Process of medical abortion

Medical abortion - Mayo Clinic

Overview

Medical abortion is a procedure that uses medicine to end a pregnancy. A medical abortion doesn't require surgery or anesthesia. It can be started in a medical office or at home with follow-up visits to your health care provider. It's safest and most effective during the first trimester of pregnancy.

Having a medical abortion is a major decision with emotional and psychological consequences. If you're considering this procedure, make sure you understand what it entails, side effects, possible risks, complications and alternatives.

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Why it's done

The reasons for having a medical abortion are highly personal. You can choose medical abortion to complete an early miscarriage or end an unintended pregnancy. You can also choose to have a medical abortion if you have a medical condition that makes continuing a pregnancy life-threatening.

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Risks

Potential risks of medical abortion include:

Incomplete abortion, which may need to be followed by surgical abortion
An ongoing pregnancy if the procedure doesn't work
Heavy and prolonged bleeding
Infection
Fever
Digestive system discomfort

If you decide to continue the pregnancy after taking medicine used in medical abortion, your pregnancy may be at risk of major complications.

Medical abortion hasn't been shown to affect future pregnancies unless complications develop.

Medical abortion isn't an option if you:

Are too far along in your pregnancy. You shouldn't attempt a medical abortion if you've been pregnant for more than nine weeks (after the start of your last period). Some types of medical abortion aren't done after seven weeks of pregnancy.
Have an intrauterine device (IUD) currently in place.
Have a suspected pregnancy outside of the uterus. This is called ectopic pregnancy.
Have certain medical conditions. These include bleeding disorders; certain heart or blood vessel diseases; severe liver, kidney or lung disease; or an uncontrolled seizure disorder.
Take a blood thinner or certain steroid medicines.
Can't make follow-up visits to your provider or don't have access to emergency care.
Have an allergy to the medicine used.

A surgical procedure called a dilation and curettage (D&C) may be an option if you can't have a medical abortion.

How you prepare

Before a medical abortion, your health care provider will likely:

Evaluate your medical history and overall health
Confirm your pregnancy with a physical exam
Do an ultrasound exam to date the pregnancy and check that it's not outside the uterus (ectopic pregnancy) and not a tumor that developed in the uterus (molar pregnancy)
Do blood and urine tests
Explain how the procedure works, the side effects, and possible risks and complications

Making the decision to have an abortion might not be easy. Consider seeking support from your partner, a family member or a friend as you think about your options. Talk with your health care provider to get answers to your questions, help you weigh alternatives and consider the impact the procedure may have on your future.

No health care provider is required to perform an elective abortion. In some places, an elective abortion may not be legal. Or there may be certain legal requirements and waiting periods to follow before having an elective abortion. If you're having an abortion procedure for a miscarriage, there are no special legal requirements or waiting periods required.

What you can expect

Medical abortion doesn't require surgery or anesthesia. The procedure can be started in a medical office or clinic. A medical abortion can also be done at home, though you'll still need to visit your health care provider to be sure there are no complications.

During the procedure

Medical abortion can be done using these medicines:

Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). This is the most common type of medical abortion. These medicines are usually taken within seven weeks of the first day of your last period.

Mifepristone (mif-uh-PRIS-tone) blocks the hormone progesterone, causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Misoprostol (my-so-PROS-tol), a different kind of medicine, causes the uterus to contract and expel the embryo through the vagina.

You may take the mifepristone in your provider's office or clinic. Then you might take the misoprostol at home, hours or days later.

You'll need to visit your health care provider again about a week later to make sure the abortion is complete. This regimen is approved by the Food and Drug Administration (FDA).
Oral mifepristone and vaginal, buccal or sublingual misoprostol. With this type of medical abortion, you take a mifepristone tablet by mouth. The next step is to use a slowly dissolving misoprostol tablet placed in your vagina (vaginal route), in your mouth between your teeth and cheek (buccal route), or under your tongue (sublingual route).

The vaginal, buccal or sublingual approach lessens side effects and may be more effective. To be most effective, these medicines must be taken within nine weeks of the first day of your last period.
Methotrexate and vaginal misoprostol. Methotrexate is rarely used for elective, unintended pregnancies, although it's still used for pregnancies outside of the uterus (ectopic pregnancies). This type of medical abortion must be done within seven weeks of the first day of your last period. It can take up to a month for methotrexate to complete the abortion. You receive methotrexate as a shot or a pill you take by mouth. The misoprostol is later used at home.
Vaginal misoprostol alone. Vaginal misoprostol alone can be effective when used before nine weeks of gestation of the embryo. But vaginal misoprostol alone is less effective than other types of medical abortion.

