The Abortion Pill: Success And Failure Rates When Using The Abortion Pill.

The Abortion Pill: Success And Failure Rates When Using The Abortion Pill.

Abortion related complications are rare, but they happen. If a problem arises, the abortion provider or hospital if closer to your home may be the best place to seek medical care. Over 47% of abortions performed in the United States in women under 8 weeks are ended by the abortion pill method. The rate of success in women who are 8 weeks or less pregnant is 96% to 99%. For women who are 9 to 10 weeks pregnant, the success rate slightly declines to 93 to 98%. Patients who are 13 weeks pregnant, the success rate is 93% to 96%.

The failure rate of the medical abortion process is less than 1%. The chance of serious complications where hospitalization, surgery or blood transfusions are required is less than 0.5%. Maternal death occurs in less than 0.0063% of cases. These complications are comparable to spontaneous miscarriages that occur in 10 to 15% of patients.

The abortion pill is actually two different pills. The first one is Mifepristone (Mifeprex, RU 486, French Pill) that was FDA approved for early medical abortions (7 weeks or less) in Sept. 2000. It works by preventing progesterone from attaching to progesterone receptors on the uterus. This leads to a response as if there is not adequate progesterone in the body. The lining of the uterine wall sheds and the pregnancy detaches. Additionally; Mifepristone also increases the pressure inside the uterus, softens the cervix and increases the sensitivity of the uterus to contract when it is exposed to prostaglandins.

Misoprostol (Cytotec) is the second pill given. Cytotec is a prostaglandin that was FDA approved to prevent peptic ulcer disease in people who take Non-Steroidal Anti-Inflammatory medications on a chronic basis. Giving Cytotec to women who are pregnant was found to cause uterine cramps, vaginal bleeding and miscarriages. Prostaglandins cause the uterus to contract and pushes the pregnancy tissue through the cervix.

1. Why Abortion Pill Didn’t Work

A study was done using Misoprostol alone to determine why in some situations the abortion pill does not work. The study included only women with a diagnosis of anembryonic gestation (only a sac seen), embryonic/fetal demise (no growth of pregnancy tissue and or absence of fetal heart beat), and incomplete/inevitable abortion (cervix open along with vaginal bleeding. There was an overall higher success rate in patients with lower abdominal pain and vaginal bleeding that occurred within 24 hours of taking the Misoprostol tablets. A higher rate of success was also noted in women who had never given birth and have a Rh negative blood type. The success rate causing a complete abortion with one dose of Misoprostol was approximately 75%. The success rate using Misoprostol alone to terminate a normal pregnancy is 85 to 95 percent. When combined with Mifepristone, the success rate increases to 93 to 99% depending on the weeks of pregnancy.

The abortion pill failure rate is extremely small. When it does fail, one has to think of a continued pregnancy, ectopic pregnancy, incomplete abortion or fetal demise (no growth of pregnancy tissue and or absence of fetal heart beat). There are situations where patients may bleed heavy for several days and yet the pregnancy remains intact and continues to grow normally. This is why it is important to follow all instructions. The 2 to 4 week follow-up appointment is extremely important. It is to assure the absence of fetal tissue and there are no other complications.

A medical abortion is considered a failure when a surgical procedure must be performed. All patients who choose to undergo a medical abortion procedure understand that the success rate is not 100%. Reasons that a surgical abortion may be required are the following.

  • Continued pregnancy

Approximately 25% of patients do not return for their 2 to 3 week follow up visit. So for example they may return 3 months later woth the complaint of no menses since her abortion procedure. A sonogram is done that shows the pregnancy is the same one and there continues to be normal growth. The patient must decide if she wishes to continue with the pregnancy or have an abortion. There are abortion clinics that perform abortions in the early and late second trimesters of pregnancy and late term abortions using the abortion pill. Women who are 13 weeks, 15 weeks, 17 weeks, 19 weeks and 21 weeks pregnant are able to terminate their pregnancies using the medical abortion methods. Hundreds of articles written in the medical literature now show that abortions from 14 to 30 weeks can be performed in a highly efficient and safe manner. Maternal or fetal criteria must be met to carry out late second trimester and third trimester abortions.

  • Patient Changes Her Mind

After taking Mifepristone, the patient may choose to have the procedure completed faster. This could be for many reasons (personal, work or school schedule, etc).

