Medical /Non-Surgical/Chemical or Instrument-Free Abortion


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Misoprostol/Cytotec

Introduction 
Abortion is one of the most common medical procedures performed in the United States. Surgical abortions are associated with rare complications which include uterine perforation, cervical lacerations, bowel and bladder injuries, retained tissue, heavy bleeding, and death. These complications generally occur less than 1% of the time. Maternal mortality associated with abortion is over 10 times less compared to that of a full term delivery.  Medical abortions have gained in popularity since the mid-80’s. Due to the unavailability of Mifepristone (RU486) in the 90’s, only Methotrexate and Misoprostol (Cytotec) in combination or Misoprostol alone were used to perform the medical abortion procedure.  

Misoprostol/Cytotec Medical Abortion Pill: The Facts
Misoprostol is a synthetic prostaglandin medication marketed as Cytotec. Misoprostol is FDA approved to prevent gastric ulcers as prostaglandin E1 in the stomach is important for protecting the gastric lining from the prolonged administration of non-steroidal anti-inflammatory drugs (NSAIDs). Prostaglandins are found throughout the body serving multiple functions. Misoprostol causes uterine (womb) contractions and is used in several areas of female reproductive health. Misoprostol was initially found to cause early miscarriages in women who did not realize they were pregnant. It is used to stop heavy vaginal bleeding after delivery or to induce labor of full term pregnancies. It is safe and effective in causing softening and opening of the cervix (priming of the cervix), which reduces the incidence of C-Sections, and Misoprostol alone is used for the medical abortion procedure in the first and second trimester, and late term abortion. Cytotec/Misoprostol is used to perform medical abortion pill pregnancy terminations in abortion clinics for patients who are 3 to 24 weeks or further (i.e. abortions at 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36 weeks) with a therapeutic medical reason for termination of pregnancy to include maternal and fetal genetic or other significant abnormalities, and rape or incest. The use of RU486 (Mifeprex/Mifepristone) helps to accelerate the procedure and provide for completion in over 99% of patients within 24 hours or less. As is noted, abortions may be performed even before a patient misses her first menstrual period using Cytotec/Misoprostol. Approximately 46% of abortion providers offer the medical or surgical procedure before a patient misses her first period. For pregnancies that are viable (generally 24 to 28 weeks; however, viability is determined on an individual basis) there must be a threat to the mother's life or health, or a genetic defect or significant fetal abnormality in order for an abortion to be performed. Cases of rape or incest are further considerations for the discovery of late term pregnancy. Cytotec/Misoprostol can also be used with Laminaria to open and soften the cervix prior to initiating medical (abortion pill or surgical abortion procedures to reduce the incidence of complications such as cervical lacerations or tears, perforation of the uterus, bowel or bladder injuries, retained products of conception (pregnancy tissue remaining in the uterus). 

Misoprostol/Cytotec - Miscarriages (Spontaneous Abortion)

Recent studies show that the use of Cytotec/Misoprostol can be used in women who have spontaneous miscarriage or incomplete abortion. Less than 10% of physicians use Misoprostol to treat miscarriage, while 50% of physicians treat them with the use of surgery (D&C). Cytotec is highly safe, efficient and effective for treating miscarriage as it promotes expulsion of the fetus and any remaining gestational contents in the uterus. This choice is not often discussed with patients as an option to aid in completion of the miscarriage. The use of Misoprostol for miscarriage management poses less risk than those associated with invasive surgery. With the use of Cytotec/Misoprostol there is no risk of complications from anesthesia or side effects from sedatives and analgesics. There is no risk of cervical tears or laceration, bowel or bladder injury or uterine perforation. There is no need for scraping with a uterine curette which can cause uterine scarring (Asherman's) leading to the possibility of chronic pelvic pain and infertility. These risks cannot be overemphasized. Misoprostol can be used in the first, second and third trimesters of pregnancy within various dosages and guidelines for treating miscarriage and fetal death in utero. In over 50% of cases, surgery can be avoided with the use of Cytotec. Cytotec has shown to be between 95 to 98% effective for the treatment of miscarriage. Retained products of conception may occur with Cytotec. There is a higher incidence of retained products if expectant management (observation only) is used as a treatment for miscarriage. Discomfort may occur with a spontaneous miscarriage or with the use of Misprostol for treating miscarriage; however, the use of narcotic medication is rarely necessary. Unlike surgical D&C's, long term complications with the use of Misprostol do not exist.

