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Abortion

Induced Abortion

Abortion is defined as ending a pregnancy either with a medication (the pill) or a medical procedure (vacuum aspiration, D&C, or labor induction abortion). It is estimated that 25% of women in the United States have an abortion by the age of 45; however, there are many factors to consider making this a complex decision for many patients.

What to Know Before Having an Abortion

If you are contemplating an abortion it is important to first confirm pregnancy. While a positive pregnancy test is considered a symptom of pregnancy, it is not a verification of pregnancy. A limited ultrasound can assess how far along you are, the location of the embryo, and if there is a detectable heartbeat. It is estimated that 10-20% of pregnancies end in miscarriage within the first trimester, so many patients who are pregnant may not require an abortion. In addition to this, assessing where the embryo is located is important. If the pregnancy is not in the uterus it is considered ectopic. Ectopic pregnancies are not viable and require immediate medical attention.

STI testing is also essential to complete before having an abortion. Chlamydia and Gonorrhea are currently two prevalent STIs in Minnesota; however, they are often asymptomatic, meaning that because many people don’t have symptoms, they never know that they’re infected. It is important to get tested to see if you are infected so that you can receive treatment before completing an abortion procedure. Untreated chlamydia and gonorrhea can lead to serious health complications including pelvic inflammatory disease, fallopian tube scarring, ectopic pregnancy and infertility.

In addition to STI testing, blood testing is also important. If the patient has a negative blood type she will require a Rhogam shot in order to ensure her body does not attack any future pregnancies. Because it is quite common for the blood of the patient and the blood of the pregnancy to mix during both birth and abortion, the patient’s blood can become sensitized to the positive antibody if the pregnancy has a positive blood type. This means that while it will not impact this pregnancy, if a future pregnancy also has a positive blood type, the patient’s blood may choose to attack it.

To schedule a pregnancy test, ultrasound, and pre-abortion consultation or post-abortion referrals please contact Options for Women St. Croix Valley by calling or texting (651) 439-5964. All information is confidential and pregnancy services are free.

The Pill (RU-486)

Available from 2-10 weeks gestation.

RU-486 known as a chemical abortion consists of two pills: Mifepristone is taken first in order to stop the growth of the fetus followed by Misoprostol which induces contractions causing the patient to deliver the pregnancy.

Mifepristone, taken at a medical facility, interrupts the pregnancy and prompts detachment of the implanted embryo by blocking progesterone. Misoprostol is then taken several days later at home inducing contractions to empty the uterus. It should be noted that 8-10% of women will require a surgical abortion (Vacuum Aspiration or D&C) to complete this process.

Contraindications include anemia, bleeding disorders, ectopic pregnancy, chronic adrenal failure, use of an intrauterine device (IUD), or taking blood thinning or steroid medications.

DO NOT BUY ABORTION PILLS (MIFEPREX) ONLINE: “You should not buy Mifeprex over the internet because you will bypass important safeguards designed to protect your health. Mifeprex has special safety restrictions on how it is distributed to the public. Also, drugs purchased from foreign Internet sources are not FDA-approved versions of the drugs, and they are not subject to FDA-regulated manufacturing controls or FDA inspection of manufacturing facilities.”

If you have already taken Mifepristone but have not yet taken Misoprostol and change your mind about abortion, call (877) 558-0333 or visit www.abortionpillreversal.com to see if you can reverse the process.

Mifepristone

A progestational and glucocorticoid hormone antagonist.

Mechanism of Action: Mifepristone inhibits progesterone leading to bleeding during the luteal phase of the menstrual cycle and in early pregnancy by releasing endogenous (created by the body) prostaglandins (a lipid produced by the body causing inflammation). Mifepristone works by attaching to the progesterone receptors blocking the progesterone from binding to those receptors. This inhibits the activity of both endogenous (progesterone made by the body) and exogenous (progesterone taken by the patient but not produced by the patient’s body) progesterone.

Indication for Use: Commonly used for the medical termination of an intrauterine pregnancy through 11 weeks.

Pharmacodynamics: Mifepristone is a synthetic steroid with antiprogestaional effects used for the medical termination of intrauterine pregnancy through 11 weeks. Doses of 1 mg/kg or greater have been linked to antagonizing of the endometrial and myometrial effects of progesterone in women. During pregnancy, the compound sensitizes the myometrium of the contraction-inducing activity of prostaglandins. Doses of 4.5 mg/kg or greater results in a compensatory elevation of adrenocorticotropic hormone (regulating cortisol and androgen production) and cortisol (the stress hormone).

