Medical/Non-Surgical/Chemical or Instrument-Free Abortion – Misoprostol/Cyotec
Misoprostol is a prostaglandin medication marketed as Cytotec. Misoprostol is FDA approved to prevent gastric ulcers resulting from prolonged administration of non-steroidal anti-inflammatory drugs (NSAIDs). Misoprostol also causes uterine (womb) contractions and is used in several areas of female reproductive health. It is used to stop heavy vaginal bleeding after delivery of a full term pregnancy, induce labor of term pregnancies, cause softening and opening of the cervix (priming of the cervix), reduce the incidence of C-Sections, and to induce labor of patients in first and second trimester, and late term abortions. It can also be used with Laminaria to open and soften the cervix in first and second trimester, and late term abortions.
Misoprostol may be used alone to terminate pregnancies; however, it is not as effective as when used in combination with RU 486, Methotrexate, or Tamoxifen. There are several regimens and dosages used to terminate pregnancies using Misoprostol alone. The success rate depends on the length of the pregnancy as there is nearly a 100% completion of abortion for patients less than 6 weeks gestation. For pregnancies less than or equal to 16 weeks gestation, the success rate is 85 to 90%. For patients 17 weeks or greater, the rate is 92 to 96% successful.
There is a known increase in fetal abnormalities when a fetus is exposed to Misoprostol. The majority of these abnormalities affect the upper and lower extremity of the fetus as well as the central nervous system. There can be absence of the fingers and toes, club foot, and abnormalities of the cranial nerves VII, VI, V, and XII. These abnormalities have an incidence of 10 per 1000 exposed fetuses.
For women who nurse, Misoprostol is rapidly metabolized and it is not known if the metabolites are excreted in human breast milk. For precautions, it is better to discard breast milk for 24 hours after administration of the Misoprostol to prevent abdominal cramps or diarrhea.
When used as the second drug during a Non-Surgical Abortion in the first trimester of pregnancy with RU486, Methotrexate, or Tamoxifen, it promotes the expulsion of the pregnancy. The medication can be taken by mouth or inserted vaginally. The patient normally takes the Misoprostol tablets within a 48 to 72 hour time window after taking one of the three first medications to begin the medical abortion procedure. If the patient is unable to take the Misoprostol within the 48 to 72 hour window, it can be taken at another time which is an additional advantage of choosing the Non-Surgical Abortion method.
Diarrhea occurs within 60 to 120 minutes after taking the medication which can last for almost 24 hours.
Fever and Chills:
Chills are very common and can occur as soon as 15 to 30 minutes after taking Misoprostol. Fever is less common and does not necessarily indicate that the patient has an infection. If the fever or chills persist for more than 24 hours after taking Misoprostol, the woman may have an infection and needs to be seen by her physician. Tylenol, aspirin, or other anti-inflammatory can be used to reduce the fever.
Nausea and Vomiting:
If nausea and vomiting occur, it general resolves within 4 to 8 hours after taking the Misoprostol. An anti-emetic (ant-nausea medication) can be taken if necessary to help relieve the symptoms.
Vaginal Bleeding: Bleeding usually starts within an hour after taking the Misoprostol. It generally lasts 7 to 14 days but can last for 30 days. The menstrual period generally returns 4 to 6 weeks after Misoprostol is taken. Bleeding alone does not indicate a complete abortion. A follow-up sonogram is mandatory.
The patient should contact the office immediately if 1) she saturates more than two maxi sanitary pads an hour for more than two consecutive hours, 2) if she stops bleeding and suddenly experiences onset of very heavy bleeding two weeks after taking the Misoprostol, 3) if she has bled continuously for several weeks or suddenly feels dizzy or light-headed, 4) if no or minimal bleeding has occurred 7 days after taking the Misoprostol.
There are several dosages that are effective for termination of pregnancy. Wetting the tablets with a few drops of water or acetic acid prior to inserting them in the vagina has shown to increase the success rate in some studies. Misoprostol seems to work well when placed under the tongue (sublingually) or between the cheek and gumline (buccally) with a slight increase in side effects (diarrhea, fever, chills).
Misoprostol is contraindicated in patients who are allergic to other prostaglandins or allergic to Misoprostol. Please look under general contraindications to having the medical abortion procedure performed.
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3 to 24 Weeks
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