One of the questions most frequently asked of Physicians is whether or not the medical or surgical abortion procedure is best for terminating early pregnancy. The answer is that it depends on what the individual patient feels is the best procedure once the benefits and risks of each technique have been discussed and whether or not any contraindications have been established. More women have preferred using the abortion pill above all other methods for terminating pregnancy following the FDA approval for use in 2000.
Contraindications for the medical abortion procedure are as follows: 1) distance the patient lives from the medical office; if more than two hours, she is not a candidate; 2) chronic use of corticosteroids; 3) bleeding disorders; 4) possible ectopic pregnancy; 5) IUD in the intrauterine cavity; 6) inability to return to the office for follow-up sonogram to assure that the pregnancy tissue has been expelled; 7) allergy to either of the medications used to perform the abortion pill procedure (Misoprostol, and RU 486); 8) refusal to have a surgical procedure if the medical abortion procedure fails; and 9) if the length of pregnancy is beyond the 14th week of gestation.
Studies have not yet determined the safety and effectiveness of the abortion pill procedure beyond the 9th week. European and South American studies have shown the medical abortion procedure to be highly effective and safe up to 14 weeks from the patient’s last menstrual period. The failure rate increases exponentially with the number of weeks. The success rate is between 94 to 98% for medical abortions up through 14 weeks of gestation. Patients who elect to have the surgical abortion procedure performed have greater than a 99.9% success rate up to 14 weeks.
For the medical abortion procedure, the RU 486 tablet is given prior to the patient leaving the office and the Misoprostol pills are administered 2 to 4 days after discharge from the medical facility. Patients need to return for at least one follow-up visit and sometimes a third visit may be necessary to assure that the gestational tissue is absent from the intrauterine cavity. An ultrasound is performed to determine if there are retained products of conception or for the presence of a continued pregnancy. This is done 7 to 14 days after the initial office visit. For surgical procedures, only one office visit is necessary. Surgical abortion procedures usually require 2 to 4 minutes to perform.
Patients indicate that the discomfort level is similar with both the medical and surgical abortion procedures. With the surgical abortion, women describe the discomfort as moderate. On a pain scale of 1 to 10 with 1 as little to no discomfort and 10 as the greatest, most patients state the level is between 4 and 5, and lasts for 8 to 10 minutes. With the medical abortion, the cramping generally begins 4 to 6 hours after taking the Cytotec tablets and may last from 6 to 24 hours. The pain is usually described as a level 4. Rarely is pain medication required; however, analgesics such acetaminophen or ibuprofen are usually effective in over 90% percent of cases.
The fees for the two procedures are nearly the same; however, the costs of a medical abortion are beginning to increase due to the escalating costs of manufacturing the medications.
Patients who have the surgical abortion generally recover within 15 minutes. Patients who are less than 6 weeks pregnant are allowed to return to their routine activities on the same day of the procedure and they may have sexual intercourse the next day. Following the abortion pill procedure, vaginal bleeding usually lasts from 8 to 14 days, but may continue up to 30. In rare instances it may last up to 60 days.
In summary; the type of abortion procedure a patient chooses is ultimately up to her as long as there are no contraindications. The abortion pill procedure is now available in some clinics up to 14 weeks. Please contact your nearest clinic for further information.