Medication termination of early pregnancy

Unwanted pregnancy - what to do? If a surprise takes you by surprise in the early stages, then you can use pills for medical abortion. It is indicated for many women, but first you need to consult a specialist.

This is a safe and effective method of artificial termination of pregnancy that does not require surgical intervention. It is allowed no later than 7 weeks from the moment of successful conception. The fact is that from the 8th week, placental vessels form, which can cause severe bleeding, dangerous to life and health.

Advantages:

• efficiency 99%;
• low risks of ascending infection;
• without injury to the pelvic cavity organs;
• without anesthesia;
• there is no risk of infection with hepatitis, HIV and other blood-borne diseases;
• universality - the procedure is recommended for everyone, including primigravidas;
• the psychotraumatic factor is minimized.

The procedure does not require a long hospital stay. After taking the prescribed medications, the patient is sent home and treatment is prescribed.

Pharmacodynamics and pharmacokinetics

Misoprostol is a synthetic derivative of prostaglandin E1 . It is capable of inducing contraction of the smooth muscles of the myometrium and dilation of the cervix, which facilitates the process of excretion of the contents of the uterine cavity. Due to its weak stimulating effect on the smooth muscles of the gastrointestinal tract, large doses inhibit the secretion of gastric juice , and the tablets act as an antiulcer agent .

Misoprostol as an active substance does not have a significant clinical effect on:

• prolactin;
• gonadotropin levels ;
• thyroid-stimulating hormones;
• growth hormones;
• thyroxine;
• cortisol;
• creatinine;
• platelet aggregation.

Pharmacokinetics

Oral administration leads to rapid absorption (max concentration - 6.08±1.64 mg/ml). When taken with meals, especially fatty ones, the bioavailability of the drug decreases without affecting the duration of absorption. In the walls of the gastrointestinal tract and liver, conversion occurs to the active diesterified metabolite - misoprostolic acid , the maximum concentration of which is reached after half an hour and is 499 mg/ml. The half-life is no more than 30 minutes; the substance does not accumulate in body tissues and is excreted primarily by the kidneys.

Conclusion

The drug Misoprostol is used for medical abortions only in combination with Mifepristone and its analogues strictly under medical supervision. Self-administration can lead to dangerous bleeding, incomplete abortion (retention of parts of the fertilized egg in the uterus) and overdose.

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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"

Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.

We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.

The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.

Indications for use

• erosions , as well as erosive and ulcerative lesions of the gastrointestinal tract due to therapy with other drugs and prevention of their ulcerogenic effects (for example, prevention and treatment of NSAID gastropathy );
• peptic ulcer of the duodenum and stomach , including exacerbations;
• for early pregnancy of amenorrhea ).

Stages of medical abortion

A medical abortion requires 3 visits to the doctor.

Visit 1

On the day of treatment, the obstetrician-gynecologist talks, examines the patient, and gives her:

1) Ultrasound for the purpose of:

• confirm pregnancy;
• establish that pregnancy develops in the uterus;
• establish the duration of pregnancy (no more than 6 weeks or 42 days from the first day of the last menstruation).

2) minimal examination, which includes:

• taking a smear on the flora;
• referral for a blood test (for syphilis, AIDS, hepatitis; determination of blood type and Rh factor).

Then, during the first consultation, the doctor will tell you in detail how the procedure should be carried out and indicate the order of repeat visits, as well as inform you about what the symptoms may be and how to behave in such cases.

The doctor will definitely warn you that in a small number of cases (2-5%) the method may be ineffective, and then you will have to terminate the pregnancy surgically.

Contraindications

• hypersensitivity to the drug, as well as to other prostaglandins and analogues;
• liver dysfunction;
• cardiovascular or endocrine diseases;
• diabetes;
• severe form of renal failure ;
• contraindications for the use of prostaglandins – bronchial asthma , glaucoma , arterial hypertension ;
• reception of VPZ ;
• inflammatory processes in the intestines , including enteritis ;
• pregnancy , suspected ectopic pregnancy , lactation (breastfeeding);
• age group up to eighteen years.

When is the procedure contraindicated?

Pharmaboration cannot be carried out in the following cases:

• allergy to components;
• intrauterine insemination;
• impaired hemostasis;
• severe anemia;
• renal, hepatic and adrenal insufficiency;
• treatment with corticosteroids;
• serious inflammatory processes of the genital organs;
• lactation period;
• pathologies of the heart and blood vessels.

