Safe Medical Abortion Procedure, Is The Abortion Pill Safe? Dangerous?

Safe Medical Abortion Procedure, Is The Abortion Pill Safe? Dangerous?

The abortion pill procedure is a highly safe and effective way to end a unplanned pregnancy. The Abortion Pill may be dangerous when women self-induce the abortion without medical supervision or do not follow discharge instructions. Over 3 million Abortion pill procedures have been performed in the U.S. since the year 2000. It is estimated that 40% of women in the U.S. will terminate their pregnancy using the abortion pill method who are 8 weeks or less pregnant. The maternal death rate is 10 times higher in women who have a term vaginal delivery or C-Section compared to a first trimester Abortion Pill Procedure.

The Abortion pill process, like any other medical procedure may be associated with complications and side effects. Only 1 to 3 percent of medical abortion procedures have complications. Serious complications that involve having to be hospitalized, requiring surgery or blood transfusion happen in less than 0.5% of cases. The most common complication of the medical abortion procedure is a continued pregnancy.

The medical abortion process consists of the combination of two pills. The first pill is Mifepristone (RU486, Mifeprex, French Pill) and the second is Misoprostol (Cytotec).

Misoprostol use is associated with causing fetal teratogenic (abnormalities) defects in the first trimester of pregnancy. Moebius syndrome is characterized by non-progressive palsy (paralysis) of cranial nerves 6 and 7. This generally presents as paralysis of the face. There may also be abnormalities of the upper and lower extremities. Mental Retardation and skeletal deformities such as crooked feet are common. Misoprostol causes uterine contractions. These contractions reduce blood flow to vital body parts of the fetus. This lack of oxygen causes damage primarily to neurological (Cranial nerves 6 and 7) and musculoskeletal parts of the fetus. These abnormalities occur in 5% to 8% of pregnancies that have been exposed to Misoprostol between the 6rh and 11th weeks of gestation.

Does the abortion pill hurt the baby?

A human must have neural connections to transmit signals from peripheral sensory nerves to the brain in order to feel any type of pain. It is important to have connections with certain neurological brain structures to process those signals. It has been shown that the pain signals are not developed enough to perceive pain until well past the 20th week of pregnancy. There are fetal pain laws that have been passed in several states outlawing abortions past 20 weeks by politicians who have absolutely no scientific or medical backing. A study published in 2005 in the Journal of the American Medical Association suggests that the structures needed for the fetus to feel pain develop between 23 to 30 weeks. Other studies show that premature babies do not begin to feel pain until the 29th to 30th week of pregnancy.

Is abortion pill painful?

In this case, everyone has a different opinion. Women who say that the abortion pill process is painful varies. No one can tell you exactly how it will feel. There are some women who compare their abortion pain as having mild menstrual cramps. Other women describe it as the most severe pain that they have ever experienced in their life. There is no doubt that the medical abortion pill process will cause lower abdominal cramps and bleeding. Generally; the earlier in pregnancy the abortion pill procedure is performed, the less severe the pain.

The medical abortion works by blocking the hormone progesterone using Mifepristone (Mifeprex, RU 486). Progesterone maintains uterine quiescence throughout the pregnancy. A lack, or a sudden drop in progesterone in the first trimester of pregnancy leads to spontaneous miscarriages. The lack of progesterone causes 1) an increase in intrauterine pressure, 2) a breakdown of the lining of the uterine wall and blood vessels supplying the pregnancy and 3) softening and opening of the cervix. This leads to the pregnancy being detached from the uterine wall and passed through the vagina. Additionally; Mifepristone increases the sensitization of the uterus to prostaglandins. Elevated prostaglandin levels are responsible for uterine contractions. This leads to faster expulsion of pregnancy tissue from the uterus.

Mifepristone is normally taken by mouth during the initial abortion clinic visit. Proper medical abortion paperwork filled out and signed, lab work is performed (urine and blood testing), a sonogram and counseling. The counselor describes the medical abortion procedure, goes through the benefits and risks and answers all the patient’s questions regarding the medical abortion procedure.

In 2012, medical abortions were performed in approximately 33% of women who were 8 weeks pregnant or earlier. In 2001, there were only 4.5% of women choosing to undergo the medical abortion procedure. It is estimated that over 40% of women will choose to have the medical abortion in 2018 who are 8 weeks or less pregnant. There is medical world literature showing performing the abortion pill procedure in the second and third trimester of pregnancy is highly effective and safe. Several Abortion Pill Clinics in the US perform late term abortions. In essence; there is no medical abortion limit regarding the number of weeks gestation. Second Trimester and late term abortions using the abortion pill process are started and completed in 24 hours or less.