The medicines used in a medical abortion cause vaginal bleeding and abdominal cramping. They may also cause:

Nausea
Vomiting
Fever
Chills
Diarrhea
Headache

You may be given medicine to manage pain during and after the medical abortion. You may also be given antibiotics, although infection after medical abortion is rare.

Your health care provider will let you know how much pain and bleeding to expect, depending on the number of weeks of your pregnancy. You might not be able to go about your usual daily routine during this time, but it's unlikely you'll need bed rest. Make sure you have plenty of absorbent sanitary pads.

If you have a medical abortion at home, you'll need access to a health care provider who can answer questions by phone and access to emergency services. You'll also need to be able to identify complications.

After the procedure

Signs and symptoms that may require medical attention after a medical abortion include:

Heavy bleeding — soaking two or more pads an hour for two hours
Severe abdominal or back pain
Fever lasting more than 24 hours
Foul-smelling vaginal discharge

After a medical abortion, you'll need a follow-up visit with your provider to make sure you're healing properly and to evaluate your uterine size, bleeding and any signs of infection. To reduce the risk of infection, don't put anything into your vagina for two weeks after the abortion.

Your health care provider may ask if you still feel pregnant, if you saw the expulsion of the gestational sac or embryo, how much bleeding you had, and whether you're still bleeding. If your provider suspects an incomplete abortion or ongoing pregnancy, you may need an ultrasound and possibly a surgical abortion.

After a medical abortion, you may have a mix of emotions, including relief, loss, sadness or guilt. If these feelings bother you, it might help to talk to a counselor about them.

Preventing pregnancy

Ovulation usually occurs as soon as two weeks after a medical abortion, and another pregnancy is possible even before your period begins. Before the abortion, talk to your provider about contraception that you can start as soon as the procedure is over.

By Mayo Clinic Staff

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The abortion pill causes cramping and bleeding that can last several hours or more. You can be at home, or wherever is comfortable for you. Plan on taking it easy for the day.

What do I need to do before I take the abortion pill?

Before you take the abortion pill, you’ll meet with your nurse, doctor, or health center staff to talk about whether abortion is the right decision for you, and what your abortion options are. You’ll get an exam and lab tests, and you may get an ultrasound to figure out how far into your pregnancy you are.

Your nurse or doctor will let you know if there’s anything else you need to do to prepare for your abortion. They’ll give you written instructions on how to take your pills. You will have access to a caring professional through the process — you’ll get a number you can call 24/7 if you have any questions or concerns.

You’ll have a lot of bleeding and cramping after you take the second medicine, so plan ahead to make the process more comfortable. You can be at home, or wherever is comfortable for you to rest. You may also want to have someone you trust with you (or nearby) that you can call for support if you need anything.

Stock up on maxi pads, food, books, movies, or whatever you like to help pass the time, and a heating pad for cramps. Make sure you have some pain medicine — but don’t take aspirin because it can make you bleed more.

What happens during a medication abortion?

The abortion pill process has several steps and includes two different medicines.

First, you take a pill called mifepristone. This medicine stops the pregnancy from growing. Some people feel nauseous or start bleeding after taking mifepristone, but it’s not common. Your doctor or nurse may also give you antibiotics to take to prevent infection.

The second medicine is called misoprostol. You’ll either take the misoprostol right away, or up to 48 hours after you take the first pill — your doctor or nurse will let you know how and when to take it. This medicine causes cramping and bleeding to empty your uterus.

For most people, the cramping and bleeding usually starts 1-4 hours after taking the misoprostol. It’s normal to see large blood clots (up to the size of a lemon) or clumps of tissue when this is happening. It’s kind of like having a really heavy, crampy period, and the process is very similar to an early miscarriage. (If you don’t have any bleeding within 24 hours after taking the second medicine, misoprostol, call your nurse or doctor.)

The cramping and bleeding can last for several hours. Most people finish passing the pregnancy tissue in 4-5 hours, but it may take longer. The cramping and bleeding slows down after the pregnancy tissue comes out. You may have cramping on and off for 1 or 2 more days.

