Management of very early medical abortion-An international survey among providers.

Objective: To record the definition and management of Very Early Medical Abortion (VEMA) in different countries.
Study Design: An Internet survey was circulated internationally among providers of medical abortion via a website. The questionnaire focused on reasons for performing or delaying medical abortion at a very early gestational age and the perceived advantages and disadvantages of VEMA.
Results: Out of 220 completed questionnaires, 50 % came from European abortion providers (n = 110). Most respondents (72 %) defined VEMA as abortion performed in the presence of a positive hCG pregnancy test but with an empty uterine cavity or a gestational sac-like structure, and no signs or symptoms of ectopic pregnancy. A total of 74 % of respondents thought it was not necessary to wait for a diagnosis of intrauterine pregnancy before starting medical abortion. Equally, 74 % were aware of the possibility of an ectopic pregnancy.
Conclusion: According to European providers of medical abortion, waiting for the diagnosis of an intrauterine pregnancy is not necessary and does not improve treatment of ectopic pregnancy. Providers should know that medical abortion can be performed effectively and safely as soon as the woman has decided. There is no lower gestational age limit.
Competing Interests: Declaration of Competing Interest The authors were all members of the external scientific advisory board of Exelgyn at the time of this study. Christian Fiala has served on an ad hoc basis as an invited lecturer for Exelgyn. Aubert Agostini is a board member at Nordic Pharma and MSD, and an investigator for some Nordic Pharma studies. Teresa Bombas is a member of advisory boards for Merck and HRA, has an occasional consultancy relationship with Exelgyn and Nordic, and is a speaker at conferences/symposiums organized by Bayer, Merck, HRA, Gedeon, and Exelgyn. Roberto Lertxundi has a financial relationship (member of advisory boards, lecturer, and/or consultant) with Exelgyn, Nordic-Pharma, Exeltis, Bayer-Pharma, and Teva. Marek Lubusky has an occasional consultancy relationship with Exelgyn and Nordic. Mirella Parachini has an occasional consultancy relationship with Exelgyn and Nordic. Kristina Gemzell-Danielsson has served on an ad hoc basis as an invited lecturer for Exelgyn, Line Pharma, and Gynuity, and as an investigator in clinical trials conducted by Concept Foundation/SunPharma. Laurence Saya is an employee of Altius Pharma CS, and as such was indirectly paid by Exelgyn for help in medical writing.
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