Medical abortions.

July 28, 2011

Medical termination requires the close observation of a practitioner. It usually requires two or more visits, and there is a potential need for emergency intervention during the process. Finally, it requires close follow-up to ensure that the process of abortion is complete.

The earlier the gestational age is, the higher the complete abortion rate. The complete abortion rate ranges from 92 to 96% if medication is begun before 56 days. The pregnancy age should be confirmed by clinical evaluation and/or ultrasonography. Most medication regimens require patients to be no more than 50 days pregnant (as calculated from the first day of the last menstrual period).

The bleeding resulting from a medical abortion is heavier than that experienced during a normal menses and is accompanied by severe cramping. Most patients require pain medication. In rare instances, women who are having a medical abortion require an emergency dilation and curettage because of heavy bleeding (1%). Postabortion follow-up with a practitioner is extremely important because not all women are able to determine whether they have completely aborted based on their symptoms. In some studies, only half of the women who thought they had aborted actually had done so. Medical abortion is contraindicated in women on long-term systemic corticosteroid therapy or anticoagulant therapy and in those with chronic kidney, liver, or respiratory disease, severe anemia, a known coagulopathy, uncontrolled hypertension, angina, valvular disease, cardiac arrhythmias, or cardiac failure.

Three medications are currently used in medical abortion: misoprostol, mifepristone (RU 486), and methotrexate.

Misoprostol is the most common medication used in medical abortion. It was originally approved to prevent gastric ulcers in persons taking anti-inflammatory drugs. It causes softening of the cervix and uterine contractions, resulting in the termination of a pregnancy. Because misoprostol is potentially teratogenic (it can cause physical malformations of the fetus), a surgical abortion must be performed in the event of a continuing pregnancy.

Mifepristone is a progestin-like structure that occupies the progesterone receptor and prevents its activation (antiprogesterone effect). This may cause an alteration in the lining of the uterus (decidua) resulting in termination of the pregnancy. It also softens the cervix so the pregnancy can be expelled.

Methotrexate blocks DNA synthesis by blocking enzymes. This halts the process of implantation (attachment of the embryo to the uterine wall). All three medications can cause side effects including pain, nausea, bleeding, vomiting, diarrhea, warmth or chills, dizziness, headache, and fatigue.

Repeated use of medical termination has not been well studied in the medical lecture. However, there is no medical basis to believe that repeated medical abortion has an untoward effect on fertility.

SEE ALSO: Birth control, Ultrasound

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