Medical abortions in early pregnancy upto 6-7 weeks using mifepristone & Misoprostol is a very good method for the termination of pregnancy , provided the drug is taken after consulting a Dr and emergency facilities for 24 hours are available nearby.
Failure rate is very low.Surgical intervention is also avoided.
In this knol I am discussing advantages , side efects , dosage schedule and regular follow ups after taking these drugs.
Unfortunately they have gone in the hands of quacks , chemists & paramedical staff .They give these drugs without much knowledge and usually give when duration of pregnancy is more than 7 weeks.Patients usually come with incomplete abortions and excessive bleeding blaming the drug which is not true.
Mifepristone or RU-486
- It is a derivative of norethindrone with antiprogestin action.It binds to progesterone receptors at endometrium and decidua resulting in necrosis of placenta.
- It also softens cervix and causes mild uterine contractions.
- It sensitizes uterus to prostaglandins , which is given within 1 to 2 days.
- Less invasive
- More privacy
- No anaesthesia
- No instrumentation
- No effect on future fertility.
- Number of late abortions have decreased due to this drug.
- Women on steroids for medical reasons
- BP >160/100
- Angina, Valvular disease, Arrythmias
- Severe renal failure
- Liver disorders
- Respiratory diseases
- Allergy to prostaglandins
- Medical abortions should not be performed if there is no 24 hours facility for an emergency.
Cautious use of drugs
- If there is an IUCD inside the uterus.Remove it before giving the drug therapy.
- Women having large fibroids , can have excessive bleeding.
- Uterine scar and previous history of caesarean , hysterotomy and myomectomy then it should be given cautiously.
- Bronchial asthma
- Misoprostol is a weak bronchodilator, can be used in asthma cautiously under medical supervision.
Pre abortion Counseling
- She should come for the regular follow up or three visits.
- Tell her about the excessive bleeding in some cases and she may require surgical intervention.
- Side effects should be told to her.
- Risk of congenital malformations in case the drug fails
- Easy approach to the hospital and transport facility should be there in case more bleeding is there.
- Consent form is signed by the patient.
- Vaginal bleeding usually occurs upto 10 to 15 days.
- She keeps on doing the card test herself and getting disturbed so she should be told about it.
- Next menses is usually delayed by 1 to 2 weeks.Till next period it is better to avoid intercourse or use barrier methods.
- In case of failure suction aspiration is required , she can not continue due to the risk of congenital malformations.
- History is taken.
- General examination is done.
- Haemoglobin is done. Blood pressure is recorded.
- Cardiovascular & respiratory systems should be examined
- Rule out ectopic pregnancy
- Bimanual examination is done to confirm the size of pregnanacy.
- Pregnancy test is must
- ABO & Rh grouping is done.If she is Rh-ve , anti -D is given after abortion.
- Usg in women who are not sure of the dates or conceived during lactational amenorrhoea or recently used OCPs
- History of bleeding to exclude ectopic.
- History is taken.
- Pelvic examination is done.
- Usg may be required if no history of expulsion is there.
- Pregnancy test and curettage may be required if incomplete.
What is Heavy bleeding ?
Delay in next menses
- Within 15 days of abortion it should be initiated.
- IUCD after first normal period should be adviced.
- Barrier methods
- Tubal ligation is adviced if she has completed the family.
- Counseling about prevention of HIV should be done.
- They shoud be informed about the emergency contraception.
Professor sunita mittal
- How do you do abortion of 1month pregnancy by pills (wiki.answers.com)
- Monty Patterson learns about RU-486 the hard way (sfgate.com)
- Drug-Based Abortion Methods (egrejeen.wordpress.com)