Medical Termination of Pregnancy

 What Is a Medical Abortion?

A Medical Abortion is a combination of two drugs used to terminate an unwanted pregnancy. These medications are Mifepristone and Misoprostol. By combining these two medications as prescribed by your Doctor, 92–95% of women can effectively terminate an unwanted pregnancy, however there are still risks of the pregnancy continuing despite the attempt to terminate. These drugs should only ever be used for women in the early weeks pregnancy (less than 9 weeks), as recommended by the TGA. The Salisbury Day Surgery only provides this method of abortion in gestations of less than 7 weeks as it is our belief that the risks using this combination of drugs between 7 – 9 weeks leads to an unacceptable complication rate.

Mifepristone

Mifepristone is a drug used to block the progesterone hormone, which is an essential hormone required for the continuation of a pregnancy. Blocking the receptors of the progesterone hormone causes the lining of the uterine walls to shed and the embryo to detach. Mifepristone also begins to soften and dilate the cervix, facilitating abortion.

Misoprostol

Misoprostol, is the name of the second drug used in the medical abortion process. The Misoprostol is to be consumed 24 – 48 hours after  Mifepristone and can be taken buccally. The purpose of the Misoprostol is used to cause uterine contractions in an attempt to expel the embryo from the female body.

What Is Required For A Medical Abortion?

  • You will be required to attend at least 2 Doctor’s visits
  • Blood samples will be taken to confirm blood group, as women with negative blood groups require the Anti-D Injection within the first 72 hours of the abortion
  • An ultrasound will be performed to confirm the gestational age of the pregnancy is less than < 7 weeks and to exclude ectopic pregnancy
  • The first medicine Mifepristone will be taken in the consultation during the first  visit to the doctor
  • The second drug Misoprostol is taken at home and must be taken 24 – 48 hours after the first medication
  • Two weeks after a medical abortion you will require a follow up appointment to confirm the termination is completed. The doctor will perform an ultrasound to confirm there is no remaining tissue in the uterus.

Other Things To Consider

  • Women considering a medical abortion must ensure they have access to emergency medical care, in the event of an emergency, or at least until the abortion process is complete
  • The doctor will provide 24 hour emergency phone support following administration of the medications
  • Cramping and bleeding generally begins to occur within a few hours of taking the second medication
  • The amount of pain & bleeding experienced by each individual varies, with some describing it as “uncomfortable” and others describing it as “excruciating”
  • When taking the second drug at home you will need to have a carer or support person (i.e. family member or friend) with you for at least 24 hours or until the expulsion of the pregnancy
  • Pain relief instructions will be provided to you by the doctor during the first consultation
  • On average bleeding lasts for 10-16 days, however some have reported to range up to 30 days or even longer after medical abortion. (This bleeding can be very heavy)
  • Blood clots and other pregnancy tissue, will be expelled during this process. For some women this can be very distressing seeing this material
  • Even if a large amount of bleeding occurs, or continued bleeding, it is still possible that the abortion did not work properly and has not fully completed. In this case a surgical termination would then be required to complete the abortion.
  • Please note there are other side effects that may be experienced which have not been listed.

Adverse Side Effects & Risks

  • Diarrhoea (up to 15%)
  • Nausea (up to 45%)
  • Vomiting (up to 14%)
  • Dizziness, headaches, chills, shivering & fever
  • More than one adverse effect is reported for most patients, with approximately 23% of all adverse events considered serious.

In U.S. trials of Mifepristone & Misoprostol, at least 99% of patients experienced at least one of the following:

  • Abdominal pain (cramping) 97%
  • Back pain 9%
  • Nausea 67%
  • Vomiting 34%
  • Diarrhoea 23%
  • Uterine haemorrhage 7%
  • Headaches 32%
  • Fever 4%
  • Viral infections 4 %
  • Dizziness 12%
  • Chills/shaking 3%
  • Vaginitis 4%
  • Fatigue 9%
 An Australian study found that Mifepristone abortions carried a much higher risk of adverse effects than surgical abortion including that:
  • 5.7% of women required hospital admission
  • 3.3% of women sought Emergency Department hospital treatment
  • 1 in 200 women suffered severe haemorrhaging
 Immediate Medical Attention Must Be Sought For Any Of These Very Serious Side Effects:
  • Fever of 38 °C or higher
  • Fainting
  • Fast heartbeat
  • Ongoing stomach/abdominal pain or tenderness more than 24 hours after taking the Misoprostol