[Induced abortion: Guidelines for clinical practice - Text of the Guidelines (short text)].
OBJECTIVE
Develop recommendations for the practice of induced abortion.


METHODS
The Pubmed database, the Cochrane Library and the recommendations from the French and foreign Gyn-Obs societies or colleges have been consulted.


RESULTS
The number of induced abortions (IA) has been stable for several decades. There are a lot of factors explaining the choice of abortion when there is an unplanned pregnancy (UPP). Early initiation and choice of contraception in connection to the woman's life are associated with lower NSP. Reversible contraceptives of long duration of action should be positioned fist in line for the teenager because of its efficiency (grade C). Ultrasound before induced abortion must be encouraged but should not be obligatory before performing IA (Professional consensus). As soon as the sonographic apparition of the embryo, the estimated date of pregnancy is done by measuring the crown-rump length (CRL) or by measuring the biparietal diameter (BIP) from 11 weeks on (grade B). Reliability of these parameters being±5 days, IA could be done if measurements are respectively less than 90mm for CRL and less than 30mm for BIP (Professional consensus). A medical IA performed with a dose of 200mg mifepristone combined with misoprostol is effective at any gestational age (EL1). Before 7 weeks, mifepristone followed between 24 and 48hours by taking misoprostol orally, buccally sublingually or eventually vaginally at a dose of 400 ug possibly renewed after 3hours (EL1, grade A). Beyond 7 weeks, misoprostol given vaginally, sublingually or buccally are better tolerated with fewer side effects than oral route (EL1). It is recommended to always use a cervical preparation during an instrumental abortion (Professional consensus). Misoprostol is a first-line agent for cervical preparation at a dose of 400 mcg (grade A). Aspiration evacuation is preferable to curettage (grade B). A perforated uterus during an instrumental suction should not be considered as a scarred uterus (Professional consensus). IA is not associated with increased subsequent risk of infertility or ectopic pregnancy (EL2). The pre-abortion medical consultations does not affect, most of the time, the decision to request an IA. Indeed, a majority of women is quite sure of her choice during these consultations. Acceptability of the method of IA and satisfaction appears to be larger when they are able to choose the abortion method (grade B). There is no relationship between an increase in psychiatric disorders and IA (EL2). Women with psychiatric histories are at increased risk of mental disorders after the occurrence of an UPP (EL2). In case of instrumental abortion, oral estrogen-progestogen contraceptives and the patch should be started from the day of the abortion, the vaginal ring inserted within 5 days of IA (grade B). In case of medical abortion, the vaginal ring should be inserted within a week of taking mifepristone, oral estrogen-progestogen contraceptives and the patch should be initiated on the same day or the day after taking prostaglandins (grade C). In case of instrumental abortion, the contraceptive implant may be inserted on the day of the abortion (grade B). In case of medical abortion, the implant can be inserted on the day of mifepristone (grade C). The copper Intrauterine Device (IUD) and levonorgestrel should be inserted preferably on the day of instrumental abortion (grade A). In case of medical abortion, an IUD can be inserted within 10 days following mifepristone after ensuring by ultrasound of the absence of intrauterine pregnancy (grade C).


CONCLUSIONS
The implementation of these guidelines may promote a better and more homogenous care for women requesting IA in our country.
Pôle Femme-Mère-Couple, service de gynecologie-obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, 330, avenue de Grande-Bretagne, 31059 Toulouse, France; UMR 1027 Inserm, université Paul-Sabatier-Toulouse III, 118, route de Narbonne, 31062 Toulouse, France. Electronic address: christophe.vayssiere@gmail.com.
C
C
Vayssière
Département de gynécologie-obstétrique, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
A
A
Gaudineau
Département de gynécologie-obstétrique, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
L
L
Attali
Département de gynécologie-obstétrique, hôpital de Hautepierre, CHU de Strasbourg, 1, avenue Molière, 67098 Strasbourg, France.
K
K
Bettahar
3, rue Pierre-d'Artagnan, 92350 Le Plessis-Robinson, France.
S
S
Eyraud
Unité fonctionnelle d'orthogénie, hôpital Trousseau, 26, avenue du Dr-Arnold-Netter, 75012 Paris, France.
P
P
Faucher
Service de gynécologie obstétrique, centre hospitalier du Belvedere, 72, rue Louis-Pasteur, 76451 Mont-Saint-Aignan, France.
P
P
Fournet
5, place Léon-Blum, 75011 Paris, France.
D
D
Hassoun
4, rue Lasson, 75012 Paris, France.
M
M
Hatchuel
169, boulevard Haussmann, 75008 Paris, France.
C
C
Jamin
Service de gynécologoe-obstétrique, hôpital Jeanne-de-Flandre, CHRU de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France.
B
B
Letombe
Service de gynécologie obstétrique, centre hospitalier Loire-Vendée-Océan, boulevard Guerin, 85300 Challans, France.
T
T
Linet
MFPF, mouvement français pour le planning familial, Tour Manto, boulevard Massena, 75013 Paris, France.
M
M
Msika Razon
Service de gynécologie-obstétrique, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France.
A
A
Ohanessian
Service de gynécologie-obstétrique, CHI de Poissy-St-Germain, 45, rue du Champs-Gaillard, 78303 Poissy, France.
H
H
Segain
Service de gynécologie-obstétrique, hôpital Bicêtre, GHU Sud, AP-HP, 94276 Le Kremlin-Bicêtre, France; Inserm, centre de recherche en épidémiologie et santé des populations (CESP), U1018, équipe « Genre, Sexualité et Santé », 94276 Le Kremlin-Bicêtre, France.
S
S
Vigoureux
Service de gynécologie-obstétrique, CHU Hôtel-Dieu-Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
N
N
Winer
Service de gynécologie-obstétrique, CHU Hôtel-Dieu-Nantes, 1, place Alexis-Ricordeau, 44000 Nantes, France.
S
S
Wylomanski
Service de gynécologie-obstétrique, hôpital de la Conception, 147, boulevard Baille, 13005 Marseille, France.
A
A
Agostini
D000028:Abortion, Induced / Q000379:methods* / Q000592:standards*; D005260:Female; D006801:Humans; D017410:Practice Guidelines as Topic / Q000592:standards*; D011247:Pregnancy
Contraception; IVG chirurgicale; IVG médicamenteuse; Induced abortion; Interruption volontaire de grossesse; Medical abortion; Regulation of induced abortion; Réglementation de l’IVG; Surgical abortion