of the literature". The European Journal of Contraception & Reproductive Health Care. 20 (6): 490–494. doi:10.3109/13625187.2015.1044083. PMID 25960283. S2CID 207523628.
  44. ↑ "Medical Abortion: What Is It, Types, Risks & Recovery". Cleveland Clinic. October 21, 2021. Retrieved June 30, 2022.
  45. ↑ "Methotrexate and Misoprostol for Abortion". Women's Health. WebMD. Archived from the original on February 27, 2015.
  46. ↑ 46.0 46.1 46.2 46.3 "Mifepristone Prescribing Information" (PDF). U.S. Food and Drug Administration (FDA).
  47. ↑ Achilles SL, Reeves MF (April 2011). "Prevention of infection after induced abortion: release date October 2010: SFP guideline 20102". Contraception. 83 (4): 295–309. doi:10.1016/j.contraception.2010.11.006. PMID 21397086.
  48. ↑ Murray S, Wooltorton E (August 2005). "Septic shock after medical abortions with mifepristone (Mifeprex, RU 486) and misoprostol". CMAJ. 173 (5): 485. doi:10.1503/cmaj.050980. PMC 1188182. PMID 16093445.
  49. ↑ Rabin RC (August 7, 2022). "Some Women 'Self-Manage' Abortions as Access Recedes - Information and medications needed to end a pregnancy are increasingly available outside the health care system". The New York Times. More than half a million women had medication abortions in 2020 in the United States, and fewer than half of 1 percent experience serious complications, studies show. Medical interventions like hospitalizations or blood transfusions were needed by fewer than 0.4 percent of patients, according to a 2013 review of dozens of studies involving tens of thousands of patients.
  50. ↑ Empty citation (help)
  51. ↑ 51.0 51.1 Creinin MD (September 2000). "Randomized comparison of efficacy, acceptability and cost of medical versus surgical abortion". Contraception. 62 (3): 117–124. doi:10.1016/s0010-7824(00)00151-7. PMID 11124358.
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  138. ↑ Baker CN (August 2023). "History and Politics of Medication Abortion in the United States and the Rise of Telemedicine and Self-Managed Abortion". Journal of Health Politics, Policy and Law. 48 (4): 485–510. doi:10.1215/03616878-10449941. PMID 36693178 Check |pmid= value (help).
  139. ↑ Jenkins J, Woodside F, Lipinsky K, Simmonds K, Coplon L (November 2021). "Abortion With Pills: Review of Current Options in The United States". Journal of Midwifery & Women's Health. 66 (6): 749–757. doi:10.1111/jmwh.13291. PMID 34699129 Check |pmid= value (help).
  140. ↑ Howard S, Krishna G (October 2022). "How the US scrapping of Roe v Wade threatens the global medical abortion revolution". BMJ (Clinical Research Ed.). 379: o2349. doi:10.1136/bmj.o2349. PMID 36261168 Check |pmid= value (help).
  141. ↑ "Insurers Are Starting to Cover Telehealth Abortion". The New York Times. 18 April 2023. Retrieved 22 April 2024.
  142. ↑ "A Texas Republican Wants to Ban People From Reading About How to Get an Abortion Online". Vanity Fair. 1 March 2023. Retrieved 22 April 2024.
  143. ↑ "SF0109 - Prohibiting chemical abortions". Wyoming Legislature. Retrieved February 1, 2024.
  144. ↑ Chen DW, Belluck P (March 18, 2023). "Wyoming Becomes First State to Outlaw Abortion Pills". The New York Times. Retrieved March 18, 2023.
  145. ↑ "Medication Abortion". Guttmacher Institute. March 14, 2016. Retrieved February 1, 2024.
  146. ↑ 146.0 146.1 Tirrell M, Carvajal N (1 March 2024). "CVS, Walgreens say they'll start dispensing abortion pill mifepristone". CNN. Retrieved 3 April 2024.
  147. ↑ Medical management of abortion. World Health Organization (WHO). 2018. p. 24. ISBN 978-9241550406.
  148. ↑ "Human Rights and Health". World Health Organization (WHO). September 21, 2019.
  149. ↑ Cha AE (April 4, 2018). "As controversial 'abortion reversal' laws increase, researcher says new data shows protocol can work". Retrieved April 23, 2018.
  150. ↑ "California Board of Nursing Sanctions Unproven Abortion 'Reversal' (Updated) - Rewire". Rewire. Retrieved November 23, 2017.
  151. ↑ Bhatti KZ, Nguyen AT, Stuart GS (March 2018). "Medical abortion reversal: science and politics meet". American Journal of Obstetrics and Gynecology. 218 (3): 315.e1–315.e6. doi:10.1016/j.ajog.2017.11.555. PMID 29141197. S2CID 205373684.
  152. ↑ Gordon M (December 5, 2019). "Safety Problems Lead To Early End For Study Of 'Abortion Pill Reversal'". NPR. Retrieved December 6, 2019.
  153. ↑ Grossman D, White K, Harris L, Reeves M, Blumenthal PD, Winikoff B, Grimes DA (September 2015). "Continuing pregnancy after mifepristone and "reversal" of first-trimester medical abortion: a systematic review". Contraception. 92 (3): 206–211. doi:10.1016/j.contraception.2015.06.001. PMID 26057457.
  154. ↑ "Counseling and Waiting Periods for Abortion". The Guttmacher Institute. March 14, 2016.
  155. ↑ Gordon M (March 22, 2019). "Controversial 'Abortion Reversal' Regimen is Put to the Test". NPR.
  156. ↑ "There's no proof "abortion reversals" are real. This study could end the debate". Vice. April 17, 2019.
  157. ↑ Gordon M (December 5, 2019). "Safety Problems Lead To Early End For Study Of 'Abortion Pill Reversal'". NPR. Retrieved December 6, 2019.
  158. ↑ 158.0 158.1 Jones RK, Kooistra K (March 2011). "Abortion incidence and access to services in the United States, 2008". Perspectives on Sexual and Reproductive Health. 43 (1): 41–50. doi:10.1363/4304111. PMID 21388504. S2CID 2045184.
  159. ↑ "Abortion drugs closer to being subsidised but some states still lag". The Conversation Australia. April 30, 2013. Retrieved April 29, 2013.
  160. ↑ "March 2013 PBAC Outcomes - Positive Recommendations". Australian Government Department of Health and Aged Care. Retrieved October 22, 2020.
  161. ↑ "Mifepristone (Mifepristone Linepharma) followed by misoprostol (GyMiso) for medical termination of pregnancy of up to 49 days' gestation". RADAR Review. National Prescribing Service (NPS) MedicineWise. August 1, 2013. Retrieved October 22, 2020.
  162. ↑ "Pharmaceutical Benefits Scheme (PBS)". Australian Government Department of Health and Aged Care. Retrieved June 14, 2023.
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