GENERALLY The organization of the abortion business look different in different hospitals / health facilities.

In the most cases, consists of teamwork between counselors, doctors, midwives, nurses and assistant nurses. VISIT ON ABORTION RECEPTION In a history of the following factors are important to highlight: bleeding disorders, adrenal insufficiency, uncontrolled severe asthma. (For successful contraceptive counseling)

Abortion The visit should include information about contraception as studies have shown that motivation To start prevention is greatest adjacent to the abortion goal should be to woman has worked contraception with high compliance when she leaves abortion clinic. While at the abortion clinic, the following investigations performed: vaginosis should be carried out routinely. At vaginosis patients should have started treatment before the abortion. Screening for chlamydia in all who seek an abortion should be routinely by the method used in the clinic. Treatment should be initiated before surgical abortion. If the answer is not present, one can consider that women are treated as if she were positive. Other STI screening is done on indication. gynstatus indicating in particular whether the uterus is retro-or anteflekterad as this has great significance in surgical abortion. Ultrasound examination should be performed to determine gestational age. The woman has the right to choose the method unless it is directly medically inappropriate. To v7 medical termination is the most effective method. MEDICAL ABORTION on healthcare facility until week 9 +0 Medical abortion can be started at a positive pregnancy test as below: suspicion if X (bleeding, pain) or molar, there shall be assessed on ultrasound image can match the last period data. If the data agree checked an S-hcg the day before mifepristonintag and about 1 week later to check that S-hcg is in decline. Patients should be informed that ectopic pregnancy can not be ruled out, and at what symptoms she should go to hospital. Treatment -48 hours administered misoprostol vaginally 0.8 mg of patient or staff she had taken misoprostol given additional 0.4 mg of misoprostol vaginally (or oral). This regimen has been

shown to give more complete abortions. Pain relief should be granted in connection with the administration of misoprostol and can tentatively contain both NSAIDs (eg diclofenac 100mg or 400mg Ibuprofen) as paracetamol (1g) and ev. supplemental oral morphine derivatives (unless there are contraindications). The patient is observed until she started to bleed. In cases where the patient is not aborted in the reception the patient should be informed thoroughly before discharge. She should be specifically instructed to take contact the continued pregnancy symptoms. MEDICAL AT HOME (to v. 9 +0) Definition: Abortion initiated in hospital with mifepristone and completed at home with administration of the misoprostol as above. The patient should:

The effect of misoprostol should be evaluated by telephone with the patient. She should be specifically informed if making contact by continued pregnancy symptoms. SUPERVISORY CONTROL for medical abortion up to week 9 +0 The caregiver shall ensure that there are procedures to ensure that subsequent verification is performed to determine that the pregnancy is over. As the concept of re-checking is not clearly defined, this done in different ways based on competence and geography etc. using U-/S-hcg or ultrasound. With continued pregnancy patients are offered surgical abortion alternatively, she offered a new medical abortion as desired and medical assessment. MEDICAL ABORTION WEEK 9 +1 toWEEK 12 +0 Treatment -48 hours administered misoprostol 0.8 mg vaginally by patient or staff. d within 4 hours, repeated misoprostol 0.4 mg orally every three hours up to 4 times (for a total maximum of 1.6 mg misoprostol). Pain relief should be given in conjunction with the insertion of misoprostol and can tentatively contain both NSAIDs (eg diclofenac 100mg or 400mg Ibuprofen) as paracetamol (1g) and ev supplemental oral morphine derivatives (unless there are contraindications). If the woman is not aborted during the day, planned for exaeres day. MEDICAL ABORTION WEEK 12 +1 to WEEK 22 +0. In patients with previous caesarean section, the risk of uterine rupture considered when gestational age of 18 weeks +0 days. Lower misoprostoldoser can be considered. Note risk of the use of Synthocinon. Fr.om v 18 +1, the application shall be made to the National Board of Legal Council. Treatment: -48 hours administered misoprostol 0.8 mg vaginally by patient or

staff. ed misoprostol 0.4 mg orally or vaginally every three hours up to 4 times (for a total maximum of 1.6 mg misoprostol). Lactation inhibition be given at gestational age of 15-16 weeks. If the woman is not aborted during the day: and repeat misoprostol administrationen with 0.4 mg orally every three hours with 4 additional doses of misoprostol. In case of no abortion repeat the above steps. Supplement with Laminaria can be considered as change of prostaglandin analogue to Cervagem 1mg every three hours. If medical treatment failure and abortion needs to be terminated surgically shall be used dilation and extraction (D & E) by van surgeon (from V13 +1, see below). Pain relief should be given in conjunction with the insertion of misoprostol and can tentatively contain both NSAIDs (eg diclofenac 100mg or 400mg Ibuprofen) as paracetamol (1g) and ev supplemental oral morphine derivatives (unless there are contraindications). Other pain relief methods: PCB and epidural After the fetus until parturition may 1 ml Syntocinon (5E) given iv. If the placenta does not depart spontaneously, the patient should be examined in gynstol. In cases where one sees placenta shall be taken by a ring forceps or fingers and using Creds grip try solved spontaneously. In case this fails, but the patient does not bleed, you can wait and ev. Give further misoprostol. Exaeres be performed on

SURGICAL ABORTION Treatment: week 12 +0. Not recommended earlier than v. 7 +0 and after 13 +0. In week 12 +0 to 13 +0 only gynecologist with special skills. y a gynecologist with a special skills v13 +1 to 15 +0). Other surgical methods should not be used Pretreatment for pharmacological cervixdilatation mg of misoprostol vaginally (or sublingual) 3 hours preoperatively -48 hours preoperatively Can be given to all patients but should be conferred in the following cases <18 yy Syntocinon 5 IU iv can be given if necessary during surgery when prescribed by respective operator. For surgical abortions must be sure that the pregnancy is over. In uncertain Abortion exchange can be done with ultrasound in the immediate vicinity of the operation. Contraception after abortion

All hormonal methods should be started immediately after surgical abortion. Implants can be inserted at surgery. The medical abortion can be hormonal contraception on the same day or day after misoprostolbehandlingen. Spiral can be deployed in conjunction with surgery or up visit after medical abortion. SUPERVISORY CONTROL Must be offered to all women who have undergone surgical abortion.