  • Heavy Vaginal Bleeding

Women who experience no bleeding, very little bleeding, light bleeding or no pain after taking the Misoprostol pill should be evaluated for ectopic pregnancy or failure of the medical abortion. It is rare but possible that neither bleeding or lower abdominal or pelvic cramps occur and the medical abortion is successful. This occurs in women who are 3 to 4 weeks gestation. They have a positive pregnancy test the day of, or 1 to 2 days after their missed menses.

On the other hand; using 2 maxi pads an hour for more than 2 hours in row is considered heavy bleeding. The most common reason for this is due to retained pregnancy tissue in the uterus. Approximately 2 to 3 out of thousand procedures, a blood transfusion is required. There are studies showing the dosage and route of how the Misoprostol is given may will help diminish the incidence of significant blood loss. Misoprostol may be given sublingually, buccally or rectally. Insertion of Misoprostol vaginally when patients are bleeding heavy because the pills will flush out of the vagina. The bleeding generally begins to subside (decrease) 15 to 20 minutes after the tablets are taken. If significant blood loss has occurred

a surgical suction curettage should be considered.

  • Retained products of conception

Continued off and on bleeding and abdominal pain may lead to the suspicion of retained pregnancy tissue within the uterus. It is confirmed when pregnancy tissue is visualized on sonogram. On vaginal examination, the cervix is noted to be open and pregnancy tissue may be protruding from the cervical os. Bleeding may be active or not present. A foul vaginal discharge may be present. Uterine tenderness elicited on pelvic exam may indicate infection. Antibiotics may be started to prevent (prophylactic) or treat an ongoing infection. Misoprostol tablets or surgical suction curettage are the two methods utilized to empty the uterus. The decision to choose between one or the other depends on how long the process has been going on, the patient’s vital signs, her hydration status, nausea, vomiting, the amount of vaginal bleeding, pain, and the entire patient’s clinical picture.

Medical abortion guidelines and take home instructions emphasize the importance of counseling women about the risk of failure and complications associated with the abortion pill procedure. Patients are asked to call a 24 hour emergency number at anytime for a elevated temperature of 100.4 that lasts more than 24 hours, significant lower abdominal pain that is not relieved by pain medication, a sudden severe right or lower quadrant pelvic pain that may indicate ectopic pregnancy, continuous diarrhea or vomiting, unable to stand up or walk without getting dizzy, tachycardia (rapid heart beat), listless, unresponsive or develop a foul smelling vaginal discharge.

A fulminate sepsis may occur in a small percentage of patients and develop multiple organ failure within 24 hours after given Misoprostol. Clostridium Sordellii is the bacteria that is associated with this deadly series of events. One must have a keen sense of suspicion when a patient has had a early medical abortion. One presents with a below normal temperature, nausea, vomiting, uncharacteristic severe lower abdominal pain, listless, unable to stand and a foul vaginal discharge. They must be immediately admitted to the hospital and given IV hydration and antibiotics.

2. When Should The Abortion Pill Be Taken?

The abortion pill procedure was recently modified by the FDA for approval to terminate abortions up to 10 weeks using the abortion pill method. For women who are further than 10 weeks pregnant, the abortion pill procedure may still be performed. One may need to call several abortion clinic facilities to find a competent experienced Physician and medical staff that are able to perform later term abortions using the abortion pill.