You can take pain medicine like ibuprofen about 30 minutes before you take the second medicine, misoprostol, to help with cramps. You can also take anti-nausea medicine if your doctor or nurse gives it to you. Don’t take aspirin, because it can make you bleed more.

It’s normal to have some bleeding and spotting for several weeks after your abortion. You can use pads, tampons, or a menstrual cup — whatever's the most comfortable for you. But your nurse or doctor may recommend you use pads for the first few days after the abortion so you can track how much you're bleeding.

The last step is a follow up with your nurse or doctor. You may go back into the health center for an ultrasound or blood test. Or you’ll get a pregnancy test to take at home, followed by a phone call with your nurse or doctor. These tests will make sure the abortion worked and that you’re healthy.

In the unlikely case that the abortion doesn't work and you're still pregnant, your doctor or nurse will discuss your options with you. You may need another dose of medication or to have an in-clinic procedure to complete the abortion.

How does a medication abortion feel?

For most people, medication abortion feels like having an early miscarriage. You might have:

lots of cramping and aches in your belly
very heavy bleeding with large clots (If you don’t have any bleeding within 24 hours after taking the second medicine, misoprostol, call your nurse or doctor. )
an upset stomach and vomiting (Your doctor or nurse may give you medicine to help with nausea.)
diarrhea
dizziness
tiredness
mild fever (99-100° F) or chills on the day you take the misoprostol (If you have a fever after the day you take the misoprostol pills, call your doctor or health center right away.)

To help ease pain and make you more comfortable, you can:

Take pain medication like ibuprofen (Advil or Motrin). Don’t take aspirin because it can make your bleeding worse.
Put a heating pad or hot water bottle on your belly.
Take a shower.
Sit on the toilet.
Have someone rub your back.

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Medical abortion

Medical methods of abortion (abortion) are based on the use of drugs of various groups that affect the function of the corpus luteum and the contractile activity of the uterus, which leads to the termination of pregnancy.

Medical termination of pregnancy (abortion) is considered effective in the case when there is a complete expulsion of the products of conception from the uterus without the use of surgical intervention. Medical abortion is performed after confirmation of pregnancy and the establishment of its term. In the Russian Federation, it is allowed to use medical abortion up to 6-9week of pregnancy. Considering that the success of medical termination of pregnancy largely depends on the gestational age, the latter is best confirmed using transvaginal ultrasound.

PROCESS DESCRIPTION

It all starts with a visit to the doctor. A transvaginal ultrasound is performed, which helps to establish the localization of the fetal egg (it should be in the uterus), as well as its size.

Next, the doctor conducts a gynecological examination and a conversation with the patient. The goal is to find out her history. Possible contraindications to taking the drug.

On the day a woman receives medical abortion drugs from a doctor, she signs a contract for the provision of this service and that she knows about possible complications. They consist in incomplete miscarriage and the need for instrumental intervention in the uterus.

It should be noted that the cause of failure may not be the drug (the domestic generic is not worse than the French original), but the duration of pregnancy. The likelihood of complications increases in proportion to it.

The doctor necessarily tells how the medical abortion goes, what happens in the woman's body, what she can feel, how abundant the bleeding should be, how much it can hurt and whether it is possible to take painkillers.

So, a woman in the presence of a doctor in the clinic takes three pills containing mifepristone. Next, she goes home. Over the next 1-2 days, cramping pains, bloody discharge from the genital tract may occur. Some women have a miscarriage almost immediately, a fetal egg comes out.

But one way or another, after 36-48 hours, the woman should take another drug - misoprostol. Usually, after taking it, active uterine contractions begin. And if a miscarriage did not occur before, then after this drug it will certainly happen.

Heavy bleeding usually lasts 2-3 days. And then the amount of discharge decreases, and after 10-14 days they should completely disappear. At the same time, the woman must perform an ultrasound scan to make sure that the miscarriage was complete. If there is a suspicion of an inflammatory process or any other pathology, treatment may be required.

Complications of an inflammatory nature occur much less frequently with medical abortion than with "classical" surgical abortion. And it almost never gives negative consequences for the reproductive system.
However, it does not serve as a method of contraception.