Misoprostol (Cytotec)

After taking the Mifepristone tablet in the Abortion Clinic, written instructions on when and how to take Misoprostol (Cytotec) are given upon discharge. Misoprostol is the synthetic prostaglandin that was initially FDA approved to treat gastritis and peptic ulcers in patients who take Non-Steroidal Anti-Inflammatory medications. It was found that it could be used alone to terminate pregnancies in the first and second trimester of pregnancy. The success rate in Misoprostol terminating pregnancies when used alone ranges from 85 to 95%. The earlier in weeks gestation, the less chance of the medical abortion procedure failing. The abortion pill failure rate is associated with the dosage, frequency and route of administration (vaginal, sublingual, buccal, or swallowed). The combination of Mifepristone and Misoprostol has a higher success rate in terminating pregnancies compared to using Misoprostol alone.

The majority of patients are told to take the Misoprostol tablets 12 to 48 hours after taking Mifepristone. It may be more convenient for women to take both medications immediately or up to 5 days later. Some studies show taking both medications immediately or more than 48 hours may be less effective in terminating the pregnancy. Other studies show minimal to no statistical difference in the success rate of when the second pill is taken.

Medical Abortion Misoprostol Dosage:

There are various dosages and routes of delivery that have the highest rate of success using Misoprostol alone or combined with Mifepristone to terminate pregnancies. Misoprostol has been given Vaginally, sublingually (underneath the tongue) and buccally (between the cheek and gum) have been compared and studied extensively in the medical literature. Certain routes of administration are associated with a higher rate of success in terminating pregnancy or side effects. Inserting Misoprostol vaginally has a higher incidence of infection and lower chance of fever and chills. Misoprostol given sublingually has the highest incidence of chills. Giving 800 ug Misoprostol via vaginal insertion vs sublingually has the highest success in pregnancy termination. Women prefer taking Misoprostol orally or inserting it vaginally. Sublingual use of Misoprostol is associated with a higher incidence of side effects compared to other routes Misoprostol is given. These include a higher elevation in temperature, heavier vaginal bleeding, diarrhea, nausea and vomiting. The simultaneous insertion of Misoprostol vaginally and placing another set sublingually, has been shown to lead to a higher abortion success rate.

Abortion Pill Failure

Signs and symptoms of the medical abortion not working include 1) no vaginal bleeding, 2) very little to light bleeding, 3) very little to no cramping, 4) continued pregnancy symptoms (nausea, vomiting, breast tenderness, fatigue, tiredness, lack of appetite), 5) cramps and bleeding getting worse, 6) develop low grade temperature, 7) foul vaginal discharge, 7) temperature greater than 101.4 at anytime.

Patients who have vaginal bleeding for the average length of time (5 to 16 days), need to return to the abortion pill clinic for a follow-up to perform a pregnancy test and/or sonogram to ensure that the uterus is empty. Experiencing heavy vaginal bleeding and passage of large blood clots does not assure the pill procedure was successful. If the pregnancy test is negative, several studies show that performing a sonogram is not required. A positive pregnancy test does not mean that further intervention is required. A Ultrasound may show evidence of retained tissue without evidence of a gestational sac or continued pregnancy. Women who are asymptomatic (lower abdominal pain, vaginal bleeding or low grade temperature), the addition of Misoprostol or undergoing a surgical suction curettage may not be required.

Abortion Pill Not Effective:

There are circumstances that may cause the abortion pill procedure to be less effective and/or not be able to be performed. They include the following:

1. It depends on the woman’s overall health. Medical abortion contraindications include ectopic pregnancy, undiagnosed pelvic mass, unexplained vaginal bleeding, Cushing’s Disease, severe anemia, porphyria, recent or current Pelvic Inflammatory Disease (PID) or allergic to Mifepristone or Misoprostol

2. How long one has been pregnant. The cutoff for the medical abortion procedure performed in the US by most Abortion Pill Clinics is 10 weeks. There are many abortion facilities that do not have a limitation on dates of pregnancy when performing medical abortions. The abortion pill procedure can be performed in the first or second trimester of pregnancy. Medical abortions may be performed at 30 weeks or throughout the third trimester for proper maternal or fetal indications.