Misoprostol should never be taken without mifepriston. Some also make the big mistake of taking only one drug to speed up the abortifacient effect, which can lead to serious health consequences. Moreover, it only works in 30% of cases.

Side effects

In relation to various organs and systems, Misoprostol can cause the following adverse reactions:

• Gastrointestinal organs: abdominal pain , dyspepsia , flatulence , nausea , vomiting , diarrhea or constipation .
• Genitourinary system: various disorders of the menstrual cycle, postmenopausal bleeding from the vagina, hypermenorrhea , dysmenorrhea , heavy uterine bleeding , pain in the lower abdomen , most often caused by contractions of the myometrium. In the pre- and postmenopausal period - convulsions .
• Cardiovascular system: hypo- or hypertension .
• Skin: rash , itching .
• Allergic reactions and angioedema .
• Other reactions: dizziness , headaches , asthenia , changes in body weight, hyperthermia and/or chills .

Consultation with a psychotherapist (at the patient’s request)

After the fact of pregnancy is confirmed, the obstetrician-gynecologist will definitely offer you a consultation with a psychotherapist. This consultation before termination of pregnancy is recommended as a prevention of the psychological consequences of abortion.

Psychological counseling for women planning artificial termination of pregnancy will help to adequately assess possible risks and consequences, as well as understand whether a conscious decision was made. The purpose of the consultation is not to dissuade a woman from having an abortion; it is carried out with the intention of supporting the patient during a difficult period of life.

After a conversation with a specialist, you are given 2 days to think about it, after which, if your decision to terminate the pregnancy remains firm and unshakable, you sign an informed consent to the subsequent procedure at the clinic and, under the close supervision of a gynecologist, proceed to the next stage .

Instructions for Misoprostol (Method and dosage)

Misoprostol for abortion in combination with Mifepristone is taken according to the following scheme:

• 3 tablets (600 mg) of Mifepristone - orally on an empty stomach or two hours after a meal.
• After 36–48 hours - 2 tablets on an empty stomach. (400 mcg) Misoprostol.

Attention! If after taking there is no bleeding for 2 days, then taking the pills on your own is prohibited. To prescribe an additional dosage, you should consult a doctor - visit an obstetrician for 2-3 days.

Instructions for the use of Misoprostol as an antiulcer drug involve taking the tablets orally with meals. Dosage: 200 mcg 3-4 times a day, a single dose in the range of 200-400 micrograms, if the patient has hypersensitivity or renal failure - the dose is 100 micrograms. How to take it and for how long should be calculated depending on the indications and the observed clinical picture of treatment.

Features of the procedure

Pharmaboration involves taking special drugs, the action of which is designed to stop the development of the embryo and its expulsion through the genital tract. Upon completion, the woman develops blood discharge similar to regula.

For emergency termination of pregnancy, Mifepriston and Misoprostol are prescribed. Let's consider each option.

Mifepristone is a synthetic steroid-type drug that has an antiprogestogenic effect. It has no gestagenic activity. The substance blocks progesterone receptors, as a result of which the contractile function of the myometrium is activated. It interferes with the production of interleukin-8, which is formed in choriodecual cells, and makes the myometrium sensitive to prostaglandins. The fertilized egg is completely expelled from the uterus.

The maximum concentration of the substance occurs 1.5 hours after complete dissolution.

The drug is taken in a hospital. The dosage is calculated by the doctor. It depends on the physiological characteristics of the patient and the volume of the fetus. In standard cases, one Mifepristone tablet is sufficient. It is taken orally with a glass of water.

Misoprostol is an addition to the first substance. It promotes rapid rejection of the embryo and its release in a natural way. This is a methyl ester, a synthetic analogue of PGE1. Its concentration actively produces prostaglandin, which causes artificial labor.

The substance stimulates the smooth fibers of the uterus, opens its cervix, increases tone, resulting in a miscarriage.

The advantage of the drug is that it does not affect gonadotropins, prolactin, cortisol, thyroxine and other hormones.

During pregnancy and lactation

Based on the type of effect on the fetus, the drug is classified in category (according to the FDA) - X.

Misoprostolic acid can pass into breast milk. Despite the fact that there is no information on the development of any adverse reactions in children, it is recommended to use Misoprostol during lactation with caution.