Among the main advantages of medical abortion, women highlight the ability to stay at home, use in early pregnancy, minimal uterine trauma, lower risk of infectious complications, the absence of manipulations that carry a certain amount of risk and complications (the consequences of anesthesia, infection with hepatitis, HIV, etc.) .

One third of women endure the procedure with little or no pain. Women who have not given birth, especially those who have experienced pain during menstruation, may develop pain syndrome, accompanied by diarrhea, nausea or vomiting. However, the usual painkillers cannot be used - the abortive effect of the drugs taken in the outpatient clinic can be blocked.

Traditional therapies such as rest, dry heat, hot drinks can be used to reduce pain. In extreme cases, "No-shpa" or "Drotaverin" are used.

Negative effects

Any termination of pregnancy cannot pass without consequences for the female body, but medication is the most gentle of all, as it is carried out in the early stages and does not involve surgical intervention that injures the cervix and uterine cavity.

Medical abortion

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Medical abortion

Unwanted pregnancy forces many women to seek help from antenatal clinics. If you make an appointment with a gynecologist when the gestational age is only 3-4 or 6-8 weeks, you can do without a surgical effect on the body. At an early stage of pregnancy, the doctor will suggest a medical abortion, for which a drug interrupter is used. This will avoid damage to the uterus and psychological consequences for the patient. Farmabort is especially effective for nulliparous women, although it has contraindications. Therefore, at the preparation stage, it is necessary to exclude the presence of inflammatory processes in the body and dangerous diseases. The Academy of Health Medical Center offers to undergo a medical abortion procedure by gynecologists of the highest category. Turning to us, patients receive complete confidentiality, attentive attitude, competent preparation for the procedure and the result. Call to make an appointment for a consultation.

What is a medical abortion

A medical or pharmaceutical abortion is an abortion that is carried out with the use of drugs, without the use of curettage or vacuum pressure on the uterus. In fact, this is an atraumatic method with a minimum number of undesirable consequences for the patient. This type of abortion is carried out in several stages under the supervision of a doctor. To carry out the procedure at the level of the Ministry of Health of the Russian Federation, the use of special tablets has been approved, the action of which is aimed at removing the fetal egg from the uterus. It will take a minimum of time to restore the body after the procedure.

There may be clear indications for drug termination of pregnancy against the background of a stop in the development of the ovum. Also, a woman has the right to apply for a service of her own free will. The main condition - the failure of pregnancy using the pharmaceutical method should occur no later than 6-8 weeks from the date of the start of the last menstruation. Therefore, an ultrasound examination is mandatory before an abortion in order to identify the exact period. In rare cases, when the drug interrupter caused incomplete rejection, mechanical removal of the remaining fragments is prescribed. In general, after taking targeted pharmaceutical drugs, miscarriage occurs at 95-98% of cases. The use of medicinal interrupters of pregnancy is possible in the absence of contraindications and with the written consent of the patient. Each tablet is taken strictly under medical supervision.

Stages of medical abortion

To get a positive result, the tablet method of removing the ovum must be carried out after a series of examinations. Preparation begins with an ultrasound scan and setting the exact gestational age. After the woman will be sent:

pass urine;
donate blood for HIV, RW, hepatitis;
will be examined to take a vaginal swab.

You may also need to undergo additional tests:

test for TORCH infection;
cardiogram.

The obtained results will allow the gynecologist to assess the state of health of the pregnant woman, exclude contraindications and prescribe a pharmaceutical abortion. After the preparatory stage, suitable medicines are selected. A conversation is held with a woman during which they tell:

How does the tablet method of abortion work?
how to prepare for the procedure;
what restrictions to follow after medical exposure.

The medical abortion procedure begins with taking a pill, the chemical composition of which, after entering the body, causes the gradual rejection of the ovum. You need to drink it under the supervision of a doctor and spend 2-3 hours in the clinic. After that, the woman is sent home.

After 36-48 hours, the patient should return to the gynecologist, where she will be given a pharmaceutical preparation that causes uterine contractions. This will be the final stage of medical termination of pregnancy, after which discharge resembling menstruation will begin. Together with them, a fetal egg will come out of the uterus. At this moment, the woman remains under the supervision of the medical staff of the clinic. This is necessary in order to prevent deterioration in the event of significant blood loss, to provide timely medical assistance in case of pain, fever or vomiting. The prescribed medication has certificates. The cost of the procedure depends on the drug interrupter of which production is used.