3. The ability to tolerate pain may prevent women having a good experience during the medical abortion. Rarely does severe pain lead to having a surgical abortion performed. The majority of women are able to undergo the medical abortion without having to take any painkillers. Approximately 40% of women take a Non-Steroidal Anti-Inflammatory medication such as Advil or Motrin for discomfort. Approximately 4% to 8% of women require narcotic pain medication. They describe the medical abortion process as causing them to have the worst pain ever. Studies show that the medical abortions performed at 3 to 4 weeks are associated with much less pain and discomfort than those performed at 8 to 9 weeks gestation or further. This is theoretically due to the larger amount of fetal tissue and the heavier vaginal bleeding that occurs due to being further along. Most women describe the pain as being similar to or little worse than a bad menses.

4. The psychological stress and emotional level for women undergoing a medical abortion procedure can be a factor in not allowing the medical abortion procedure to be carried out in some women. The medical abortion process can be long for some women. It may require 2 to 4 follow-up visits to the medical abortion clinic. The side effect and complication rate is low but retained tissue and the incomplete abortion rate is slightly higher than undergoing the surgical abortion procedure. Undergoing the medical abortion procedure can be highly stressful. Most women are immediately relieved after the procedure is complete. Some women experience post-abortion blues. It is rare for a woman to go into a psychotic depression. Most women who experience significant psychological problems after abortions have a history of psychological illness or do not have family or companion support.

Medical Abortion Failure Rate:

Medical abortions have a high rate of success with very few complications or side effects. The earlier in pregnancy the abortion pill process takes place, the less chance of failure. The rate of success for women less than 6 weeks is over 99%. The success rate drops to 93% to 97% for women who are 9 to 10 weeks pregnant using combined Mifepristone and Misoprostol tablets.

In pregnancies that are 3 to 10 weeks, uterine cramps may begin within 30 mins of taking the second pill; Misoprostol. Bleeding may start as early as 30 minutes after taking Misoprostol. The average time it takes the pregnancy tissue to pass is 4-5 hours. Heavy bleeding and passage of large clots through the vagina may occur. Soaking 2 sanitary pads an hour for two hours in a row may be a sign of heavy blood loss and is a indication to immediately contact the abortion facility.

Abortion pill procedures performed under medical supervision are rarely associated with serious complications that include hospitalization, surgery and/or trees blood transfusion. A fulminate sepsis may lead to multiple organ failure and maternal death. This is extremely rare and it is not known if Misoprostol or Mifepristone actually causes this infection. The rapidity of death may occur in 24 hours or less after taking Misoprostol. The bacterium clostridium sordellii is the sole bacteria that is responsible for this overwhelming sepsis. This severe infection occurs in women who have had surgical abortions, other gynecological surgeries, term vaginal deliveries or C-Sections. Patients may present with a low grade or no elevated temperature, marked lower abdominal pain, listless, tachycardia, listless, low blood pressure, foul smelly vaginal discharge and high elevated white counts. One must have a high index of suspicion to begin aggressively treating these patients with IV hydration and antibiotics.

Despite the serious complications that may occur with the abortion pill procedure, they are extremely rare. Maternal death is 10 times more likely to occur in women who have a vaginal delivery or C-Section with a full term pregnancy than having a medical abortion.

Common side effects when taking the medical abortion pills (Mifepristone) include the following:

1. Headache

2. Mild to Severe Cramping

3. Breast tenderness

4. Stomach upset

5. Nausea

6. Low grade fever

7. Fatigue

8. Dizziness

9. Diarrhea or Constipation

10) Vaginal Bleeding

These side effects normally last for no longer than 2-3 days.

How to minimize the pain:

Talk to the healthcare provider regarding pain. Taking ibuprofen or another anti-inflammatory medication 30 minutes prior to taking Misoprostol may help reduce the pain and discomfort. Zofran or Phenergan may be used to combat nausea and vomiting.

Other methods that may help with pain and discomfort are the following:

1. Always try and schedule this process on a day when you can stay at home. Being at work, school or going shopping during the medical abortion procedure will not work.

2.Try to wear loose clothing for a few days.

3. It is a good idea to apply hot water bottles or a heating pad to the lower abdomen for pain relief.

4. Use pillows to get a comfortable position.

5. Try deep breathing exercises.

6. Take a long warm shower.

7. Get a back and uterine massage. The uterine massage helps to remove clots and blood inside the uterus that may be the reason for moderate to severe lower abdominal pain. In order to perform, one should lie down on your back and place one hand and fingers in the midline of the abdomen below the navel. Press deeply and down towards the public bone. Once reaching the pubic bone, lift the hand and continue this process for 2 to 3 minutes.

Are emotional side effects possible?

