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It was until the 1950-60s that dilatation and curettage (D&C) was believed to be the only and the most secure way to terminate an early pregnancy. In the 1960s vacuum aspiration became a standard of care therapy and a common method to do abortion. Another safe way to do abortion during the first trimester of pregnancy (0-12 weeks) is medical abortion.
Medication intake of 800 mcg (4 tablets of 200 mcg) of misoprostol (Cytotec) vaginally each 12 hours is effective from 85% to 90% and is described as complete abortion.
The oral route is less effective than vaginal.
- Unstable hemodynamics;
- Allergy to misoprostol;
- Non-diagnosed adnexal mass or suspected ectopic pregnancy.
- It is preferable to do intrauterine aspiration and curettage when molar pregnancy was spotted.
- An intrauterine device (IUD) if in place ought to be extracted before taking misoprostol.
- You ought to inform a woman that there are cases when the therapy fails and a woman ought to be ready to have surgery as it was reported that there might be congenital malformations in newborns if mothers took misoprostol during their first three month of pregnancy.
- It's advisable that breast milk is not given to a baby during 4 hours after taking misoprostol orally and 6 hours after taking misoprostol vaginally.
- Coagulation disorders.
- Past caesarian operation does not influence the effectiveness and safetyof an early abortion (no longer than 7 weeks).
4. Rate of administration
There are two alternatives: the first choice is 800 mcg (4 pills of 200 mcg) of misoprostol taken vaginally every 12 hours thrice; the other option is 800 mcg taken sublingually every 3 hours thrice.
It is not advisable to exceed the dosage for it can increase side effects.
During the first pregnancy trimester complete abortion is observed in 90% of cases.
Determined by the administration chosen, pregnancy is not terminated in 4-8% of women with the duration of gestation of more than 63 days when misoprostol is taken vaginally.
6. Time to achieve effects
The time of the result varies depending on time intervals, dose and type of medication intake chosen but in most cases the expulsion of the products of conception takes place several hours after the intake:
- from 70% during first 12 hours,
- 80% during first 24 hours,
- 95% during 48 hours.
And so on until 72 hours after the initial dose.
7. Side effects
Serious side effects are rarely abserved.
Vaginal bleeding is normal during abortion associated by misoprostol. It is heavier than usual menstrual bleeding and does not differ from the one that takes place with miscarriage. It may be individually, but usually it's either menstrual-like or a bit heavier within the first week
It often starts griping just after 30 minutes of misoprostol intake or during the next few hours. About 80-90% of women experience pain which might be stronger than the spasms during menstrual period. To relieve the pain you can take non-steroidal anti-inflammatory drugs (Ibuprofen (Motrin) is advised). They won't affect the results of the method.
It is a general side effect of misoprostol administration but it is temporary and does not necessarily mean inflammation. To relieve fever an antipyretic (Ibuprofen/Motrin) can be taken.
7.4 Vomiting and nausea
It is reported that about 20% of women suffer from nausea when pregnant. Misoprostol administration might intensify those symptoms. If necessary an antiemetic (Metoclopramide (Reglan) is advised) can be taken though the symptoms will disappear during next 2-6 hours.
Diarrhea may be a symptom of misoprostol administration but it will disappear in a day.
7.6 Fetal abnormalities
Women should be aware that after misoprostol administration congenital malformations may be observed, though the risk is quite low. If after the treatment intake pregnancy was not terminated, surgical abortion should be done. Vacuum aspiration is an advisory option.
If a woman does not abort during 72 hours after the last misoprostol administration she has two options:
- Try second course of misoprostol (the success rate is one in three).
- Do surgical abortion.
It is necessary to have ultrasound investigation after medical abortion.
9. Important Note
Only once you follow all the instructions of your health care provider you get the intended effect from these medications. Because otherwise, we do not bear any responsibility for the effects after incorrect usage of medications.