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Abortion Pill

Unwanted pregnancy can put a lot of stress on the physical and mental health of a woman. In such situation, Termination of Pregnancy (TOP) or abortion can be a blessing for her. The termination can be safely performed till the 20 weeks of pregnancy safely. There are two types of procedures available for Medical Termination of Pregnancy.

  • Medical Abortion: Use of medicines for termination of pregnancy
  • Surgical Abortion: Use of surgical methods for termination of pregnancy

In this article we will be discussing about Medical Abortion.

When to prefer medical abortion?

  • If woman prefers medications over surgical procedure
  • Up to 70 days of pregnancy, it is considered more effective than surgical abortion
  • If woman has congenital deformity of uterus or narrowing of lower part of uterus (cervix)
  • The woman can take some medicines at home also which is more convenient

Pre-abortion procedures:

Abortion can be a mentally stressful procedure, so counselling holds an important place in pre-abortion procedures. The main objectives of this counselling are

  • Help the woman to take an informed decision
  • Provide knowledge about the procedure
  • Remove the anxiety related to the procedure

This counselling can be performed by a nurse, doctor or even an experienced counsellor. During counselling the woman is given pregnancy options counselling and informed consent related counselling. A woman may have variety of reasons for opting for an abortion. The counselling helps in taking the correct decision without any mental stress. The counselling also gives an opportunity to prepare the woman for possible adverse effects of the medical abortion.
Your doctor will have to ascertain few things before he/she can administer the procedure. These include following investigations.

  • Ultrasonography for confirmation of pregnancy and estimation of duration of pregnancy
  • Measurement of vital signs (Temperature, Pulse, Blood Pressure, Respiratory Rate, )
  • Blood grouping
  • Lab tests for sexually transmitted diseases

Following medicines can be used to induce abortion during early pregnancy

  • Mifepristone and Misoprostol
  • Methotrexate and Misoprostol

Mifepristone and Misoprostol:

This is the most commonly used regimen for an embryo of 7. Misoprostol is an antagonist of progesterone. Progesterone is a hormone essential for continuation of pregnancy. Thereby, misoprostol inhibits the further development of the embryo. Misoprostol is a prostaglandin, a chemical which contracts the uterus. Therefore it is administered after mifepristone. This regimen has shown the success rate of 92-97%.

Contraindications of this regimen:

  • Ectopic pregnancy (implantation of embryo outside uterine cavity)
  • Ovarian tumour
  • Presence of Intra Uterine Device
  • Kidney or liver disease
  • Heart Disease
  • Asthma
  • Problem in blood coagulation
  • Treatment with corticosteroids
  • Aged more than 35 years and
  • Heavy smokers

How this regimen is used (FDA regimen)?

It requires 3 days and at least 2 visits to a clinic are required for this method.

Day 1

During initial visit, history is taken and examination of the woman is done followed by pre-abortion counselling and investigations. Once the consent is obtained and contraindications are excluded, a tablet containing 200 mg of Mifepristone (RU-486) is given orally to the woman and advised to re-visit on day 2-or 3

Day 2 0r 3

She is given the second tablet containing misoprostol (800 microgram) on day 3 at clinic. She is kept under observation for at least 4 hours. Usually following consumption of second tablet, there will be bleeding from vagina and cramps will be felt in the abdomen. This is due to contraction of uterus and expulsion of aborted products of pregnancy. Antibiotics may also be given to prevent the infection. A pain killer medicine can be given to alleviate the pain.

Follow up visit-

She is advised to visit on day 15 for re-examination and to ascertain that the abortion is complete. It also gives an opportunity for a doctor to check the health status of the woman.

The side effects of this regimen:

Abdominal pain and bleeding are the most common side effects. The other side effects include vomiting and diarrhoea. In rare cases, this method may fail and has to be followed up by a surgical method.