Emotional side effects that occur before, during or post-abortion are not the same in every person. Most women feel immediate relief, pleased, thankful, and have a speedy recovery and are able to move on with their lives. Other women may develop post-abortion blues where they are sad and may feel guilt or shame for terminating their pregnancy. The majority of women recover mentally after having brief counseling with the provider who performed the abortion procedure. There are several non-profit organizations that have qualified experts who help women navigate through their emotional challenges. In rare cases, patients may develop significant psychological disturbances that require immediate medical intervention and possible hospital admission This is commonly seen in women who have a previous history of anxiety, depression or other psychological problems.

If you are suffering from negative emotions or having feelings that interfere with your normal daily routine, you must consult with a healthcare professional. They are able to provide proper support and therapy.

Do abortion pills make you bleed?

Vaginal bleeding occurs in over 99% of cases where the abortion pill is used to terminate pregnancies. Taking Mifepristone alone is successful in ending pregnancies 8 weeks or less 40% of the time. It generally takes greater than 30 days to complete. When combined with Misoprostol, the success rate for the medical abortion procedure increases to 96% to 99% in women who are 8 weeks or less pregnant.

Cramping and vaginal bleeding are two of the most common signs and side effects that occur with taking the second pill; Misoprostol. As the abortion process continues, the vaginal bleeding and cramps may become severe. The moment the gestational tissue passes through the cervix, the heavy vaginal bleeding and pain subside.

Normally, the bleeding and uterine cramping will continue for one to three weeks after passage of the fetal tissue. The cramps and bleeding may increase in decrease on a daily basis for the first couple of weeks. There are women who may experience heavy vaginal bleeding around day 10 post-abortion. Misoprostol tablets may be required or Surgical Suction Curettage may needed to be performed to control the bleeding.

Medical Abortion For Ectopic Pregnancy:

Ectopic pregnancies are associated with a decreased incidence in women who have the abortion pill using the combination of Mifepristone and Misoprostol. This combination is not used to treat ectopic pregnancy as its mechanism of action involves detaching the pregnancy from the lining of the uterine wall.

Methotrexate Used For Medical Abortion and Treat Ectopic Pregnancy:

The combined use of Methotrexate and Misoprostol was commonly used to terminate early pregnancies prior to approval of Mifepristone by the FDA in the year 2000. It is still being used today. The combination of Methotrexate and Misoprostol is less effective and efficient in ending early pregnancies compared to the Mifepristone and Misoprostol regimen.

Another name for the combined use of Methotrexate and Misoprostol is the “medical abortion shot.” Methotrexate can be administered by injection or taken orally. Methotrexate has a different mechanism of action in how it works in stopping the growth and development of early pregnancies that are 7 weeks or less. Methotrexate blocks the enzyme dihydrofolate reductase that is important for the production of DNA. Trophoblastic (placental) tissue differentiates into cytotrophoblast and Syncytiotrophoblast. It is the latter trophoblastic tissue that is the the forms the outer lining of the villi that invade the uterine wall setting up the vessels that supply oxygen and nutrients to the gestational tissue. It also produces Beta-HCG, Human Placental Lactogen, Leptin and Progesterone. It is the production of Beta-HCG that maintains the corpus luteum. It is the corpus luteum that is responsible for maintaining the pregnancy up until approximately 12 to 16 weeks where the syncytiotrophoblast become primarily responsible for the production of progesterone. Methotrexate does not work after the 7th week of pregnancies in ending pregnancy. Due to its mechanism of action, Methotrexate which is still used today to provide the medical abortion procedure, is used to treat ectopic pregnancies when certain criteria are met. The Abortion Pill Procedure which uses Mifepristone and Misoprostol is not used to treat ectopic pregnancies.

Do medical abortions affect future fertility?

The normal menstrual period usually returns four to six weeks following the medical abortion procedure. Studies comparing women who have had medical abortions to women who have never been pregnant show a higher fertility rate in women who have previously underwent the abortion pill procedure. Several studies show that the medical abortion procedure does not have an adverse effect on a woman’s chances of becoming pregnant in the future. The incidence of maternal death following a medical abortion procedure is 0.00063% for abortions 8 weeks or less.

Birth Control:

Ovulation may occur as soon as 5 or 6 days after the medical abortion is complete. Sperm can live for five days. After undergoing the abortion pill procedure, a woman having unprotected intercourse is almost immediately able to conceive. This scenario occurs numerous times after pregnancy termination. Women have had 2, 3, 4 or 5 medical abortions in a 6 month to year period of time. There is always a small chance of maternal morbidity or mortality when undergoing an abortion procedure. Why should a woman take the chance of harming her body from an unwanted pregnancy if it can be prevented?