Adverse Effects: 90% of women reported adverse effects due to misoprostol on the third day of treatment. Side effects included heavy bleeding (more than a heavy menstrual period), abdominal pain, uterine cramping, nausea, vomiting, and diarrhea.

Drug Interactions: check with your healthcare provider to ensure you are not currently taking a drug that would interact adversely with mifepristone.

Food Interactions: avoid grapefruit products as grapefruit inhibits the metabolism of mifepristone causing increased serum levels of mifepristone.

Misoprostol

A prostaglandin (a lipid produced by the body causing inflammation) E1 analogue used to terminate pregnancies, treat miscarriages, and prevent post-partum hemorrhaging.

Mechanism of Action: Misoprostol simulates the prostaglandin receptors in the uterus and cervix increasing the strength and frequency of contractions and decreasing cervical tone. Misoprostol binds to smooth muscle cells in the uterine lining to increase the strength and frequency of contractions as well as degrade collagen and reduce cervical tone. Misoprostol is <90% protein bound in serum but it’s active metabolite, misoprostol acid, is 81-89% protein bound in serum. It is de-esterified to it’s active metabolite, misoprostol acid (SC-30695). This metabolite is further reduced to dinor and tetranor metabolites (SC-41411: a prostaglandin, analog, and w-16-carbosylic acid derivative).

Indication for Use: Approved to reduce the risk of NSAID (nonsteroidal anti-inflammatory drugs) induced gastric ulcers but not for duodenal ulcers in high risk patients. Commonly used off label for miscarriage treatment, prevention of post-partum hemorrhage, and first-trimester abortions.

Pharmacodynamics: Misoprostol is a prostaglandin E1 analog used to manage miscarriage alone or in combination with mifepristone for abortions up to 11 weeks. Dosed orally misoprostol has an onset of action within 8 minutes and a duration of action for approximately 2 hours. A sublingual (under the tongue) dose has an onset of action within 11 minutes and a duration of action for approximately 3 hours. A vaginal dose has an onset of action within 20 minutes and a duration of action for approximately 4 hours. A rectal dose has an onset of action within 100 minutes and a duration of action for approximately 4 hours.

Adverse Effects: An overdose may result in sedation, tremor, convulsion, dyspnea (difficulty breathing), abdominal pain, diarrhea, fever, palpitations, hypotension (low blood pressure), and bradycardia (low heart rate). Oral activated charcoal may help reduce absorption. If you believe you have overdosed seek immediate medical care.

Drug Interactions: check with your healthcare provider to ensure you are not currently taking a drug that would interact adversely with misoprostol.

Food Interactions: take with food to decrease incidence of diarrhea.

Abortion Pill Reversal

Although it has not been clinically approved, no adverse effects have been shown to result from the abortion pill reversal protocol. For patients who change their minds about an abortion replacing the second pill (Misoprostol) with a high dose of progesterone (the hormone that has been decreased by Mifepristone) many women are able to safely carry their pregnancy to term. For more information visit www.abortionpillreversal.com.

1st Trimester Surgical Abortion

SUCTION D&C

14-16 weeks gestation

For a suction dilation and curettage abortion the cervix is first stretched with dilators wide enough to allow the abortion instruments to pass through into the uterus. A cannula (thin, hallow tube with a sharp pointed end) is attached to tubing that is inserted into the uterus. The cannula is then attached to a suction system and the fetus, placenta, and membranes are suctioned out.

Adverse Effects: perforation/laceration of the uterus, cervical laceration, hemorrhage, and infection. See “what to know before having an abortion” for more information.

 

2nd Trimester Surgical Abortion

DILATION & EVACUATION

16-22 weeks gestation

For a dilation and evacuation abortion the cervix is first stretched with dilators wide enough to allow the abortion instruments to pass through into the uterus. The doctor uses a canula to suction out the amniotic fluid before dismembering and removing the fetus and placenta. A follow up appointment should be made to ensure the abortion is complete and monitor for complications.

Adverse Effects: perforation/laceration of the uterus, cervical laceration, hemorrhage, infection, and complications to future pregnancies. See “what to know before having an abortion” for more information.

3rd Trimester Surgical Abortion

LABOR INDUCTION

20+ weeks gestation

A needle is inserted into the amniotic sac injecting digoxin into the fluid in order to stop the fetus’s heart. The fetus will die within 24 hours and death is confirmed with an ultrasound before the start of delivery. The woman will then take misoprostol to induce labor and vaginally deliver the fetus.

Adverse Effects: incomplete abortion, cervical laceration, hemorrhage, infection, uterine rupture, and complications to future pregnancies. See “what to know before having an abortion” for more information.

*The information on this website is intended for general educational purposes and should not be relied upon as a substitute for professional medical advice.

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