Exposure of Fetus to Cytotec/Misoprostol in Early Pregnancy

Exposure of a fetus to Misoprostol in early pregnancy increases the incidence of fetal abnormalities. The majority of abnormalities affect the upper and lower extremities and central nervous system (Mobius Syndrome). This was first noted in Brazil in the early 90's with women who used Misoprostol to terminate pregnancy. Absence of the fingers and toes, club foot, and abnormalities of the cranial nerves VII, VI, V, and XII can occur. These abnormalities have an incidence of 10 per 1000 exposed fetuses. Thus, women who undergo an abortion pill procedure with Cytotec must agree to having a surgical procedure if the medical abortion fails.

For women who nurse, Misoprostol is rapidly metabolized and it is not known if the metabolites are excreted in human breast milk. For precautions, it is better to discard breast milk for 24 hours after administration of Misoprostol to prevent abdominal cramps or diarrhea to the infant.

When used as the second drug during a Non-Surgical Abortion in the first trimester of pregnancy with RU486, Methotrexate, or Tamoxifen; Misoprostol promotes the expulsion of the pregnancy. This medication can be taken by mouth or inserted vaginally. The patient normally takes the Misoprostol tablets within a 48 to 72 hour time frame after taking RU486, Methotrexate, or Tamoxifen to begin the medical abortion procedure. Misoprostol can be taken as early as 24 hours or as late as one week after taking the initial dose if used as part of a two drug regimen.  If the patient is unable to take the Misoprostol within the 48 to 72 hours, it can be taken at another time which is an additional advantage of choosing the Non-Surgical Abortion method.

Side Effects and Risks Associated with the Use of Cytotec/Misoprostol

Mild Side Effects

Headaches, blurred vision, chills, nausea, vomiting, rash on palms and feet, diffuse body pruritic (itchy) rash, constipation, diarrhea, abdominal and lower back pain.

Diarrhea
Diarrhea can occur within 60 to 120 minutes after taking the medication which can last up to 24 hours.

Fever and Chills
Chills are very common and can occur as soon as 15 to 30 minutes after taking Misoprostol. Fever is less common and does not necessarily indicate that the patient has an infection. If the fever or chills persist for more than 24 hours after taking Misoprostol, the patient may have an infection and need to be seen by her physician. Tylenol, aspirin, or other anti-inflammatory medications can be used to reduce the fever. There have been episodes of severe sepsis in which an elevated temperature and chills are not present.  Severe lower abdominal and back pain, foul vaginal discharge, weakness, fatigue and difficulty responding may be signs of a significant rare bacterial infection.  These infections have been noted with regular vaginal deliveries and surgical abortions in the first and second trimester of pregnancies. Death has occurred in only rare cases.

Nausea and Vomiting
If nausea and vomiting occur, it general resolves in 4 to 8 hours after taking the Misoprostol. An anti-emetic can be taken if necessary to help relieve the symptoms.

Vaginal Bleeding
Bleeding usually starts within 4 to 7 hours after taking the Misoprostol, though it can be as early as an hour or late as 24 hours. It generally lasts 7 to 14 days, but can last for up to 30 days. The menstrual period generally returns 4 to 6 weeks after Misoprostol is taken. Bleeding alone does not indicate a complete abortion. A follow-up sonogram is mandatory.

The patient should contact the office immediately if: 1) she soaks more than two maxi sanitary pads an hour for more than two consecutive hours, 2) if she stops bleeding and suddenly experiences an onset of very heavy bleeding two weeks after taking the Misoprostol, 3) if she has bled continuously for several weeks or suddenly feels dizzy or light-headed, has tingling of the fingers, hands or toes for more than one hour, 4) if none or only minimal bleeding has occurred 7 days after taking the Misoprostol. Blood transfusions have been necessary for heavy bleeding although the incidence is rare (1 to 3/1000). 

