Abortions are either chemical, which involves the use of medications to cause the uterus lining to shed and abortion to occur, or surgical, which involves a doctor using surgical tools inserted into the vagina and uterus to remove the fetus via outpatient surgery. Neither abortion method is without risk, although the amount of risk involved in abortion is equal to the risk involved in a colonoscopy, according to a 2014 study by the University of California, San Francisco (UCSF).
Women who chose chemical abortion take on more responsibility for their own care than women choosing surgical abortions because chemical abortions typically conclude at home as opposed to clinics or medical centers. It is imperative that women choosing chemical abortion be able to obtain necessary care at emergency departments or hospitals should a complication arise.
Chemical abortions, also referred to as medical abortions, can only be performed during the first nine weeks of pregnancy. According to the Guttmacher Institute, a non-profit organization that has been compiling abortion statistics for decades, medical abortions accounted for one-quarter of all abortions performed before nine weeks in gestation in 2008.
The two medications used during chemical abortions are mifepristone and misoprostol. Mifepristone, also known as RU-486, is a synthetic steroid that works by blocking the effects of the natural hormone progesterone which is required to maintain the lining of the uterus during pregnancy. Once the uterine lining breaks down, the lining is lost along with the developing embryo.
First approved for use in France in 1988, mifepristone was approved by the Food and Drug Administration for use in the United States in September 2000, where the drug is sold under the brand names Mifeprex and Mifegyne. The drug was approved weeks ago for use in Canada, where it will be available in January 2016 under the brand name Mifegymiso, which will be dispensed as a single unit containing both mifepristone and misoprostol.
Globally, mifepristone is approved for use in nearly 40 countries including Britain, Sweden, Austria, Belgium, Finland, Germany, Greece, Luxembourg, the Netherlands, Spain, Switzerland, Norway, Russia, Ukraine, Serbia, Montenegro, Belarus, Latvia, Estonia, Moldova, Albania, Portugal, Romania, Italy and Australia.
RU-486 was intentionally designed as an anti-progesterone for terminating pregnancies. Up to four visits to a hospital or clinic are necessary to complete the chemical abortion process: the consultation, the taking of mifepristone, the possible taking of misoprostol and the follow-up visit. On its own, mifepristone is not very effective, with some studies showing its efficacy to be as low as 54 percent. Adding misoprostol boosts the efficacy of RU-486 and helps ensure the chemical abortion process is completed.
Misoprostol is a prostaglandin, which is a group of fatty acid compounds found in nearly every tissue in humans and other animals. Misoprostol is used primarily to prevent stomach ulcers while taking non-steroidal anti-inflammatory drugs (or NSAIDs) such as aspirin, ibuprofen and naproxen. The main role of misoprostol in patients with stomach ulcers is to decrease complications such as bleeding from the ulcers.
The drug misoprostol is contraindicated in pregnant women because of its uterotonic properties, which means it can induce contractions in the uterus. This quality is what gives misoprostol its abortifacient (abortion causing) properties which is why the drug is used in chemical abortions.
For pregnancies up to nine weeks in gestation, the Royal College of Obstetricians and Gynaecologists (RCOG) recommends a patient take one 200 mg tablet of mifepristone orally, followed one to three days later by vaginal administration of 800 micrograms (mcg) of misoprostol. In the United States, common practice is that the woman is checked by her health care provider on the third day of treatment and, if pregnancy is still detected, will then be given misoprostol.
During the chemical abortion process in pregnancies of 13 to 24 weeks in gestation, RCOG recommends a patient take one 600 mg tablet of mifepristone orally. This is followed by vaginal administration of misoprostol in 1 mg to 5 mg doses every three hours until abortion occurs. If an abortion does not take place within 24 hours of the start of treatment, a repeat course of misoprostol in up to 5 mg doses will be given.
If a chemical abortion fails, the abortion will proceed as a surgical abortion. An incomplete chemical abortion can result in birth defects should the pregnancy proceed full-term.
Besides the usual side effects of nausea, vomiting, diarrhea, headache and dizziness associated with a myriad of medications, chemical abortion includes the risk of hemorrhage requiring a blood transfusion, severe pain, incomplete abortion, rupture of the uterus, vaginal bleeding and abdominal cramping.
The effects of chemical abortion are not long-term as these medications do not interfere with fertility after the abortion is complete. Women who undergo successful chemical abortions can became pregnant immediately after using mifepristone. To avoid pregnancy, these women should start birth control as soon as the pregnancy ends and before having sexual intercourse again.
The UCSF Medical Center has published easy-to-understand literature about both surgical and chemical abortions. Click here for more information.