3. How Effective Is The Abortion Pill?

Studies show that the Abortion Pill process can be as high as 100% effective for patients who are 6 weeks or less to as low as 93%. The route of administration can be an important factor in completing the abortion procedure. When the procedure has failed twice, the last option before having to perform a surgical procedure is to give women the choice of performing a in-clinic medical abortion procedure. Performing the medical abortion in a hospital or medical facility was quite common in the past. Millions of procedures were carried out in this manner worldwide. After numerous studies and millioms of patients going through the medical abortion pro ess, it has been proven to be highly safe. The instructions for taking the second set of pills (Misoprostol) that includes dosage, route of administration (vaginal, sublingual, buccal or swallowed) and frequency are not generally difficult to follow. Perhaps the pills if inserted vaginally are not placed in as deep or underneath the cervix as required. Or perhaps the Misoprostol tablets did not dissolve (melt) and thus an adequate dosage was not achieved for the abortion process to be completed. On the other hand, placing the tablets buccally or sublingually may not be able to be achieved. Some women find the taste of the tablets in the mouth is not comfortable. Some complaimts are that they are chalky, make the mouth have a slight tingle and they are a few who just cannot hold the tablets in theor mouth for 30 minutes and then swallow them as directed. Thus it can be determined in the clinic or medical facility setting the medications are being utilized properly. Isolated medical papers discuss administering Misoprostol by several routes at the same time. The rate of success has been reported as 100%. Tj3e use of Cimetidine or Zantac have anti-histaminic effects. Histamines effect in the uterus helps to build the lining of the uterine wall during pregnancy. It has also been utilized as an adjunct with the Misoprostol tablets in initiating and completing the medical abortion process. Zantac and Cimetidine have been studied as a Emergency Contraceptive method in several countries for over 20 years. They have been shown to reduce the pregnancy rate by altering the lining of the uterine wall that prevents implantation. This is the same mechanism that is also believed to reduces the incidence of retained products of conception after a medical abortion, but to initiate the abortion process when combined with Misoprostol.

Only 23% of patients are confirmed on sonogram to have a complete procedure in 1 week. A sonogram should only be performed to document absence of the gestational sac or fetal heart beat. It is not uncommon for the pregnancy test to remain positive up to 3 weeks or longer and patient are not pregnant documented by sonogram. It may take up to 4 weeks or longer to achieve a negative= pregnancy test. A new pregnancy or ectopic pregnancy must also be considered. Studies show that even at 3 weeks there may be what appears to be products of conception that remain in the uterus. If patients are asymptomatic (no fever, lower abdominal pain, foul vaginal discharge or uterine tenderness) and absence of a intact sac or fetus, then aggressive intervention is not warranted. The medical literature suggests that expectant management (observation) is appropriate. Women are informed their menses may be significantly heavier and possibly experience moderate to severe cramping when menstrual cycle returns.

The next period normally starts 4 to 6 weeks after the medical abortion process is complete. Ovulation may occur 4 to 5 days after taking the Misoprostol tablets. Pregnancy can happen within 1 week of taking the Misoprostol tablets. Emergency Contraception (Morning After Pill) is able to be purchased at most pharmacies over the counter without a prescription. Plan B consists of 1.5mg of Levonorgestrol. All women of reproductive age who are active sexually need immediate access to Emergency Contraception after a unprotected sexual event. Some Abortion Clinics do include Levonorgestrol for free in their abortion package price. Women should always ask about Emergency Contraception as possibly one of the criteria to use when making the decision which abortion clinic she choose to terminate her pregnancy. Emergency Contraception prevents or delays ovulation and used after each unprotected event. Birth control should be discussed in counseling and started after the second abortion pill is given.

5. Which abortion pill is more effective?

The combination of Mifepristone and Misoprostol is highly effective in the first trimester of pregnancy. There are several protocols that are used in performing the medical abortion process.

Step 1: The current standard guidelines are to take Mifepristone in the medical facility. Most women do not experience any side effects. Some side effects women may experience are headache, nausea, vomiting, abdominal pain, constipation and vaginal bleeding.

Step 2: After 24 to 48 hours, two tabs are placed between the cheek and gums on both sides. The vaginal route has a higher rate of success but women prefer the oral route. The tablets may also be placed sublingually. There is a higher incidence of chills, fever and diarrhea when tablets are used sublingually verses being inserted vaginally. The Misoprostol tablets are held between the check and gum or sublingually for 30 minutes. The residual paste may be swallowed. The blood vessels come within milimeters to the surface of the mucus membranes in the mouth and underneath the tongue. This significant complex of vessels allow rapid absorption of medications into the blood stream. Uterine contractions may begin within 30 to 45 mins of taking the Misoprostol tablets. Pregnancy tissue may pass aa soon as 30 mins after the Misoprostol tablets are given. In approximately 70% of women, the pregnancy tissue passes within 4 to 6 hours after taking the second pill.

Step 3: After Abortion- Women need to follow-up 2 to 4 weeks following the procedure. This appointment is important and it is used to confirm the abortion process is complete and there are no problems or complaints. A urine test can determine the if pregnancy test is negative and the ultrasound determines if the uterus is empty.

