The following section discusses various elective, induced abortion techniques along with potential side effects and possible complications. There are 2 categories: medical abortions and surgical abortions. In the US, approximately 1.2 to 1.6 million women choose to terminate their pregnancy each year. Up to 90% of abortions occur in the first trimester with the procedure of choice being a surgical abortion (97%).
Prior to having any procedure that electively terminates a pregnancy, a woman should receive basic information from which she can make an informed decision. Each procedure carries its own specific complications, associated risks and possible side effects.
NOTE: It’s important to remember that up to 30% of all pregnancies end in spontaneous abortions or miscarriages. So, you need to document whether your current pregnancy is viable. This should be done through a sonogram BEFORE you make your appointment for an abortion. You may not need an elective, induced abortion if you are in the process of having a miscarriage.
What is it?
This procedure involves the use of 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.
How does each chemical work?
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.
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 / 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:
Heavy and extended bleeding
Impaired future fertility
Nausea, vomiting and diarrhea
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).
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.
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.
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.
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.
Any Complications or Side Effects?
May require a surgical abortion:
5% of pregnancies at 7 weeks gestational age are not complete after this procedure and require a D&C.
Up to 16% of pregnancies between 7 and 8 weeks gestational age are not complete after this procedure and require a D&C.
12% to 35% of women may experience a delay in abortion for up to 1 month.
Up to 90% of women may require a pain reliever, sometimes codeine for cramping and abdominal pain
Vaginal 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.
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: Week 1
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.
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).
Any Complications or Side Effects?
May need a surgical abortion
Incomplete abortions occur in about 2% of the women and continued pregnancy in about 1%.
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.
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.