Abortion is a medical procedure that ends a pregnancy before the fetus can survive outside the womb. People seek abortions for a range of reasons, including medical, social, personal, and economic factors. There are different methods for performing abortions, such as using medication (known as medical abortion) or in-clinic procedures. It's worth mentioning that the rules and accessibility of abortion services can vary by country and region, and the subject of abortion often sparks passionate debate and controversy. Laws and regulations surrounding abortion and public opinions on the matter vary significantly across the globe. The choice to undergo an abortion is deeply personal and is frequently shaped by an individual's unique circumstances, personal beliefs, and ethical reflections. The selection of the method hinges on considerations such as the stage of pregnancy and the woman's well-being and personal choices. Generally, as the pregnancy progresses, the abortion method tends to become more intricate and challenging.
Medication abortion
In the early stages of pregnancy (≤70 days of gestation), a woman might be offered the choice of a medication-induced abortion rather than a surgical procedure. To go through this process, the woman must first consult a healthcare professional in order to receive all necessary information pertaining to the medication. Additionally, a follow-up appointment is required in order to confirm the completion of the medication abortion. If the process is not successful, she might require a surgical abortion instead. It's crucial for the woman to adhere precisely to the healthcare provider's instructions when taking the medication.
FDA-approved medication:
Major medical organizations worldwide endorse a medication abortion procedure involving two drugs: mifepristone and misoprostol. In cases where mifepristone is not available, a misoprostol-only regimen is considered an acceptable alternative. Mifepristone, a medication used in this process, works by binding to the progesterone receptor with a higher affinity than progesterone itself (acting as an antiprogestin). Its effects during pregnancy include causing softening of the cervix and increasing uterine contractility and sensitivity to prostaglandins. Misoprostol, the other medication, is an analog of prostaglandin E1, which also softens the cervix and triggers uterine contractions. The FDA has approved misoprostol for oral use to prevent stomach ulcers in individuals who regularly take anti-inflammatory drugs, and it is included in the FDA-approved instructions for using mifepristone in abortion procedures.
Precautions before choosing medication abortion:
Women with severe anemia, ischemic heart disease, or significant renal or respiratory issues should seek specialized medical guidance when considering abortion. Additionally, for individuals with asthma that is challenging to manage, it is crucial to consult with a specialist due to the potential antagonistic effects of mifepristone, which could interfere with the effectiveness of corticosteroids used for asthma control. Patients with intrauterine devices (IUD) cannot receive the medication unless they decide to remove the IUD. Those with stable, long-term inhaled preventer therapy for asthma should review their asthma management plan to prepare for any potential worsening of symptoms. Women using insulin need to monitor their blood glucose carefully during the abortion process, as factors like vomiting, changes in dietary intake, and the risk of dehydration can impact blood sugar levels. Furthermore, women with epilepsy who experience seizures triggered by vomiting or pain require extra attention and care during the abortion process.
What tests will be performed by the physician?
- Ultrasound: Before treatment can be started, an intrauterine pregnancy must be confirmed. Ectopic pregnancies cannot be effectively treated using the above-mentioned medication.
- General laboratory testing: Complete blood count to check for anemia; screening for various sexually transmissible diseases.
- Measurement of human chorionic gonadotropin (beta-HCG): It is advisable to measure the initial quantitative serum concentration of human chorionic gonadotropin (HCG) on the same day that mifepristone is taken, or as close to that date as possible. This baseline measurement serves as a reference point for comparison with a follow-up measurement taken seven days after the mifepristone dose. This second measurement helps to verify the successful completion of the abortion process.
Side effects to expect and possible complications
- Cramping discomfort, typically more intense than regular menstrual cramps, may commence within 1 to 4 hours after taking misoprostol.
- Bleeding, which is often heavier than a typical menstrual flow and may include blood clots, usually follows the pain. This bleeding tends to subside once the products of conception have been expelled from the body. (Note: The visibility of the products is more likely seen in cases of later gestations, which can be a source of distress for some individuals while providing reassurance for others.) The bleeding typically continues at a level akin to a menstrual flow for about a week before gradually diminishing. Variations in bleeding intensity and the presence of blood clots are common during this period. Spotting might still be present after this period.
- Complications in first-trimester abortions are rare but should still be discussed with the patient. The following include: continued viability of pregnancy; genital tract infections; retained products; and hemorrhage.
What’s next?
- Check-in after a three-day period: After receiving the medication, the doctor will ask the patient about the level of bleeding and/or other possible complications and symptoms. To check if the pregnancy was appropriately terminated, beta-HCG is measured and expected to fall 80% or more from the baseline previously measured. The patient will also be asked to do a home pregnancy test 3 weeks after the medication. After the three-week period has passed, another check-in, mostly via telemedicine is performed in order for the physician to confirm that everything is in order.
- It is important to inform the patient that after a medication abortion, pregnancy is still possible, thus the patient should be put on contraceptive medication.