4) Fertility & Breast Feeding

There is no evidence that there is a decline in the fertility rate of patients after a medical abortion is performed. One study showed a increased pregnancy rate in women undergoing the abortion pill procedure in comparison to the control group with a lower fertility rate.

Breast feeding:

There is no evidence that Mifepristone or Misoprostol causes medical complications due her breast feeding her child. Small amounts of Mifepristone and Misoprostol are measured in breast milk after ingestion. The small amounts are not believed to harm the child. The Mifepristone levels in the breast milk reduce dramatically over 12 hour period of time after taking the medication. The study concludes that women should be allowed to continue to breastfeed. Other’s recommend to discard the first breast pumped milk after taking the initial dose of Mifepristone. Thereafter the baby may continue to breastfeed. Other studies suggest that the breast milk should be discarded for the first 24 hours after taking the pills and then resume normal breastfeeding.

5.1 How safe is medical abortion?

There is less than a 0.5 percent chance of a serious complication when terminating pregnancies using the medical abortion method. There is a much higher complication rate with getting a wisdom tooth pulled and a 10 times higher chance of maternal death during delivery of a full term birth.

4.2 Precautions

It is important to take care of oneself after taking the pills. Follow the steps below in order to have the minimum chance of complications:

1. Avoid introducing objects into the vagina including tampons and the menstrual cup. Taking a shower is fine by not a bath until after the first week. Intercourse may resume as soon as the woman is comfortable.

2. Avoid heavy physical activities for a minimum of 24 hours after taking the Misoprostol pills. Intense exercise, lifting or carrying heavy objects, prolonged standing or walking more than normal are examples of activities to avoid for 24 to 48 hours after the procedure.

3. Women should avoid driving after taking the Misoprostol tablets. The pain and discomfort could be potentially distracting and lead to an auto accident and possibly death.

6. How do you know if you have incomplete Abortion?

An incomplete abortion is where patients generally have cramps and bleeding. The abortion is incomplete when all of the fetal and/or pregnancy tissue has not passed out of the uterus. This can cause continuous or off and on abdominal pain or vaginal bleeding. A temperature of 100.4 or higher may occur. At times the bleeding may be heavier than other times. Blood clots the size of lemons or golf balls may pass vaginally. The onset of a foul vaginal discharge may occur. Just walking around the house or pushing down when going to restroom (increased intra-abdominal pressure) may elicit lower abdominal discomfort and back pain. Being seen at the abortion clinic or hospital is a must. Getting treatment early is the key to a good outcome following a medical abortion procedure. Complications are going to happen. There does not seem to be any predictive measures to say what population of women are at a higher risk of developing complications. A pelvic or vaginal sonogram will be performed to determine if retained tissue is noted in the intrauterine cavity. On pelvic exam, a dilated cervix with visual or palpable gestational tissue inside the cervix may be noted. Treatment with antibiotics and surgical removal of the pregnancy tissue by suction curettage may be elicited.

7. Is abortion pill detectable?

There is no commercial blood or urine test that can detect the levels of Mifepristone or Misoprostol. If for whatever reason a woman must emergently go to the hospital, she does not have to reveal that she took the abortion pill. There are many reasons that women would not want to indulge this information. The main reason is protecting one’s privacy. Suggesting to medical personnel that she is possibly having a miscarriage is all that is required. The way complications of a miscarriage or an abortion are managed, happen to be the same.

Medical Abortion Cost: Abortion Pill Price From $0.0 to $10,000.00 at Abortion Clinics:

The cost of the medical abortion depends on:

1) where in the country the procedure occurs 2) number of weeks pregnant the patient is

3) and whether insurance or funding sources. can help with payment

The price of abortions can be different in different parts of the same State. For example, let’s take the State of Florida. In the South Florida region, Planned Parenthood is located in a building very close to downtown Miami. Women from North Miami, South Miami, Miami Beach, Miramar, Coral Gables, Hialeah, the Florida Keys, Hollywood, Ft. Lauderdale and Boca Raton, have convenient access to their Abortion Clinic Facility. Medical abortions are performed up to 10 weeks gestation. The price for their first trimester medical abortion procedure that serves the counties of Miami/Dade and Broward is $525.00. They do have a discount sliding scale. Numerous other Abortion Pill facilities are in the area. Their abortion pill cost ranges from $285 to $600. It is imperative to ask what is included in the fee such as medications, sonogram, and a 3 week follow up visit. Other medications that when calling one should ask if free is the Emergency Contraceptive Pill. Many abortion clinics charge an additional fee if surgery is required to remove retained tissue or stop heavy vaginal bleeding after using the abortion pill method. This could easily add an addition $50 to $500 to the original fee. Several of the abortion clinics do not charge additional money for a surgical procedure if deemed warranted.

