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Medical/Non-Surgical/Chemical/Abortion by Pill or Instrument-Free Abortion (3 to 9 weeks) There are many ways to describe Medical Abortions. The different names used are Abortion by Pill, early non-surgical, chemical or instrument-free abortion. It is a procedure that has been frequently performed in the United States since the year 2000. This was the first time the FDA approved a medication specifically for terminating pregnancies without the use of surgery. Prior to the year 2000, Non-Surgical Abortion procedures were performed in the United States using medications that were found to stop the growth of early pregnancies. They were used “off label” which means that the medications are FDA approved for other indications besides abortion. In several European countries, nearly 50% of women choose to undergo abortion using the Non-Surgical Abortion process. Early abortions both surgical and medical are very safe and effective when supervised and performed by an experienced, skilled Physician. Different medications are used to carry out a medical abortion procedure which include RU486 (Mifeprex, Mifepristone, Abortion Pill, Early Option Pill, French Pill), Methotrexate, or Tamoxifen. RU486 is the only medication approved by the Federal Drug Administration (FDA) to use specifically for medical abortion in the United States. The other two medications are FDA approved for other medical indications, but were also found to be highly effective in terminating pregnancy. The medical abortion is an option for women who are no more than 9 weeks pregnant. During the first appointment at our offices, you will receive the Mifepristone or Tamoxifen pill which are taken by mouth, or Methotrexate which can be taken by injection or by mouth. 48 to 72 hours later, in the privacy of your own home, you will insert Cytotec (Misoprostol) tablets into your vagina, which causes contractions resulting in a miscarriage. The Cytotec (Misoprostol) tablets can be inserted later than 72 hours if your schedule does not permit the tablets to be inserted vaginally before then. When used in combination, there is a 90 to 98% rate of success. The success rate decreases with the further number of gestational weeks. There is close to a 99.9% success rate for patients 6 weeks or less from their last menstrual period. What occurs at the first visit? At the first appointment to our office, a medical history is obtained to alert the staff and physician of any medical problems you may have. This is very important to determine if you meet the criteria for undergoing the abortion using the non-surgical procedure method. Lab tests will be performed to verify the pregnancy, check the blood count and determine your Rh factor. Each patient will undergo counseling and the abortion procedure will be explained in detail. The risks, benefits and alternatives to the abortion procedure will also be explained. More importantly, it will be determined if having an abortion is the right thing for you at this time. The decision to have an abortion is one of the most difficult decisions a woman may have to make in her lifetime. The decision is based on age, family, religious, ethical, moral, financial, social, and personal values. No one truly wants to have an abortion. The question is whether or not it’s the right time to become a mother. A sonogram will be performed to confirm that the pregnancy is 9 weeks or less from the last menstrual period. If more than 9 weeks and a patient would still like the option of undergoing a medical abortion procedure, arrangements can be made to stay overnight in our office to allow for this service. What to Expect Upon taking the initial medication at our offices, there is a chance that bleeding may begin and a 1% chance of a miscarriage occurring before taking the second medication (Misoprostol) 48 to 72 hours later. Most women do not experience any bleeding until taking the Misoprostol. Misoprostol can be taken later than 72 hours if your schedule does not permit it to be taken before. Once the Misoprostol is inserted, you can expect to experience lower abdominal cramping, with a range in bleeding from very light, to the same as a normal period. Some women experience very heavy vaginal bleeding but this is not common. Nausea, vomiting, and diarrhea can occur. The bleeding and cramping can begin as soon as 20 minutes after taking the Misoprostol tablets. Most women miscarry within 6 to 8 hours of taking the Misoprostol pills. Bleeding usually lasts between 6 days and 2 weeks. A small percentage of patients can have bleeding for up to 30 days. Follow-up Exam It is necessary for the patient to return in one week for a sonogram to make sure that the medical abortion procedure was successful and complete. A small percentage of patients have an incomplete passage of tissue and usually request taking the Misoprostol tablets