Medication abortion, often referred to as “the abortion pill,” is a widely used, non-surgical approach to ending an early pregnancy. This method involves taking a sequence of medications to induce a miscarriage-like process. Questions often arise regarding its effectiveness, particularly the possibility of the pregnancy continuing. This article addresses the possibility of continued pregnancy after medication abortion and explains what signs to look for.
How Medication Abortion Works
The medication abortion protocol functions by using two different drugs in sequence to halt the pregnancy and then expel the uterine contents. The first medication, Mifepristone, is a synthetic steroid that works by blocking the effects of progesterone. Progesterone is the hormone responsible for sustaining the uterine lining and supporting the developing pregnancy.
The second medication, Misoprostol, is typically taken 24 to 48 hours later. This drug is a prostaglandin analog that causes the cervix to soften and the muscular walls of the uterus to contract forcefully. These contractions are necessary to detach the gestation sac and push the pregnancy tissue out of the body. The entire process is designed to mimic a spontaneous miscarriage, resulting in heavy bleeding and cramping.
The Likelihood of Continued Pregnancy
While the medication abortion process is highly effective, the possibility of the pregnancy continuing, known as failure, does exist. The overall success rate typically ranges between 95% and 99% when used within the first 10 weeks of gestation. The primary factor influencing the likelihood of success is the gestational age of the pregnancy. Procedures performed earlier in the first trimester—specifically at eight weeks gestation or less—demonstrate the highest success rates. As the pregnancy advances toward the limit of medication use, the effectiveness may slightly decrease.
Improper adherence to the two-drug protocol can also contribute to the failure of the procedure. For example, if the Misoprostol is not taken at the correct time or if vomiting occurs too soon after taking the medication, the full therapeutic effect may not be achieved. This incomplete dosage means the necessary uterine contractions may not be strong enough to expel the tissue. Rare biological factors, such as an undiagnosed ectopic pregnancy, can also play a small role in the outcome. It is important to distinguish between a continued, viable pregnancy and an incomplete abortion, where some tissue remains but the pregnancy itself has ended.
Identifying Signs of Incomplete Abortion
Recognizing whether the medication abortion has been unsuccessful or incomplete involves monitoring physical signs and symptoms in the days following the procedure. A successful abortion is typically characterized by heavy bleeding and strong cramping that gradually subsides. The passage of clots and tissue is expected, usually followed by bleeding similar to a heavy period.
A key indicator that the pregnancy may be continuing is the persistence or worsening of initial pregnancy symptoms. If symptoms like morning sickness, breast tenderness, or fatigue do not begin to noticeably diminish within a week, it suggests the hormone levels are still high and the procedure may have failed. The body’s production of human chorionic gonadotropin (hCG) drives these symptoms.
Another significant sign is a lack of the expected physical response, such as minimal cramping or bleeding that is significantly lighter than a typical heavy menstrual period. If the bleeding is unusually light, it can suggest the Misoprostol did not effectively stimulate the uterus. Passing very little or no identifiable tissue may also indicate an incomplete expulsion or a continued pregnancy.
It is important to understand that home urine pregnancy tests are not a reliable tool for immediate confirmation. The hormones that trigger a positive result (hCG) can linger in the body for up to four weeks after a successful abortion.
Required Medical Follow-up and Options
Due to the small chance of failure, medical follow-up is a mandatory step following a medication abortion. This appointment is typically scheduled one to two weeks after taking the medication to confirm the procedure’s success. Confirmation is usually achieved through a transvaginal ultrasound, which can confirm the absence of gestational tissue in the uterus. Alternatively, blood tests to measure the levels of human chorionic gonadotropin (hCG) may be used; a significant drop in hCG over several days indicates a successful termination.
If the follow-up confirms that the pregnancy is still viable or the abortion is incomplete, medical professionals will discuss the available next steps. Options usually include administering a second dose of medication or proceeding with a surgical procedure, known as aspiration abortion. It is generally advised not to continue a pregnancy after exposure to the medications used in the protocol. Misoprostol has been associated with an increased risk of certain birth defects, making termination the safer medical recommendation.