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Medical Termination of Pregnancy

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Overview of Medical Termination of Pregnancy

This is the procedure through which pregnancy is terminated by using medicines – rather than by having an operation. There are three different methods of medical abortion. The first method uses a drug called misoprostol alone. The second method uses methotrexate followed by misoprostol; while the third method uses mifepristone followed by misoprostol.

The one most commonly used method is the combination of mifepristone and misoprostol. This procedure can be conducted up to 63 days or nine weeks after the start of the last period. 


Treatment procedure for Medical Termination of Pregnancy

Day 1 (First stage): Oral consumption of mifepristone 600 mg at the hospital. 

Day 3 (Second stage): Vaginal prostaglandin tablets are given in the hospital 2 days later. Misoprostol, a prostaglandin (PG) analogue can also be administered after mifepristone. Rh negative women are given Rh (D) immune globulin any time before the administration of misoprostol. 

Follow-up treatment: A swab test for Chlamydia.

A final check-up 1-2 weeks later. 


How does the Termination of Pregnancy works

During the first stage of the treatment, the mifepristone works by blocking the action of the hormone which makes the lining of the uterus (womb) hold onto the fertilized egg. 

During the second stage, the prostaglandin tablets work by relaxing the cervix (neck of the womb) and making the uterus contract so that the pregnancy is expelled. Thereby resulting in a miscarriage. Misoprostol, the analogue of prostaglandin (PG) increases the efficacy of treatment by inducing uterine contractions.

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Medical Termination of Pregnancy is not for

  • People with ectopic pregnancy (where the egg is implanted in the fallopian tubes rather than in the womb) or undiagnosed adnexal mass.
  • People fitted with contraceptive coil (IUD or IUS). The coils should be removed before the procedure is undertaken.
  • People allergic to mifepristone, misoprostol, or other prostaglandins.
  • People on concurrent long-term corticosteroid therapy.
  • People with chronic adrenal failure.
  • People suffering from hemorrhagic disorders or on concurrent anticoagulant therapy.
  • People with inherited porphyrias.
Moreover, patients with the following health issues should consult the physician before under going this treatment: 
  • People suffering from heart problems or high blood pressure.
  • People suffering from asthma, bronchitis or diabetes.
  • People with high blood cholesterol level.
Additionally, lactating mothers should stop breast feeding for 14 days after the treatment. She should express and discard the breast milk during these 14 days. She can restart breast feeding only after consulting her physician.

Side Effects for medical termination of pregnancy

Following are the side effects for medical termination of pregnancy

Pain and cramping: An expected part of the abortion process is pain resulting from uterine cramping. The use of methotrexate / misoprostol for medical abortion have reported cramping in more than 75% of women. The cramping pain associated with medical abortion ranges from mild to severe. The pain reaches its peak after the administration of misoprostol. However, it subsides soon after the completion of the abortion.

Both non-narcotic and narcotic analgesics are used for controlling the pain caused by medical abortion. Non-narcotic medications used for this purpose are acetaminophen and nonsteroidal anti-inflammatory drugs (NSAIDs), namely, ibuprofen and naproxen. These drugs do not interfere with the action of misoprostol. Narcotic analgesics like codeine or oxycodone can also be used in combination with non-narcotic drugs.

Bleeding: Bleeding is an expected side effect of medical abortion. However, excessive bleeding causing a clinically significant change in hemoglobin concentration is uncommon. Under such circumstances, the patient may require transfusion or surgical aspiration to achieve hemostasis.

Gastrointestinal side effects: Gastrointestinal side effects may also result from the use of mifepristone or methotrexate. Side effects like nausea, vomiting and diarrhea also can be associated with both early pregnancy as well as abortion process itself. The gastrointestinal side effects are primarily managed with antiemetics or antidiarrheals.

Thermoregulatory changes: During the medical abortion process, thermoregulatory changes like fever, chills, or a sensation of warmth may occur. Short-term temperature elevations or chills result from the medications used as well as from hormonal fluctuations. However, changes do not usually require treatment, as they are commonly brief in duration. In case if its necessary, occurrence of fever in a patient can be treated with acetaminophen or NSAIDs.

Headache and dizziness: Approximately 20% of medical abortion patients suffer from headache and dizziness. If a heavily bleeding patient reports dizziness, there is a possibility that significant amount of blood loss have caused hypovolemia.



Risk Factors for medical termination of pregnancy

Medical termination of pregnancy carries a small chance of complication.

Around 5% of women experience continued bleeding in the first few weeks following medical termination. In some cases Haemorrhage, or excessive bleeding, requires blood transfusion. However, Haemorrhage is an extremely uncommon side effect.

The common risk factors are:

Treatment failure: Although bleeding and pain is a common part of the process, it doesn't essentially mean that the treatment has been a total success. In some cases the pregnancy may not be expelled at all. In some cases only part of it may be expelled. The rate of failure of this treatment is 2% in pregnancies of less than 7 weeks duration, 5% in pregnancies between 7 and 9 weeks duration and 5 to 10% in pregnancies of over 9 weeks duration. Under such circumstances, a second course of treatment involving a simple operation becomes essential to complete the process.

Pelvic inflammatory disease (PID): A common complication related to medical termination of pregnancy is infection within the pelvic cavity. This infection involves the uterus, fallopian tubes and ovaries. However, the use of antibiotics reduces this risk. Still around 5% of women usually experience this type of infection. Though quite rare, at times this PID leads to reduced fertility and ectopic pregnancy.

Emotional and psychological problems: Around 6% women experience some form of emotional or psychological problem in the weeks following a medical termination. These problems are common in case of termination of pregnancy.

Other complications: Other complications experienced to a lesser extent following a medical termination of pregnancy, are abdominal pain and vaginal discharge. 


Vacuum Aspiration

In most cases vacuum aspiration is necessary as a backup for medical abortion. The vacuum aspiration is provided in an office setting using either electric or manual suction. 

Follow-up After Medical Abortion

Follow-up of all medical abortion patients is critical to determine if the abortion is complete. Moreover, such treatments also detects the occurrence of any complications. The schedule for the followup treatment depends on the employed medical abortion protocol. Usually, it is scheduled within 2 weeks of administration of mifepristone or methotrexate.


Medical Abortion and future pregnancy

The risk of ectopic pregnancy, miscarriage, preterm birth or low birth weight babies in future pregnancies after medical abortion is the same as that in surgical abortions. Research conducted on a group of 12,000 women showed that rates of ectopic pregnancy in subsequent pregnancies were 2.4% for medical abortion and 2.3% for surgical abortion. Similarly, rate of miscarriage was 12.2% for medical abortion and 12.7% for surgical abortion.

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Written by: Healthplus24 team
Date last updated: October 03, 2012