again. Upon returning in one week, if the patient is still pregnant, then a surgical procedure is performed. The surgical procedure will be carried out in our offices without an additional fee. Failure to have the surgical procedure after a failed Non-Surgical Abortion can lead to complications, such as continuous, profuse blood loss that may require a blood transfusion, or continuing a pregnancy with severe birth defects. The patient is given a 24 hour emergency number to call if there are any problems or questions. A medical staff person is always on call. With the recent use of the non-surgical regimen to end the pregnancy, how long will the pregnancy test remain positive? Is there a possibility of still being pregnant? The follow-up visit is extremely important. You must return to the office 7 to 14 days after taking the Mifeprex, Tamoxifen or Methotrexate to be certain the pregnancy has ended. To verify this, a sonogram will be performed. If the pregnancy has not ended, there is a chance of fetal birth defects. Therefore, in all cases, there must be an additional insertion of the Misoprostol or a surgical procedure performed to end the pregnancy. A pregnancy test can remain positive up to 4 to 6 weeks after the procedure is complete in 3 to 6% of the patients. Risks of the Non-Surgical Procedure Cramping and bleeding are an expected part of ending a pregnancy. It is rare, but serious and potentially life-threatening bleeding, infection, or other problems can occur following a miscarriage, surgical abortion, medical abortion or childbirth. Prompt medical attention is needed in these circumstances. Serious infection has resulted in death in a very small number of cases in which Misoprostol was used in the vagina. There is no evidence indicating vaginal use of Misoprostol caused these deaths. If you have any questions, concerns or problems, or if you are worried about any of the side effects or symptoms, you should contact our office immediately. Be sure to contact our office immediately if you have any of the following: Heavy Bleeding Bleeding enough to soak through two, full-size sanitary pads per hour for two consecutive hours or if you are concerned about heavy bleeding. In about 1 out of 100 women, bleeding can be so heavy that it requires a surgical procedure (Surgical Abortion/D&C) to stop it. Abdominal Pain or “Feeling Sick” If you have abdominal pain or discomfort, or you are “feeling sick,” including weakness, nausea, vomiting or diarrhea, with or without fever, more than 24 hours after taking Misoprostol, you should call our office without delay. These symptoms may be a sign of a serious infection or other problem (including ectopic pregnancy, a pregnancy outside the womb). Fever In the days after treatment, if you have a fever of 100.4F or higher that lasts for more than 4 hours, you should contact us immediately. Fever may be a symptom of a serious infection or other problem (including an ectopic pregnancy). Failure to have the surgical procedure after a failed Non-Surgical Abortion can lead to complications such as continuous, profuse blood loss that may require a blood transfusion, or continuing a pregnancy with severe birth defects. All patients are given a 24 hour emergency number to call if there are any problems or questions. A medical staff person is always on call. Eligibility for Medical Abortion
The Medical Abortion is contraindicated in patients with the following problems:
Other Options For Early Abortion (3 to 6 weeks) If you are found to be 6 weeks or less by sonogram, and there is a contraindication for you to undergo the Non-Surgical Abortion, then a surgical abortion is still an option for you. The advantage of the early surgical procedure is that the abortion procedure is quick and over within a matter of minutes, and the pregnancy symptoms of nausea, vomiting, bloating, and breast tenderness can end within a few hours after the abortion procedure is performed. Early Abortion: Choosing Medical or Surgical Because our Physicians are highly trained to perform the early abortion procedures surgically and medically, both are equally safe and effective. More women are choosing the medical abortion method because they feel it is more natural and there are no instruments used in the procedure. Most women are very satisfied with the outcome of either method. Birth Control We encourage all women to start birth control on the day of the surgical procedure or the day of the follow- up visit of the medical abortion procedure. You can become pregnant two weeks after having the procedure performed. When can I have sex? With the medical abortion procedure, you can have sex at any time. For the early abortion procedure, (6 weeks or less) we suggest you wait 24 hours before having sex again.
Have a Question? Dr. Pendergraft is available to answer your sexual health related question by
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