Medical abortion is a common and safe method to end an early pregnancy using medication. This non-surgical option is typically completed through a two-step process involving two different medications.
The Two-Step Medical Abortion Process
A standard medical abortion involves two distinct medications that work sequentially to end a pregnancy.
The first medication, mifepristone, is taken orally. Mifepristone functions by blocking the action of progesterone, a hormone crucial for maintaining a pregnancy. Without sufficient progesterone, the uterine lining begins to break down, and the pregnancy cannot continue to develop.
The second medication, misoprostol, is usually taken 24 to 48 hours after mifepristone. This medication causes the uterus to contract, leading to cramping and bleeding. Misoprostol also helps to soften the cervix, facilitating the expulsion of the pregnancy tissue from the uterus. The medications work together to effectively end the pregnancy.
Outcomes Without the Second Pill
If only mifepristone is taken, the intended outcome of ending the pregnancy is unlikely to be achieved. Mifepristone alone is generally not sufficient to complete a medical abortion, and the pregnancy will likely continue.
Sometimes, taking only mifepristone can result in a “missed abortion,” where the pregnancy is no longer viable but the tissue does not fully leave the body. It is also possible, though less common, for a complete abortion to occur without the second pill. However, the effectiveness of mifepristone by itself is significantly lower compared to the combined regimen.
Potential Health Considerations
Not taking misoprostol can lead to health considerations. A primary risk is an incomplete abortion, where some pregnancy tissue remains within the uterus. This retained tissue can cause prolonged or heavy bleeding, which may lead to anemia. Infection is another serious complication, as retained tissue can become a breeding ground for bacteria, resulting in symptoms like fever, chills, and foul-smelling vaginal discharge. Such complications often necessitate further medical intervention, including a surgical procedure like dilation and curettage (D&C) to remove the remaining tissue.
If a pregnancy continues after exposure to mifepristone, concerns about potential effects on the developing fetus may arise. Studies suggest that the rate of major congenital malformations after first-trimester exposure to mifepristone alone is only slightly higher than the expected rate in the general population, which is around 2-3%. However, if misoprostol was also taken and the pregnancy continues, there is a small increased risk of specific malformations. Healthcare providers generally recommend against continuing a pregnancy that has been exposed to both medications due to these medical uncertainties.
Seeking Professional Medical Guidance
Anyone who has taken only mifepristone or who is experiencing unexpected symptoms after a medical abortion attempt should contact their healthcare provider immediately. This includes persistent or heavy bleeding, severe abdominal pain, fever, or any signs of infection.
Prompt medical consultation is important to assess the situation and determine the appropriate next steps. A healthcare provider can evaluate whether the pregnancy is continuing, check for complications like retained tissue or infection, and discuss options for completing the process or managing any health issues. Being open and honest with medical professionals ensures proper care and the best possible health outcome.