Pain
Pain is the most common side effect which occurs in approximately 50% of patients and just before they begin to bleed, the pain and discomfort reaches its peak. Most patients do not require analgesics; however, if necessary, Non-Steroidal Anti-Inflammatories (NSAID's) are effective the majority of the time.

Retained Pregnancy Tissue
Pregnancy tissue not expelled and remaining in the uterus may lead to persistent vaginal bleeding that may be bright red, pink or dark brown in color. There may be mild discomfort in the lower abdomen or back, but most often there is no pain or discomfort. Patients are treated surgically or with the use of the Abortion Pill (Cytotec/Misoprostol) to expel the pregnancy tissue.

Maternal Infections

Maternal Infections (Endometritis, Myometritis and Pelvic Inflammatory Disease/PID)
Infections may occur due to bacteria migrating from the vaginal area into the uterus. Retained pregnancy tissue acts as a nidus for causing bacteria to replicate and lead to infection of the lining of the uterine wall and may penetrate the uterine muscle and eventually spread to the fallopian tubes and ovaries which can lead to Pelvic Inflammatory Disease and possibly Tubo-Ovarian Abscess if not treated aggressively with antibiotics and surgical removal of the pregnancy tissue.

Infection Leading to Maternal Death
A severe infection can enter the blood stream. This bacterial infection is called Clostridium Sordelli. It can cause severe sepsis affecting all of the major bodily organs (kidney, liver, heat, lungs and brain) and lead to maternal death in rare cases. Clostridium Sordelli has also been found to cause maternal death in patients who deliver their pregnancy by C-Section, vaginal delivery and spontaneous miscarriage. Patients usually have an odorous vaginal discharge, severe lower back and lower abdominal pain, severe headaches, dizziness, nausea, vomiting and low grade fever. The patient may rapidly lose consciousness. Antibiotics must be immediately started along with aggressive hydration in order to save the life of the patient.

Failed Abortion
A failed abortion is defined as either a pregnancy that is still viable (alive) or one where the fetus has expired without any indication of bleeding or contractions. This occurs in 1 to 4% of the time when using Cytotec/Misoprostol alone. The further the weeks of gestation the procedure is performed, the higher is the incidence of a failed abortion. A surgical abortion or a repeated abortion procedure must be done. If the Abortion Procedure fails, the patient must agree to electively undergo a surgical abortion due to the increased risk of fetal abnormalities associated with exposure to Cytotec/Misoprostol.

Cytotec/Misoprostol Dosage for Medical Abortion (Termination of Pregnancy)
There are several regimens and dosages used to terminate pregnancy using the Misoprostol medical abortion process. The success rate depends on the length of the pregnancy and the dosage used as there is nearly a 100% completion of abortion for patients less than 6 weeks gestation. For pregnancies less than or equal to 10 weeks gestation, the overall success rate is 85 to 96% using Misoprostol.  Insertion of Misoprostol vaginally or by mouth (orally, bucally, or sublingually) has been shown in numerous studies to be more effective; although patients generally prefer taking the Cytotec by mouth. There is a higher incidence of side effects with placing the tablets sublingually such as diarrhea, fever and chills. Misoprostol has been studied and found to be highly effective and safe for use up to 14 weeks gestation and further. Additionally, Misoprostol is commonly used in second trimester and late term abortions including third trimester if indicated.

Success Rate of Misoprostol Abortion Procedure vs. Mifepristone (RU486, Mifeprex), Methotrexate and Tamoxifen alone or in Combination
Efficacy of mifepristone (Mifeprex, Mifepristone, RU486) and Misoprostol, Methotrexate and Misoprostol, Tamoxifen and Misoprostol and Misoprostol alone have a success rate ranging from 75 to 98% depending on length of pregnancy, dosages and route given, and additional techniques performed to achieve a high success rate. The earlier in pregnancy the Medical Abortion (Abortion Procedure) is performed, the higher the success rate. The medications used alone or in combination have been found to be highly safe and effective.

