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1. Introduction

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.

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The oral route is less effective than vaginal.

2. Counter-indications

  • Unstable hemodynamics;
  • Allergy to misoprostol;
  • Non-diagnosed adnexal mass or suspected ectopic pregnancy.

3. Precautions

  • 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.

5. Efficacy

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.

7.1 Bleeding

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.

7.2 Griping

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.

7.3 Fever

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.

7.5 Diarrhea

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.

8. Follow-up

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.

Additional Information (Optional)

Abortion Pill nowadays is the most popular pregnancy termination option

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Medical abortion (Abortion Pill) - is a method of abortion in early pregnancy (6-7 weeks), which does not require surgical operation.

A special drug causes the death of the fetus: the uterus contracts triggering the expulsion of the fetus from the uterus.

Medical abortion can be carried out within 42-49 days from the first day of the last menstrual period in the presence of an ovum in the uterine cavity. The abortion pill is most effective for up to 4 weeks when the fertilized egg is weakly attached to the uterus, and hormonal changes in the woman's body are not much expressed.


  • This is the least traumatic method; the lining of the uterus remains intact
  • No surgery is needed
  • Restoration of the menstrual function after 28-30 days
  • It does not require anesthesia
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  1. Allergy to drugs
  2. Chronic or acute liver failure
  3. Chronic adrenal insufficiency
  4. Smoking more than 20 cigarettes per day
  5. Active inflammation of any localization

Additional information

If you decide to perform medical abortion, make sure that you are fully conscious of possible side effects and complications after this procedure.

The reasons that cause a woman to interrupt pregnancy are highly individual. For some, the birth and upbringing of a child is impossible due to financial problems; for others, there are problems with health, etc. The main task of the doctor is to give full information about the procedure itself and possible threats to women's health.

Possible complications

Potentially, the procedure can cause the development of the following complications:

Incomplete abortion, in which case part of the fetus and the placenta remains in the uterus (may require additional surgery); - Severe bleeding, life-threatening; - Damage to the uterus (up to irreversible damage, preventing further conceiving and carrying a child); - The development of infectious inflammation.

It is recommended to discuss with the doctor the possible risks of the procedure before taking the abortion pill. Ask your doctor to tell you what typical complications are possible and how often medical abortion causes death. Remember that if you choose to continue the pregnancy after taking the first pill, your child will be exposed to the risk of multiple birth defects. Therefore, your decision should be definite before the drug consumption.

Currently there is no evidence that medical abortion, if it had no complications, can somehow influence subsequent pregnancy. However, many experts suggest that negative effects are still possible.

Medical abortion cannot be used if:

  • The term of your pregnancy is greater than 9 weeks from the start of the last menstrual period (when taking certain medications, this period is reduced to 7 weeks);
  • If you have an increased risk of uterine rupture (for example, you have surgical scars on the uterus);
  • If there are medical contraindications for health reasons (for example, you have high blood pressure, diabetes, certain heart disease, kidney disease, epilepsy, etc.) You can find the full list of contraindications at your gynecologist performing the procedure;
  • You have an intolerance to steroids;
  • If you cannot see a doctor after the procedure, or live in a place without transport access to intensive care vehicle;
  • If you have allergies to medicines used.

If you have at least one of the above contraindications, you'd better give up medical abortion in favor to surgical or even decide not to interrupt pregnancy.

Preparation for the procedure

If you decide to have a medical abortion, you need first to discuss the procedure with your doctor who is likely to undertake the following activities:

  • Evaluate the state of your health and study your medical history;
  • Send you to an ultrasound examination to confirm pregnancy and to identify factors that can complicate the procedure (ectopic pregnancy, tumors, etc.);
  • Takes your blood and urine for analysis;
  • Tell you about the form of medical abortion and warn of the possibility of complications after the meeting.

Keep in mind that in some countries, abortion may be prohibited at the legislative level.

After the procedure

To reduce the risk of complications after medical abortion it is not recommended to have sex and to use tampons for two weeks.

Preventing pregnancy after the procedure

A normal menstrual cycle usually begins 5-6 weeks after medical abortion. However, keep in mind that you can get pregnant even after a few days after the abortion. Talk with your doctor about contraceptive methods that you can use after the procedure.