This is where several choices of birth control come into play. Condoms (female or male), birth control pills, progesterone injections or pellets that are placed underneath the skin or insertion of an Intrauterine Device (IUD) are all safe methods of birth control. The majority of medical facilities highly encourage women to start birth control immediately after having the abortion procedure performed. Many women decide to wait and make appointment with their private physician or will wait to make decision during their follow-up visit regarding their choice and method of birth control Nearly 26% of women who undergo a medical abortion and over 50% of women who have a surgical abortion do not return for their follow-up visits. There is always a small percentage of women who return to the office after the medical abortion who did not start their menses after 4 to 6 weeks and on sonogram they have a new pregnancy. Medical abortion failure can lead to a continued pregnancy. All patients are counseled to return for their 2 to 4 week check up to ensure the abortion process is complete.

Second Trimester Abortion Pills:

Given the above scenario, patients who return to the office after 3 months of no no menses, may find themselves 16 to 22 weeks pregnant. A ssecond trimester or late term abortion may be performed surgically by Dilation and Evacuation (D&E) procedure or a Medical Abortion procedure using the Abortion Pill process. The late term medications that may be used are Misoprostol alone or Mifepristone and Misoprostol.

Free Emergency Contraception (Morning After Pill:

In an attempt to prevent another unwanted or unplanned pregnancy, most women are open to taking home the Free Emergency Contraceptive Pill. It is different from the Abortion Pill. The Morning After Pill prevents or delays ovulation (egg release). It does not cause abortion. Levonorgestrel (Plan B) 1.5 mg tablets is commonly used as Emergency Contraception. Studies show it is most effective in preventing pregnancy immediately after the unprotected event. It is effective up to 5 days (120 hours) in preventing pregnancy. The sooner after the unprotective event the Morning After Pill is taken, the greater success in pregnancy prevention. There are no contraindications in taking Levonorgestrel. Our offices encourage the Emergency Contraceptive Pill be carried in every woman’s purse or placed in her medicine cabinet. Women who are sexually active and of reproductive age who are exposed to an unprotected event or contraceptive failure (condom leakage or breakage) can immediately take Emergency Contraception. The Morning After Pill is included free in our Abortion Pill and Surgical Abortion prices. Our Abortion Clinics do not have hidden costs or fees.

Do abortion pills make you gain weight?

The majority of women lose weight after termination of their pregnancy. This holds true whether the procedure is performed surgically or by the abortion pill method. Pregnancy is associated with a significant rise in the hormone estrogen and progesterone. They increase storage of fat and retention of fluids and thus weight gain. Some women develop hyperemesis gravidarum. This is theoretically due to the elevation of beta-HCG and Progesterone. Elevated progesterone slows down the stomach emptying and may lead to severe constipation. Continued elevation of Beta-HCG may lead to incapacitating nausea and vomiting and weight loss. The severe nausea and vomiting may last throughout the first trimester of pregnancy (first 14 weeks). The nausea and vomiting for most women subsides between the 10th and 12th week of pregnancy. Though rare, there are a few women that may have severe nausea and vomiting that may last the entire pregnancy. Women who lose weight during pregnancy are generally at high risk for complications later during pregnancy.

Women who gain weight after the abortion pill procedure may need to be evaluated for hypothyroidism or severe depression.

Wrapping Up:

The Abortion pill is a highly effective and safe way to terminate pregnancies throughout the first and second trimesters of pregnancy. Recent studies show that women undergoing the medical abortion procedure at 12 to 13 weeks have a success rate of 92% to 93%. The abortion pills do not affect fertility or cause problems with future pregnancies (preterm births, preterm labor, Intrauterine Growth Restriction). Normal menses returns four to six weeks after the abortion pill procedure is complete. The 2 to 3 week follow up visit after taking the Misoprostol tablets is important to insure the medical abortion process did not fail. It is imperative to immediately get on some form of birth control. Ovulation may occur 5 to 6 days after Misoprostol is given. Plan B or a generic form of Levonorgestrel 1.5mg tablet, should be dispensed to all women who are undergoing a medical abortion procedure. It is not the standard of care to include Free Emergency Contraception in the discharge packet. Unplanned pregnancies can be reduced up to 96% by using Emergency Contraception. The unintended pregnancy rate in the US stands at nearly 2.4 million a year. Pregnancy related complications are the 5th leading cause of death of women in developing countries. It is our moral and ethical duty to reduce the incidence of maternal morbidity and mortality. This certainly can be done by using the Morning After Pill to prevent an unwanted pregnancy.

Dr James S Pendergraft Orlando Abortion

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