Medical abortions use drugs or chemicals to end the life of the
developing baby during the early stages of human growth. Currently,
3 chemicals are used to perform a medical abortion: methotrexate,
misoprotol, and mifepristone (RU-486). These chemicals are used
in combination protocols.
Methotrexate
Methotrexate is a chemical that prevents the developing baby
and placenta from properly using folic acid. Without the normal
use of folic acid, the baby cannot make, repair, or replicate
DNA in order to survive, and dies.
Misoprotol (Cytotec)
Misoprotol (Cytotec) is a chemical that resembles a prostaglandin
in its action. It causes very intense uterine contractions to
expel the developing baby and placenta. According to the 2001
Physician's Desk Reference, abortions caused by Cytotec may be
incomplete leading to potentially dangerous bleeding, hospitalization,
surgery, infertility, or maternal deaths.
WARNING: Searle, the manufacturer of Cytotec, warns against
the use of misoprotol in pregnant women. There have been reports
of severe uterine contractions, including uterine rupture with
the use of this drug in pregnant women. It can also cause diarrhea
and abdominal pains.
Mifepristone (RU-486/Abortion Pill/Mifeprex)
Mifepristone (RU-486 / The Abortion Pill/Mifeprex) is a chemical
that blocks the action of the hormone progesterone. Progesterone
is needed to continue the pregnancy by maintaining the lining
of the uterus; this is necessary for normal implantation as well
as normal placental attachment and development. RU-486 causes
the the lining to die and separate from the uterine wall. When
this happens, the baby's blood supply (carrying nutrients and
oxygen) is cut off. Both the placenta and the baby eventually
fall from the uterine wall attachment site.
Warnings about the side effects and major complications of Mifeprex
that may include:
Methotrexate and Misoprostol Combination Technique
This technique is used in a pregnancy less than 49 days old (7
weeks after the first day of the last normal menstrual period).
Procedure Description:
Day 1
Patient should receive necessary blood tests and a sonogram to
confirm the pregnancy and its gestational age. She is given Methotrexate
orally or by injection.
Day 3-7
Patient inserts Misoprostol tablets into her vagina three days
after receiving Methotrexate. Bleeding usually begins within the
first 24 hours after inserting Misoprostol. Contractions may begin
up to 2 days later.
Day 8
Patient receives a sonogram one week later to determine whether
the baby is still present there and attached to the uterine wall.
If so, a second dose of Misoprostol is given.
Day 15
A week later, a repeat sonogram is needed to verify that the abortion
is complete. If not the patient will need a D&C. Sometimes the
abortion clinic will elect to observe the patient several weeks
before performing the surgical abortion.
Complications / Side Effects:
May require a surgical abortion:
Pain
Up to 90% of women may require a pain reliever, sometimes codeine
for cramping and abdominal pain.
Bleeding
V aginal bleeding can last up to 3 weeks with the passage of blood
clots. Anemic women are not candidates for this procedure.
Nausea, Vomiting, and Diarrhea
Women experiencing these symptoms may require medication to stop
the vomiting and diarrhea.
Infection
May result from retained pregnancy products, undiagnosed STD or
possible destruction of the body's white blood cells (neutropenia,
4%).
Sources: Hatcher RA, Nelson AL, Zeiman M et al. A Pocket Guide
to Managing Contraception. Tiger, Georgia: Bridging the Gap Foundation,
2001. Scott JR, Di Saia PJ, Hammond CB and Spellacy WN. Danforth's
Obstetrics and Gynecology, 8th edition-Philadelphia: Lippincott
Williams & Wilkins, 1999
RU-486 (Mifepristone) / Mifeprex combined with Misoprotol Technique
RU-486, also known as the "Abortion Pill" was approved for use
in a pregnancy that is no older than 49 days old (7 weeks after
the beginning of the last menstrual period).
Procedure Description:
Day1
Patient should have a pelvic examination, blood tests and a sonogram.
The sonogram will document the viability and gestational age of
the pregnancy. RU-486 is given to cause the destruction of the
baby's nutritional support, and eventually the baby itself. 60-80%
of women will abort after using Mifepristone alone.
Day 3
Within 48 hours after receiving RU-486, Misoprotol is given vaginally
or orally to start uterine contractions. Up to 70% of women will
abort within 4 hours of receiving misoprotol.
Day 14 or 15
Patient will return for a sonogram. Up to 98% of women will have
completed the abortion after receiving both mifepristone and misoprotol.
If the abortion is not complete, she will need a surgical abortion
(D&C).
Complications / Side Effects:
May need a surgical abortion
Incomplete abortions occur in about 2% of the women and continued
pregnancy in about 1%.
Bleeding
Sometimes, a woman may have excessive bleeding or hemorrhaging
that requires surgical intervention (<1%) with rarely needed blood
transfusions.
Nausea, Vomiting and Diarrhea
These symptoms may require medications to stop vomiting and diarrhea.
Tubal Pregnancy
There is a possibility of maternal death in the case of an undiagnosed
ectopic pregnancy.
Sources: Hatcher RA, Nelson AL, Zieman M et al. A Pocket Guide
to Managing Contraception. Tiger, Georgia: Bridging the Gap Foundation,
2001. HHS News. Department of Health and Human Services. September
28, 2000. New England Journal of Medicine, 338: 18. April 30,
1998. s.
