Introduction to Abortion
An abortion is carried out to terminate an unwanted pregnancy. In India, an induced abortion is permitted within 20 weeks of pregnancy in cases where continuing with the pregnancy puts the life of the mother at risk, the baby is likely to be born with abnormalities that will last a lifetime, or for social causes like for a pregnancy following rape, or an unplanned pregnancy in a woman with low socio-economic status who already has other children to care for.
An abortion can be induced with the help of medications and through a surgical procedure. Oral medications are used in the first trimester (up to 49 to 63 days since the last period depending on the local laws) and include mifepristone, misoprostol and sometimes methotrexate.
- Mifepristone blocks the effect of progesterone (the hormone that supports the pregnancy) on the uterus. It also stimulates the release of prostaglandins by the uterus and sensitizes the uterus to the effects of prostaglandins. Prostaglandins increase uterine contractions and soften the cervix, thereby promoting expulsion of the uterine contents.
- Methotrexate interferes with cell division and interferes with the development of the placenta. Though it is usually administered intramuscularly, it can also be given orally.
- Misoprostol is a prostaglandin that stimulates uterine contractions, softens the cervix and helps in the expulsion. It thus has a synergistic effect when administered with mifepristone or methotrexate.
The preferred option for abortion pills is mifepristone followed by misoprostol 36 to 48 hours later. Mifepristone is administered in a dose of 600 mg, though a lower dose of 200 mg has also been found to be effective and is often used. Misoprostol or another prostaglandin can be administered either orally as pills or can be inserted into the vagina. The intravaginal route appears to be more effective than the oral route and is also associated with lesser side effects. The combination produces a complete abortion in around 95% cases when administered within 63 days of the last period.
The combination of methotrexate with misoprostol also has a good success rate. Methotrexate is administered first followed by misoprostol a week later.
Several women prefer medical methods of abortion as compared to the surgical methods since they are more private and often less invasive. Every woman should, however, be informed of the possible adverse effects before undergoing a medical abortion. Side effects of abortion pills include the following:
- Excessive and prolonged bleeding: Bleeding to expel the products of conception is normal following the intake of abortion pills. Normal bleeding following abortion pills is usually more than what occurs during a menstrual period and may last for 9 to 16 days, and sometimes even for more than 30 days. Large clots may be present in the initial period. Excessive bleeding should be suspected if the woman soaks through 2 thick sanitary pads per hour for 2 consecutive hours. Excessive and continuous bleeding may result in dizziness and shock and should therefore be treated with medications to tighten the leaking blood vessels (vasoconstrictors), saline infusion, and curettage of the inner lining of the uterus to scrape off the inner lining of the uterus. Blood transfusion may be required in rare circumstances. To prevent excessive bleeding, mifepristone should not be used for abortion in women with previous bleeding or clotting disorders, severe anemia, or those taking blood thinners.
- Infections: Bacterial infections that can be serious enough to cause septic shock have been reported in patients who have taken misoprostol. The patient may complain of high fever, abdominal or pelvic pain along with other symptoms like nausea, vomiting, diarrhea, or weakness. Antibiotics are required for the treatment of infections.
- Incomplete abortion: In some cases, some products of conception may remain in the uterus, resulting in continuous bleeding. A complete abortion can be confirmed through clinical examination, an ultrasound done one to two weeks following the intake of the medication, or the measurement of the blood levels of human Chorionic Gonadotropin (hCG), the level of which is high during pregnancy and falls following the abortion. A surgical procedure to completely evacuate the uterus will be required to resolve the issue. The medications methotrexate and misoprostol cause fetal malformations, and therefore, if the abortion does not take place following the oral medications, surgical abortion is a must. The absence of bleeding following the medications should prompt an immediate visit to the doctor.
- Pain in the abdomen: Pain in the abdomen is usually due to contractions of the uterus and is more pronounced following misoprostol as compared to mifepristone. Over-the-counter painkillers can be used to reduce the pain. Aspirin should not be used, since it is a blood thinner and can cause excessive bleeding.
- Nausea, vomiting and diarrhea: The abdominal pain is often accompanied by nausea and vomiting. Diarrhea may also occur, especially since prostaglandins stimulate the gut. Treatment is symptomatic. These side effects may be less if mifepristone is followed by intravaginal instead of oral misoprostol.
- Other side effects may include chills, headaches, hot flashes, fever, worsening of migraine, or psychological effects which could include a feeling of guilt or regret.
- KD Tripathi. Essentials of Medical Pharmacology
- Kulier R et al. Medical methods for first trimester abortion. The Cochrane Library. DOI: 10.1002/14651858.CD002855.pub4
- DC Dutta’s Textbook of Obstetrics
Latest Publications and Research on Principal Side Effects of Abortion Pills You Need to Know
- From the Grassroots to the Oireachtas: Abortion Law Reform in the Republic of Ireland. - Published by PubMed
- Self-managed abortion: A systematic scoping review. - Published by PubMed
- Knowledge of and Utilization of Emergency Contraceptive and Its Associated Factors among Women Seeking Induced Abortion in Public Hospitals, Eastern Tigray, Ethiopia, 2017: A Cross-Sectional Study. - Published by PubMed
- Knowledge and attitudes of Irish GPs towards abortion following its legalisation: a cross-sectional study. - Published by PubMed