The Planned Parenthood located in Saint Petersburg, Fl. covers Pinellas county. The cities covered include Clearwater, Dunedin, Largo, Palm Harbor, Seminole and St. Petersburg, Florida. The abortion pill procedure is not performed in St. Petersburg. Women are referred to their Sarasota, Fl. Abortion clinic office. The cost of the abortion pill procedure in Sarasota is $525. We saw other abortion clinics in the area that offer the medical abortion procedure in the price range from $350 to $600. Once again; women should Please what is included in the fee to determine if prices are comparable.

The Planned Parenthood facility located in Tampa Florida serves the counties of Hillsborough and Polk. Cities include Brandon, Plant City, Apollo Beach, New Tampa, Valrico, Lakeland, Haines City and Plant City. The price of the medical abortion is $565 and a sliding scale is used in reducing the price to $424. Prices at other Abortion Clinics in area range from $355 to $700.00.

The Planned Parenthood facility in Kissimmee, Fl. serves the counties of Orange, Seminole, and Osceola. The cities served include Kissimmee, Orlando, Winter Park, Maitland, Winter Garden, Apopka, Lake Buena Vista, Ocoee, Windermere, Hunters Creek, Poinciana, Kissimmee, St Cloud, Celebration, Sanford, Lake Mary, Altamonte, and Oviedo. The cost of the medical abortion up to 10 weeks at the Kissimmee Planned Parenthood is $565 and $464 on sliding scale. Other Abortion Clinics in the area charge between $395 and $600. Ask what is included in the fee and whether or not Emergency Contraception is free. In some instances, is included in the price of the procedure.

At times, there are abortion pill clinics that offer the medical abortion for free after the patient pays for the State mandatory sonogram.

The Abortion Pill may be used by Physicians who are experienced to terminate pregnancies beyond 10 weeks gestation. The process has been used to perform medical abortions in the second trimester of pregnancy and late term pregnancies. Abortions at 16, 18, 20 and 21 weeks are frequently performed in a highly effective and safe manner. The procedures are started and completed in 24 hours or less. Late term abortions are always completed in the clinic to assure there are no complications. The most common problems that occur are vaginal bleeding or the after birth (placenta) is retained in the uterus. Second trimester and late term abortion procedures hardly ever cause any medical problems. They are as close to a natural delivery as possible. The complication rate is the same as women who deliver full term. The size of the pregnancy tissue is much smaller. There is no evidence that active labor from a medical abortion allows the baby to experience any pain or discomfort. The cramping and discomfort is generally much less than going through a full term delivery. Pain medication is always available for comfort. There are Physicians that have 20 years or more experience terminating pregnancies in this manner. The cost with second trimester procedures can cost between $1,000 and $10,000. The amount involves the number of weeks of pregnancy, cervical preparation required and several other factors.

Final Thoughts

The Abortion Pills; Mifepristone and Misoprostol when combined together are highly effective in terminating pregnancies. Over 3.4 million women in US have used this medical abortion process to end their pregnancies. Life threatening complications may occur but are extremely rare when problems are addressed immediately. Most women are relieved when they are told that the chance of dying from a medical abortion is 10 times less than having a normal vaginal delivery or C-section. Late term abortions remain legal in some parts of the U.S. State laws restricting abortions continue to occur on a yearly basis. Women who have the means to travel to other States in the US where abortions are legal. They will also be able to travel to other countries in order to obtain legal abortions. This will leave the US in a precarious state. Limiting access to abortions does not reduce the number of abortions. It increases the number of illegal abortions. This in turn leads to a higher number of illegal abortions. Unwanted pregnancies must be reduced by Emergency Contraception (Morning After Pill) or other forms of birth control. This in turn will reduce the number of unwanted pregnancies in half. Women should always have the right to choose when they want to become a mother. They must be able to control their own bodies and destiny.

Dr James S Pendergraft Orlando Abortion Clinicwww.womencenter.com.

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