Methotrexate and Misoprostol

This was a common method in the past, but following introduction of mifepristone, this method has been used occasionally now a day. Methotrexate is more commonly used in the cancer chemotherapy. It inhibits the multiplication of cells. It mainly affects all those cells which are rapidly multiplying. These also include embryo!

Contraindications of this regimen:

  • Severe anaemia
  • Corticosteroid therapy
  • Diseases of guts, adrenal gland, liver, kidney, cardiovascular system and blood clotting
  • Intra Uterine Device is present
  • Anticoagulant therapy
  • Alcoholism
  • Decreased RBCs, Platelets or WBC
  • Hypersensitivity

How this regimen is used?

It is important to note that this regimen is not approved by FDA for medical abortion. But occasionally when other regimen is contraindicated, this regimen is used. This regimen is less costly but takes longer time (as long as 7 days).

Day 1

All the procedures remain same as in the earlier method except the medicine. Methotrexate (50 mg/m2) orally on the first day and the woman is asked to revisit on the 7th day.

Day 7

She is given Misoprostol (800 micrograms) inside vagina. This usually induces the bleeding and uterine contractions. The dose of misoprostol may have to repeat after 24 hrs, in case the first dose fails. A pain killer medicine may be given to alleviate the pain.

Follow up visit-

Just like in the earlier regimen the woman is asked for a follow up visit on the 15th day.

The side effects of this regimen:

These include nausea, vomiting and diarrhoea. In rare cases there may be suppression of bone marrow leading to decreased red and white blood cell counts. It has been said that the failure rate of this regimen is higher than the earlier regimen.
Apart from these two regimens, misoprostol alone can also be used for medical abortion, but the failure rate is too high.

 

Frequently Asked Questions:

According to guidelines by Food and Drug Administration of United States, these regimens are highly effective and should be used for termination of pregnancy of less than 70 days.
The pain associated with medical abortion is varied but one should expect some degree of mild
to moderate abdominal pain depending on their pain threshold and the gestational age
of the pregnancy.
The price of a medical abortion would depend on the center where the abortion is carried out,
the type of abortion that is done and the gestational age of the pregnancy. So generally the price would vary.
Most insurance companies would cover a medical abortion but it is always important to check with your insurance company just to be sure.
Minors would generally require their parent’s consent, but it is also important to find out about abortion laws relevant to your state of residence.
Women who are rhesus negative would need to receive this anti-D immunoglobulin after a medical abortion to prevent miscarriages in subsequent pregnancies.
After taking the second tablet, you may feel abdominal cramps and the product of pregnancy starts coming out with blood. But there is no need to freak out. You can take a pain killer and let the pill do its work.
Consult your doctor for this matter. You may not be advised to take the bath immediately. This is to prevent water entering the exposed area and prevent infection due to it.
You can do that. But always remember that it may take few weeks before the pregnancy test becomes negative. So if you will do it immediately, you will get positive result.
If you are doing abortion with qualified doctors and nurses, they will always maintain their patients’ confidentiality. There is no need of worry about your information being leaked out.
It is said that medical abortion is more effective than surgical abortion in the early pregnancy. For pregnancy of less then 7 weeks old, this method will be 98% effective. After that the effectiveness will decrease, but still remains as high as 93%.
Yes. Mifepristone and methotrexate need some time for their work. Only after that the misoprostol will be effective in expulsing all the content. So you need to keep some distance between two pills.
There are some regimens available, but rarely used. Sometimes single pills are also used. But the studies have shown them to be much less effective than the combination.
For mild to moderate pain, you can take paracetamol (500-1000 mg). If pain is more you may take ibuprofen (200 mg). In very severe cases, even codeine is prescribed.
If you have fever, nausea, vomiting or diarrhoea after medical abortion, you can suspect infection. You should immediately contact a doctor as this is a dangerous condition to be in.
If medical abortion fails, it can be followed by surgical abortion. There are not enough evidences available to show that abortion pills can cause anomaly in embryo except for methotrexate.
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