1ST CITY CLINICAL HOSPITAL

Obstetrician-gynecologist (head) of the 4th antenatal clinic

Shakrupa A.S., first qualification category

Medical abortion (hereinafter referred to as MA) is a non-invasive method of terminating a pregnancy (with the help of medications), which is a safe alternative to surgery. MA avoids the risks associated with surgery and anesthesia. It occurs as a spontaneous miscarriage. Psychologically, women tolerate medical abortion much easier, due to the absence of a stress reaction to surgical trauma and pain

The procedure for medical abortion is carried out no later than 42 - 49 days from the first day of the last menstruation and consists of taking medications in 2 stages:

• The first stage - taking Mifepristone
• Stage two – taking Misoprostol

Mifepristone blocks progesterone-sensitive receptors (this is the main hormone that maintains pregnancy), as a result of which the fertilized egg stops developing. This drug also significantly increases the sensitivity of uterine cells to prostaglandins (in particular, Misoprostol), which cause uterine contractions that promote the release of the contents of the uterine cavity.

Before the procedure, it is necessary to do an ultrasound of the pelvic organs to determine the duration of pregnancy and the location of the fertilized egg (exclude ectopic pregnancy, pregnancy in the scar).

Performing MA includes 4 visits to the doctor.

During the first visit, the doctor determines the gestational age, the location of the ovum, the presence/absence of contraindications to LA, explains the possible risks and complications associated with the procedure, prescribes the required minimum examination, and also refers for pre-abortion counseling.

The second visit to the doctor is carried out no earlier than 3 days from the date of pre-abortion counseling. The doctor informs the patient about the test results and obtains the patient’s informed consent to undergo MA. Then, in the presence of a doctor, the patient takes Mifepristone, after which she is under the doctor's supervision for some time. Most often, after taking Mifepristone, a woman subjectively does not feel anything. THIS IS THE NORM! The main effect begins after taking Misoprostol. And only in some cases may minor bleeding and aching pain in the lower abdomen begin. This is also normal.

36-48 hours after taking Mifepristone, a 3rd visit is scheduled , at which the patient, in the presence of a doctor, takes the next drug (Misoprostol). Usually, over the next 3-5 days, spotting (slightly heavier than menstrual discharge) is observed. The average duration of bleeding (with decreasing intensity) is 12-14 days. Women with negative Rh factor blood must be given anti-Rh immunoglobulin simultaneously with the administration of Misoprotol to prevent Rh sensitization.

The 4th visit is scheduled for 10-14 days from the onset of bleeding. It will be necessary to conduct a control ultrasound examination of the pelvic organs. Minor bleeding should not be a reason to delay an ultrasound.

Briefly about possible side effects of medical abortion .

General symptoms

During the use of Mifepristone and Misoprostol, the following symptoms may be observed: dizziness, headache, nausea, vomiting, discomfort, weakness, increased body temperature up to 37.5 degrees, diarrhea. Typically, these symptoms are mild and disappear without medical intervention.

If vomiting occurs within one hour after taking Mifepristone, you must re-take the drug in the same dose. If Misoprostol was taken correctly (dissolved under the tongue), then vomiting does not affect the effect of Misoprostol, and re-taking the drug is not required.

Pain

Pain during medical abortion can be of varying intensity and depends on the duration of pregnancy (pain intensifies with increasing gestational age), as well as on the individual sensitivity threshold. Usually the pain is tolerable and does not require additional interventions. According to women, the pain is somewhat stronger than during menstruation.

The pain usually goes away within 1-3 days after the fertilized egg is released. To eliminate severe pain, it is possible to use antispasmodics, for example, No-shpa. Please note that the use of non-steroidal anti-inflammatory drugs (NSAIDs) for pain relief is contraindicated: Ketorol, Nise, since they block the action of Misoprostol (!), thereby reducing the abortive effect of the complex.

Bloody issues

The volume of bleeding in most cases slightly exceeds the usual amount of menstrual blood loss; Moreover, the longer the pregnancy, the more pronounced the volume.

Possible complications:

1. Bleeding
2. Remains of fertilized egg
3. Prolongation of pregnancy

After MA, you should seriously think about and consult with your doctor about using reliable methods of contraception .

Obstetrician-gynecologist (head of consultation) of the 4th antenatal clinic of the first qualification category Shakrupa A.S.