If the drug is used as:

• Gastroprotective agent: pregnancy or planning it is unacceptable, since increased uterine tone can cause miscarriage . The drug can be prescribed only after pregnancy test Taking Misoprostol is usually started 2-3 days after the start of the menstrual cycle ; a prerequisite is the use of reliable methods of contraception , for example, barrier ones.
• Uterotonic: use for the purpose of termination of pregnancy, otherwise the drug is contraindicated in case of planned pregnancy.

What do you need to know?

Medical abortion can only be prescribed by a doctor. Before this you need to go through:

• taking urine, blood, glucose, ECG tests;
• Ultrasound, which will exclude ectopic development;
• bimanual examination with collection of vaginal smears.

The doctor also measures blood pressure, checks pulse rate and breathing.

The method is suitable for frozen pregnancies of the gestational age allowed in the protocol. If problems with blood clotting are detected, then they undergo a coagulogram.

Reviews of Misoprostol

Reviews about Misoprostol can be found absolutely varied. Many note the drug as an effective means for terminating pregnancy, although they complain about side effects and negative consequences after use.

Pencrofton and Misoprostol are used in combination for medical abortion , but it must be supervised by medical staff and supervised by a doctor. In addition, medical specialists usually prescribe Misoprostol for the treatment of erosive and ulcerative lesions of the gastrointestinal tract and to prevent the ulcerogenic effects of other drugs.

After taking medications

Usually, over the next 3-5 days, spotting is observed (usually a little heavier than menstruation). The average duration of bleeding (with decreasing intensity) is 12-14 days.

After 10-14 days from the onset of bleeding, it is necessary to conduct a control ultrasound examination of the pelvic organs. Minor bleeding should not be a reason to delay an ultrasound.

Briefly about the possible complications of medical abortion. Remedies

General symptoms

The following symptoms may occur during the use of Mifepristone and Misoprostol:

• Dizziness;
• Headache;
• Nausea;
• Vomit;
• Feeling of discomfort;
• Weakness;
• Increase in body temperature to 37.5 degrees
• Diarrhea.

Typically, these symptoms are mild and disappear without medical intervention.

If vomiting occurs within one hour after taking Mifepristone, then you must take the appropriate 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.

If the patient has severe early toxicosis of pregnancy (vomiting of pregnant women), then before using the complex for medical abortion, it is necessary to administer Cerucal intramuscularly, 2.0 ml, after 30 minutes, eat food (in a small volume), and then take the drug.

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-shpu.

Please note that the use of non-steroidal anti-inflammatory drugs (NSAIDs) (most analgesics, for example Analgin, Paracetamol, Ketanov, Nimesulide, etc.) for pain relief is contraindicated, since they block the action of Misoprostol (!), thereby reducing the abortive effect of the complex. Read more about Pain with MA.

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. If the pregnancy period does not exceed 9 obstetric weeks, then despite possible heavy bleeding, there is no need for additional treatment. Read more about Bleeding with MA.

Incomplete abortion

If this complication is detected, then vacuum aspiration is necessary to evacuate the remnants of the fertilized egg. Read more about Incomplete abortion.

Details about all possible complications.

Cost of some services in our clinic

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Can an abortion fail?

This situation occurs extremely rarely - only in 1.6% of cases. Moreover, the earlier the interruption was carried out, the higher the likelihood that it will be successful.

It is almost impossible to determine by external signs whether a medical abortion has occurred, therefore, after the termination is completed, an ultrasound diagnosis is required to make sure that the fertilized egg has been completely released.

Unfortunately, it is impossible to create a pregnancy that is not terminated after taking the pills. Mifepristone and Misoprostol have a negative effect on the fetus and can lead to the development of severe congenital anomalies. Therefore, the pregnancy will have to be terminated in any case.

What is the difference between prostaglandins and antiprogestins?

Antiprogestins reduce the sensitivity of special receptor cells located on the surface of the uterus. The task of these cells is to take in the pregnancy hormone progesterone. After taking antiprogestins, the fetus dies, remaining in the uterus.

Prostaglandins act on smooth muscle receptors, stimulating the contractility of the myometrium (the muscular layer of the uterus), and thereby causing contractions. Under the influence of the medicine, the fertilized egg is rejected and comes out along with the endometrium (the inner layer of the uterus, which is renewed every monthly cycle).

At short stages of pregnancy, a medical abortion, carried out according to all the rules in compliance with the dosages of both drugs, proceeds like menstruation, but the discharge will be thicker and will contain blood clots.