Why Choose the Abortion Pill Procedure vs. the Surgical Abortion Procedure?
There are many reasons why women choose to have the Abortion Pill Procedure (Non-Surgical Abortion, Chemical Abortion, Medical Abortion) which include but are not limited to the following: 1) Worries about the risks and complications of undergoing a surgical abortion; 2) Concern for how the surgical procedure may affect the risks of becoming pregnant and/or having complications during pregnancy; 3) Stress and anxiety associated with having a surgical procedure; 4) Feeling more in control of when and where the abortion procedure is performed; 5) The ability to carry out the abortion procedure in the privacy of a home environment; 6) Ability to have a partner, friend or family member present when taking the Cytotec/Misoprostol Medications. 

Contraindications to Cytotec/Misoprostol Medical Abortion Pill Procedure
Allergy to Misoprostol (cytotec) or prostaglandins; possible ectopic pregnancy; blood dyscrasias; severe anemia; cervicitis; upper genital tract infection; Pelvic Inflammatory Disease (PID); Intrauterine Device (IUD) in the intrauterine cavity; undiagnosed vaginal bleeding; recent treatment for Sexually Transmitted Diseases (Gonorrhea, Chlamydia, etc.)

The Medical Abortion Pill Procedure is not recommended for patients who are not able to return to the office in two weeks; if they are not able to return to the office for more than two or more visits; or if they live further than 2 hours from the office or a hospital should emergency evaluation become necessary.

Where to Get the Abortion Pill (Cytotec/Misprostol)
It is not recommended by Physicians in the United States or reputable health organizations that Self Induced or Home Abortion Methods be used to terminate pregnancy. Women who wish to undergo any abortion procedure (medical or surgical) should be under the care of a physician. Medical Abortions can be safely performed over 90% of the time; however, there are side effects that can be life threatening or even fatal which is why medical supervision is necessary.

In most third world countries women can get Cytotec/Misoprostol at a pharmacy. It can be purchased over the counter without a prescription. Additonally, Cytotec/Misoprostol can be bought on the black market, at abortion clinics or in a medical office where women are under the care of a physician.

Buying Abortion Pill or Cytotec/Misoprostol Online
Buying Abortion Pills (Misoprostol/Cytotec; RU486 [Mifeprex, Mifepristone] online can be inexpensive. Generic Misoprostol can be found at low cost and highly discounted prices. The usual delivery time can be within one to five days. In 1997, the FDA issued a statement advising against the purchase of abortion kits online. This is due primarily to the following reasons regarding the self administration of Cytotec/Misoprostol; 1) Medications purchased online cannot be guaranteed to be safe; 2) All patients should be under medical supervision and receive a sonogram prior to the procedure to determine the number of weeks gestation and a repeat sonogram within one week to 10 days after taking the Misoprostol to assure the pregnancy tissue has passed; 3) Excessive bleeding and infection must be attended to immediately by medical personnel.

For women who have an address outside the United States who are considering buying the abortion pill (Mifeprex, Mifepristone, Mifegyn, Cyrotec, Misoprostol), please go to www.buyabortionpillonline.com.

Cost/Fees of Misoprostol/Cytotec Medical Abortion (Abortion Pill) Clinics
The Cost of the Misoprostol Medical Abortion is approximately the same as the surgical abortion procedure from 3 to 14 weeks gestation which is usually between $300.00 to $1,500.00 depending on the location and what individual Physicians may charge. The further along the patient is in pregnancy, the more expensive the procedure will be. Patients that are 24 weeks may be charged from $2,500.00 to $12,000.00 depending on multiple factors. 

We now offer a pre and post counseling service which includes a detailed explanation about the indications and contraindications of using the abortion pill; the dosage and how to take the Misoprostol (Abortion Pill) Medications; and information about complications and when it is necessary to obtain medical attention. A sonogram to be performed before and after the procedure is included in the pre and post counseling fee. The cost for this exclusive service is only $225.00. In most cases, patients may expect to be in and out of the office in less than 60 minutes and are able to return later in the week to receive their medications, or if they have already obtained their medications through a different source, may proceed to take them. For more information regarding this service, please contact myabortionpill@gmail.com.

 

A patient may request an exclusive or private appointment with Dr. Pendergraft by contacting him by E-mail preferable: Drpendergraft@gmail.com or call him directly at 321-445-2545 or call office location nearest you by clicking locations. Same day appointments can be arranged.

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