Medical abortion refers to the use of pills to terminate a pregnancy. Medical abortion may also be referred to as "non-surgical abortion" or "medication abortion". Abortifacient pills used to terminate a pregnancy are commonly referred to as "abortion pills."
Medical abortion became an alternative method of abortion with the availability of prostaglandin analogs in the 1970s and the antiprogestogen mifepristone (also known as RU-486) in the 1980s. The combination of mifepristone and misoprostol, or misoprostol alone, are the safest and most effective drugs to medically induce an abortion.
Maps, Directions, and Place Reviews
Medical uses
According to the World Health Organization (WHO) 2012 Safe abortion: Technical and Policy Guidance for Health Systems-2nd Edition, both surgical and medical options are recommended. Considering the geographical and political barriers that hinder some women's access to abortion services, medical abortion is designed to allow for a safe abortion to be completed privately and within a home setting. This process of medically inducing an abortion is similar to a miscarriage, and when done within the first 9 weeks of pregnancy poses minimal risks.
The safest and most effective method to induce a medical abortion is via a regimen that involves both mifepristone and misoprostol. If used as directed, mifepristone plus misoprostol is effective in ending a pregnancy before 10 weeks 95% of the time. This regimen can be found at websites such as the site of the organization Women Help Women. However, misoprostol alone may also be used to terminate a pregnancy. A different regimen of 12 tablets of misoprostol is used and is 80-85% effective in ending a pregnancy up to 12 weeks. Medical abortion is a less invasive procedure than an aspiration abortion (also called surgical abortion). Medical abortion is safe regardless of:
- Age
- Weight,
- Single or twin pregnancies
- Women who are breastfeeding at the time of their pregnancy
- Women who have previously undergone a caesarean procedure
HIV-positive women are also eligible for medical abortion, however they may be at a higher risk of infection and may need to use antibiotics following the administration of the abortion pills. In addition, women who are more than 9 weeks pregnant and RH-negative should receive RH-immunoglobin injection within the same day or up to 72 hours following the administration of the abortion pills if possible.
Side effects
According to the World Health Organization (WHO) 2012 policy guidance, the possible side effects of medical abortion are the same as those associated with miscarriages. These include uterine cramping and prolonged menstrual bleeding which typically takes place over the span of 9 days but in a rare number of cases can last for up to 45 days.
Nausea and vomiting are frequent pregnancy-related symptoms. Therefore, it is recommended that a woman use an anti-nausea medicine (an anti-emetic) before using the medicines if she has been experiencing nausea. If a woman vomits the mifepristone medication within the first 1.5 hours after having taken the pill, the medicine may not be effective. However, usually mifepristone is absorbed within 1.5 hours, so vomiting after this period usually will not impact the abortion process. Misoprostol must be absorbed either under the tongue (sublingual) or in the cheek (buccal) for 30 minutes. If vomiting takes place before the 30 minutes, the misoprostol may not be effective.
Nausea, chills, diarrhea, headache, and flu-like symptoms are other reported side effects of misoprostol and are often resolved within 6 hours of using the drug. If any of these symptoms last for more than 24 hours, seeking medical attention is advised.
A table in the 2010 Handbook of Obstetric and Gynecologic Emergencies, 4th edition lists these possible complications of medical and surgical abortion:
- Medical abortion
- Hemorrhage
- Incomplete abortion
- Uterine or pelvic infection
- Ongoing intrauterine pregnancy, requiring a surgical abortion for completion
- Misdiagnosed/unrecognized ectopic pregnancy
- Surgical abortion
- Hemorrhage
- Incomplete abortion
- Uterine or pelvic infection
- Ongoing intrauterine pregnancy, requiring a second procedure
- Misdiagnosed/unrecognized ectopic pregnancy
- Hematometra (blood clots accumulating in the uterus)
- Uterine perforation
- Cervical laceration
Although medical abortion is associated with more bleeding than surgical abortion, overall bleeding for the two methods is minimal and not clinically different. In a large-scale prospective trial published in 1992 of more than 16,000 women undergoing medical abortion using mifepristone with varying doses of gemeprost or sulprostone, only 0.1% had hemorrhage requiring a blood transfusion. It is often advised to contact a health care provider if there is bleeding to such degree that more than two pads are soaked per hour for two consecutive hours.
