: What ’ s a medical abortion and how does it work ?

: A medical abortion is a safe and effective method of terminating a pregnancy using medications rather than surgery . It ’ s a two-stage process involving first taking one mifepristone ( 200 mg ) tablet which blocks the action of progesterone , a hormone which makes the lining of the uterus suitable for a fertilised egg and supports continuation of a pregnancy . This is followed 24-48 hours later by taking four 200mcg tablets of misoprostol , a synthetic prostaglandin which softens the cervix and causes contractions of the uterus to expel the pregnancy .

A medical abortion is similar to a miscarriage , with cramping pain starting within one to four hours of taking misoprostol followed by bleeding which is usually heavier than normal menstruation . The bleeding generally settles after the pregnancy is passed and remains similar to menstruation for five to seven days before gradually decreasing over the next two weeks or more . It is important to have follow-up two to three weeks after the medication to make sure the process has been successful . It can be important to have a support person present , and pain killers and anti-nausea medications are often provided .

: What are the risks of undergoing a medical abortion ?

: Complications are uncommon . However , it ’ s important for people to understand the expected effects of the medications and when to seek medical advice if needed . The most common complication is called incomplete abortion or retained products of conception when the pregnancy has been expelled but some pregnancy-related tissue remains in the uterus . Around three to five percent of those having a medical abortion require a surgical procedure , although sometimes it can be treated by an extra dose of misoprostol or it can resolve itself . There can be other less likely complications , such as ongoing pregnancy , bleeding , or infection .

: In which cases are people not able to undergo it and why ?

: Most people can have a medical abortion . However , there are some medical conditions which make it unsuitable , including having a bleeding disorder or taking anticoagulants , using oral corticosteroids ( because the mifepristone can reduce its effectiveness ) and allergy to the medications . People with severe anaemia , insulin-dependent diabetes , ischaemic heart disease , or severe kidney or lung disease need specialist advice .

: How does it compare to surgical abortion ?

: Surgical abortion up to 12 to 14 weeks is similarly a lowrisk procedure which involves gentle suction to remove the pregnancy from the uterus . The procedure takes between five to 15 minutes and is usually performed under intravenous sedation or local anaesthesia . It is associated with less pain than a medical abortion and is quicker . It has a high success rate with less than one percent of surgical abortions requiring a subsequent surgical procedure for retained products of conception . Surgical abortion occurs in a clinical facility and can be more costly and difficult to access than medical abortion which usually occurs at home . Medical abortion is seen as a more natural and less medical process which provides more autonomy and convenience , e . g ., for those in rural or remote areas or who are looking after small children at home . People with medical conditions which increase the risks of anaesthesia , such as obesity , are generally recommended to have a medical rather than a surgical abortion , but for those where the gestation is beyond nine or 12 weeks ( depending on local regulations ) and where medical abortion is unsuitable , a surgical procedure will generally be needed .

Neither medical or surgical abortion affect the ability to become pregnant or bear a child in the future , and fertility returns immediately , with the chance of pregnancy returning within days , so contraception planning can be important to consider .

Dr Deborah Bateson

Dr Deborah Bateson is Professor of Practice in the Faculty of Medicine and Health at The University of Sydney in Australia and an expert in safe abortion care .

8 ISSUE 5 | 2022 GlobalHealthAsiaPacific . com