MEDICAL TERMINATION OF PREGNANCY
Medical Abortion is the 2 step termination of pregnancy with Mifepristone followed by Misoprostil (48 hours later), registered for use up to 7 weeks( 63 days.)
Mifepristone interferes or blocks the effects of Progesterone, the main hormone to sustain a pregnancy.
After it is taken with water, it relaxes the Cervix and helps the contraction of the uterus.
Misoprostil causes the uterus to contract and expel the pregnancy. Completing the abortion process.
It should be taken 36-48 hours after to increase its efficiency/success rate
HOW TO TAKE 2 STEP:
STEP 1 :
Mifepristone should be taken orally. 1 tablet ( 200mg)
Some women may start to bleed at this stage.
36-48 hours later 4 Misoprostil tablets (800mcg) should be placed between the cheek and gum for 30 minutes before swallowing. ( Bucally)
At this point vaginal bleeding is expected with cramping and pain.
You should stay at home and rest during this stage. Some women can feel nausea and dizziness. A supportive adult should be with you. Most pregnancies will be expelled within 4 hours.
Bleeding can be expected to be as heavy as a period for at least 2 days. Bleeding may continue for weeks. If you are concerned at all or have any bleeding greater than a normal period for greater than 2 hours, Please phone Dr Jones 0428388819. Or the MSI afterhours phone number that is given to you when you have your appointment.
A follow up appointment is required . WE recommend 14 days to ensure the abortion has been successful.
Any issues before this time however you may be required to see the doctor. DO NOT HESITATE TO PHONE FOR AN APPOINTMENT BEFORE 14 DAYS.
On the day of your booking you will be given a follow-up appointment time and date that suits you.
Pain management requires over the counter drugs usually. Paracetamol with Codeine or Naproxen or Ibobrufen is recommended. Please ensure they are
available to you before starting the process. Any issues call the doctor or MSI help line.
Please ensure you have a sensible, adult, support person during the abortion process. Someone who can drive you to hospital if it is required. You will need to nominate a suitable hospital with an emergency department that is close to your location. Be sure you have a working phone in case you need to call an ambulance.
Infection: Signs of infection include Temperature of 37.5 degrees or higher, nausea and vomiting, lethargy or tiredness, feeling unwell, ongoing abdominal pain, and /or offensive vaginal discharge. This is a very serious complication rated at less than 1: 100.
Pill Failure: An estimated 3 in 100 women the pill will not work /failure.
Most of these will require a surgical intervention. Surgical termination.
Continuing after failure is not recommended as the medication may cause fetal abnormalities.
It is important to attend a follow-up appointment to ensure the abortion is completed.
Retained products: Ongoing bleeding requiring surgical Intervention. D&C
1.8-4.2 in 100 women
Blood Transfusions: 0.3 to 6 in 1,000.
Hospitalisation : 0.4 to 9 in 1,000.
Complications and Rates according to Chen MJ and Creinin MD “Mifepristone With Buccal Misoprostil for Medical Abortion: A systematic Review. Obstet Gynecol. 2015 Jul ;126(1) 12-21.
WHO CANNOT HAVE A MEDICAL TERMINATION
- A pregnant woman with a greater than 9 week gestation
- A pregnancy where an ectopic pregnancy cannot be excluded
- A Breastfeeding woman
- An Intrauterine device in place
- A woman with a bleeding disorder or adrenal problems
- Serious , varied medical conditions ( Low Hb)
- If the woman suspects an allergy to Mifepristone or Misoprostil
- If a woman is taking corticosteroids for eg asthma
- If a woman is taking anti-coagulant medicine eg Warfarin for DVT
- If the woman does not have appropriate support person for the entire abortion process
- If the woman does not have ready access to emergency services