Since 2001, ten women--one in Canada, eight in the United States, one in Portugal--have died from clostridial toxic shock syndrome (nine from Clostridium sordellii, one from Clostridium perfringens) following early medical abortions using 200 mg mifepristone orally followed by 800 mcg misoprostol--nine vaginally, one buccally--without prophylactic antibiotics.
A retrospective study published in The New England Journal of Medicine in July 2009 of 227,823 women who underwent medical abortion at Planned Parenthood affiliate centers from January 2005 through June 2008, found that the rate of serious infection after medical abortion declined by 93% after a change from vaginal to buccal administration of misoprostol combined with the routine prophylactic administration of doxycycline antibiotics.
Contraindications
According to the 2006 WHO Frequently asked clinical questions about medical abortion:
There are very few absolute contraindications to medical abortion. They include:
- previous allergic reaction to one of the drugs involved;
- inherited porphyria;
- chronic adrenal failure;
- known or suspected ectopic pregnancy.
Caution is required in a range of circumstances including:
- if the woman is on long-term corticosteroid therapy (including those with severe, uncontrolled asthma);
- if she has a hemorrhagic disorder;
- if she has severe anemia;
- if she has pre-existing heart disease or cardiovascular risk factors (e.g. hypertension and smoking).
Management of prolonged bleeding
According to the 2006 WHO Frequently asked clinical questions about medical abortion, vaginal bleeding generally diminishes gradually over about two weeks after a medical abortion, but in individual cases spotting can last up to 45 days. If the woman is well, neither prolonged bleeding nor the presence of tissue in the uterus (as detected by obstetric ultrasonography) is an indication for surgical intervention (that is, vacuum aspiration or dilation and curettage). Remaining products of conception will be expelled during subsequent vaginal bleeding. Still, surgical intervention may be carried out on the woman's request, if the bleeding is heavy or prolonged, or causes anemia, or if there is evidence of endometritis.
Methods
There are three methods for medical abortion: the drug mifepristone followed by misoprostol, methotrexate followed by misoprostol, and misoprostol alone. The World Health Organization (WHO) recommends an evidence-based mifepristone-misoprostol combination regimen for medical abortion; where mifepristone is not available it recommends a misoprostol-only regimen. A methotrexate-misoprostol regimen can also be used; however, because methotrexate may be teratogenic to the fetus in cases of incomplete abortion, the WHO does not recommend a methotrexate-misoprostol combination regimen for medical abortion. Mifepristone-misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate-misoprostol combination regimens. Mifepristone-misoprostol and methotrexate-misoprostol combination regimens are more effective than misoprostol alone.
Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used to induce second-trimester abortions in Canada, most of Europe, China and India; in contrast to the United States where 96% of second-trimester abortions are performed surgically by dilation and evacuation.
The early first-trimester medical abortion regimen (200 mg of oral mifepristone, followed 24-48 hours later by 800 mcg of buccal misoprostol) currently used by Planned Parenthood clinics in the United States since April 2006 is 98.3% effective through 59 days gestation.
A 2011 systematic review found that it was simpler and equally safe to administer mifepristone in clinic and have the pregnant woman later take misoprostol at home as it was to administer both drugs in the clinic.
Cost
In the United States in 2009, the median price charged for a medical abortion up to 9 weeks gestation was $490, four percent higher than the $470 median price charged for a surgical abortion at 10 weeks gestation. In the United States in 2008, 57% of women who had abortions paid for them out of pocket.
In April 2013, the Australian government commenced an evaluation process to decide whether to list mifepristone (RU486) and misoprostol on the country's Pharmaceutical Benefits Scheme (PBS). If the listing is approved by the Health Minister Tanya Plibersek and the federal government, the drugs will become more accessible due to a dramatic reduction in retail price--the cost would be reduced from between AU$300 and AU$800, to AU$12 (subsidised rate for concession card holders) or AU$35.
On 30 June 2013, the Australian Minister for Health, the Hon Tanya Plibersek MP, announced that the Australian Government had approved the listing of mifepristone and misoprostol on the PBS for medical terminations early in pregnancies consistent with the recommendation of the Pharmaceutical Benefits Advisory Committee (PBAC). These listings on the PBS occurred on 1 August 2013.
Source of the article : Wikipedia
EmoticonEmoticon