Pregnancy Termination/Abortion Pill
Until the second half of the 20th century, dilatation and curettage (D&C) was the most common and virtually only method used for safe termination of early pregnancy. Abortion by vacuum aspiration gained greater acceptance in the 1960s and has become the standard of care. First trimester pregnancy can also be terminated safely pharmacologically (medical abortion).
Vaginal administration of 800 mcg (4 tablets of 200 mcg) of misoprostol (Cytotec) medication repeated up to three times at 12h intervals has 85% to 90% effectiveness, defined as complete abortion.
The oral route is less effective than vaginal. Vaginal administration should therefore be chosen unless there are reasons to avoid it.
- Known allergy to misoprostol;
- Suspected ectopic pregnancy or non-diagnosed adnexal mass;
- Unstable hemodynamics.
- If molar pregnancy is diagnosed, intrauterine aspiration and curettage is preferred.
- If there is an intrauterine device (IUD) in place, this should be removed before administering misoprostol.
- Coagulation disorders
- Woman should be advised that the treatment can fail and she should be prepared to pregnancy termination by surgical method, because there have been reports of congenital malformations in newborn infants of mothers given misoprostol during the first trimester of pregnancy.
- Breastfeeding: It is recommended that breast milk is not given to the infant for 4h after oral administration or 6h after vaginal misoprostol administration.
- Previous cesarean section: The safety and efficacy of early abortion (up to seven weeks) is unaffected by previous cesarean section.
The first choice is 800 mcg (4 tablets of 200 mcg) of misoprostol administered by the vaginal route every 12 hours for a maximum of three doses. Three doses of 800 mcg at 3h intervals can also be used sublingually. Doses higher than 800 mcg are not recommended due to increased side effects.
5. Effectiveness and Time to achieve effects
The success rate, defined as a complete abortion is around 90% during the first trimester of pregnancy.
Depending on the regimen used, pregnancy continues in 4% to 8% of women with gestational age of up to 63 days when vaginal misoprostol is used.
In the majority of cases, expulsion of the products of conception occurs hours after the administration: close to 70% within the first 12h, around 80% during the first 24h, 95% within 48h and further increases until least 72h after the initial dose. However there may be a large variability depending on route, dose and time interval between misoprostol doses.
6. Effects and side effects
Prolonged or serious side effects are rare.
Vagina bleeding during abortion induced with misoprostol is generally more intense than regular menstrual bleeding and is usually no different from that which occurs with a spontaneous abortion. Althrough there may be great variations, there is typically menstrual-like or heavier bleeding for the first week.
Cramping usually starts within the first few hours and may begin as early as 30 min after misoprostol administration. The pain may be stronger than that experienced during a regular period and can be present in 80%-90% of women. Non-steroidal anti-inflammatory drugs (Ibuprofen (Motrin) is recommended) can be used for pain relief without affecting the success of the method.
6.3 Fever and chills
Chills are a common side effect of misoprostol but are transient. Fever does not necessarily indicate infection. An antipyretic can be used for relief of fever. Ibuprofen (Motrin) is effective in this case, too.
6.4 Nausea and vomiting
About 20% of women report pregnancy-related nausea and vomiting before treatment. These symptoms may increase after misoprostol administration. An anti-emetic (Metoclopramide (Reglan) is recommended) can be used if needed, but symptoms will usually resolve within 2 to 6 hours.
Diarrhea may also occur following administration of misoprostol but should resolve within a day.
6.6 Fetal abnormalities
The risk of fetal abnormalities after misoprostol used early in pregnancy is probably very low, but women who do not abort after misoprostol, should have access to surgical abortion, if that is the woman’s informed choice. Vacuum aspiration is the recommended option.
For those women who have not aborted within 72h after the last dose there is the option of a second course of misoprostol treatment or surgical abortion. It should be mentioned that the chances of success of the second course is around one in three.
Ultrasound is highly recommended to check the result of medical abortion.
abortion options; medical abortion; early abortion; abortion procedure; abortion alternatives.
On this occasion I read a lot of feedback that many of you were born using the drug in question of Cytotec and now many wonder when I go to the gynecologist to have an abortion and he prescribes tsitotek vaginal tablet 4 hours before the abortion itself, respectively after Cytotec- curettage .. I want to ask is there anyone who has an abortion in this way and that whether it is standard procedure for an abortion or just my doctor thinks so? Incidentally, I am 7 weeks .. I care too much whether it will hurt by that Cytotec and contractions, which will cause at this stage of pregnancy (I guess it matters whether it happens in later pregnancy or not). I would be grateful if you let even the opinions without you have experienced ..
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I have three miscarriages, one desired and two missed. The second MD from the doctor gave me abortion pill about 8 hours before curettage. I put it my home well after about 2 hours in the morning I went to the hospital I was bleeding a lot. After curettage doc told me that the sac has fallen into the vagina itself .- pain is difficult to speak - rather like menstrual. But once I was able to sleep at night with only two awakening for changing the bandage, then no problem. My friend's the first curettage for blighted ovum in Tokuda also put her 1-2 hours before. I do not know whether it was actually Cytotec or otherwise.
One should conduct a thorough clinical examination of women to detect possible contraindications to medical abortion, including ectopic pregnancy, severe anemia, cervicitis or infection of internal genital organs, the presence of an intrauterine device, or any contraindications to the use of certain medicines.
Women can propose to introduce the misoprostol at home after the first clinic visit.
Recent tests have shown that the dosage of 200 mg - is most effective. Prostaglandins (usually 1 mg of gemiprost vaginally or 200 mcg of misoprostol per os or 800 mcg) used 36-48 hours after mifepristone. According to analysis using mifepristone in conjunction with prostaglandins, complete abortion occurred in 94% of women. The most frequent side effects were nausea, vomiting, diarrhea, prolonged loss of blood. The only developing country in the healthcare industry, which is widely used mifepristone, is China. Public services for family planning have developed a medical factors and issue permits medical facilities to use danogo method. Since the registration of medicines for use in pregnancy an abortion in 1988, it was reported a few cases of serious complications. Although the majority of women using this method were quite satisfied and expressed their desire for having to re-use it. Despite the overall positive attitude toward this method, according to several scholars, this method is less convenient and takes more time than surgical termination, and abortion pills.