Medical Abortion Using Mifepristone and Misoprostol
Two drugs, Mifepristone and Misoprostol, are used to end an early pregnancy. According to the U.S. Food and Drug Administration, early pregnancy means that your doctor has confirmed through a valid and reliable manner that your pregnancy began 49 days (seven weeks) or less from the beginning of your last menstrual period.
In practice, your physician may make a clinical decision that Mifepristone and Misoprostol are appropriate for use to end pregnancies that began up to 63 days (nine weeks) from the beginning of your last menstrual period.
Mifepristone blocks a hormone (progesterone)that is necessary for pregnancy to continue. When followed by the second drug, misoprostol (which causes the womb to contract), the pregnancy is usually ended.
What You Must Do
You will need to visit your doctor two or three times. On the first visit, the doctor will determine the length of your pregnancy. Before you can take the first of the two drugs to start the abortion process, you must read a special medication guide and discuss the benefits and risks of using Mifepristone.
If you decide on the procedure then you must sign a consent form acknowledging that you understand the risks of the procedure. After an exam, you will be given Mifepristone tablets to take in the doctor's office.
Depending on the length of your pregnancy as determined by your physician, you will be given Misoprostol tablets to induce contractions one, two or three days later. These tablets are to be inserted into the vagina either at home or at your doctors office. Vaginal bleeding and uterine cramping are a normal part of this abortion procedure and will occur in almost all patients. Misoprostol may also cause nausea, vomiting, diarrhea, and other symptoms. Your doctor may send you home with additional medicines for these symptoms.
Two weeks later, you will return for an important follow-up visit. Your doctor will check whether your pregnancy has completely ended. If you are still pregnant, a surgical procedure will be necessary.
How Effective Is It?
In U.S. research trials, ABORTION OCCURRED 96-97% WITH THIS METHOD. The remainder required surgical interventions for reasons that included excessive bleeding, patient request, incomplete abortions and ongoing pregnancy, after receiving the drugs.
Risks Associated With Medical Abortion
There are some risks and complications that can occur with this abortion procedure. Not all risks may pertain to all patients. This procedure should be discussed with your doctor for information on the risks that apply to you.
As noted earlier, vaginal bleeding and uterine cramping will occur in almost all patients. In some cases, bleeding can be very heavy. You should expect to experience bleeding or spotting for an average of nine to 16 days. Some women experience bleeding for 30 days or more. In some cases, excessive bleeding may require blood transfusions, treatment with medication, surgery, and/or saline transfusions. Commonly reported side effects included nausea, vomiting and diarrhea.
Death related to abortion occurs in less than one of every 100,000 abortions. It is extremely important to get medical care if you are experiencing more than the usual side effects and in the event of an emergency. Talk to your doctor about complications and be sure to get the phone number of your doctor in case you have questions, have concerns, or need emergency care.
While rare, some women may experience depression, feelings of guilt, anger, sleep disturbance, or loss of interest in work or sex, as a result of an abortion. If these symptoms occur and are intense or persistent, professional help is recommended.
Who Should Not Use Mifepristone and Misoprostol?Do not start taking these drugs if you cannot return to your doctor for all follow-up visits. All three visits are extremely important.
Do not take these drugs if you have:
- a confirmed or suspected pregnancy outside of the womb (for example, a tubal pregnancy);
- an undiagnosed mass in your lower abdomen;
- an IUD in place (must be removed before procedure);
- problems with your adrenal glands;
- current use of medicine to thin your blood;
- history of allergy to mifepristone or misoprostol or other medicines that contain them;
- bleeding disorders or current anticoagulant therapy;
- porphyrias (a rare inherited blood disorder)
Do not take these drugs from any doctor who is not a qualified dispenser of mifepristone. Under Federal law, mifepristone can only be provided by a doctor who has:
- the ability to assess the duration of pregnancy accurately;
- the ability to diagnose a pregnancy outside of the womb;
- the ability to provide surgical intervention in cases of severe bleeding or incomplete abortion, or have made plans to provide such care through others, and are able to assure patient access to medical facilities equipped to provide blood transfusions and resuscitation, if necessary.
There are no data on the safety and efficacy of Mifepristone in women with chronic medical conditions such as cardiovascular, liver, respiratory or kidney diseases; high blood pressure; insulin-dependent diabetes; severe anemia or heavy smoking.
Risks Associated With Pregnancy and Delivery
Most pregnancies are normal. Most women deliver without problems with good prenatal and health care during delivery. However, a small percentage of women who are pregnant require hospitalization or special care for pregnancy complications.
Some of the complications of pregnancy which may result in hospitalization or death include heavy bleeding, infection, or pregnancy induced high blood pressure. Death related to pregnancy occurs approximately eight times in every 100,000 pregnancies.
Many services may be available should you choose to continue the pregnancy. It is important to get prenatal care for a good pregnancy outcome. Contact your local health department, your county Family Independence Agency, or the Michigan Department of Community Health for information about services available in your area.
You may choose to place your child in an adoptive or foster home. Contact your county Family Independence Agency or a private adoption agency for services related to adoption. Check your local yellow pages phone book under the listing for adoption or pregnancy services.
If you experience psychological effects from your abortion, you may contact your private provider, local community mental health, public health or Family Independence Agency for counseling help. Your local phone book will contain telephone numbers for these agencies.
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