Medical Abortion

Medical Abortion

First- and second-trimester medical abortion

• First-trimester (first three months of a pregnancy) terminations are accomplished medically with misoprostol alone, methotrexate-misoprostol combination regimens, or Mifeprex (RU-486) with or without misoprostol. Other prostaglandins are used in other countries.
• Medical abortions are indicated for women who consent to a medical abortion but are also willing to undergo a surgical abortion if the medical abortion fails. Gestational age is usually less than 42-49 days, but many protocols can be used, including for gestations up to 63 days from the last menstrual period.
• The Mifeprex/misoprostol drugs are given as follows:
  • On day one, Mifeprex (200mg or 600mg) as pills are taken by mouth in the doctor's office.
  • On day two or three, misoprostol (800mcg is taken as pilsl or inserted vaginally) or in an office setting with four hours of observation.
  • Between days 7 and 10, you return to the office to determine if the abortion has been completed.
  • If it has not, a repeat dose of misoprostol is given or you may undergo a surgical abortion.
  • About 50% will abort in the first three days, about 80% of patients by the next day, and only about 5% of patients will need a surgical abortion.

The methotrexate/misoprostol regimen is similar, as follows:

• Methotrexate is injected on day one.
• On days six to seven, misoprostol is taken at home vaginally, and you return to the office on day eight to determine if the abortion has taken place. Misoprostol can be repeated with monitoring, or surgical abortion may be completed.
• Prostaglandin-induced second-trimester abortion: Medication can be given vaginally, orally, or injected into the fetus. The most typical regimen is usually 200mcg vaginally every four hours until the process is complete.
• Saline-induced abortion: A long process that was used 20 years ago is not often performed but is safe.