Medical abortion came as a boon for couples with unwanted pregnancies. No hospital, no anaesthesia, no pain and no surgery. However, we shall see whether it is really a boon or another hurdle in the pathway of medical termination of pregnancy.
This method of abortion can only be used for pregnant women seeking termination of pregnancy up to 7 weeks only (21 days overdue). They must understand that at least 3 visits to the doctor’s clinic are mandatory and should be ready for surgical intervention at any point of time if needed.
The good thing about medical termination of pregnancy is that it is done by medicines, gives complete privacy, is inexpensive and technically simple office procedure and can be started immediately.
It is important that only registered medical practitioners prescribe it with access to a place approved by government for emergency back –up. A special consent for medical abortion should be taken by the doctor apart from the routine consent taken for surgical MTP. Ultrasound should be done to see the age of the foetus in case there is a controversy regarding duration of pregnancy before advising medical abortion. Blood group estimation and Anti D injection should be given to all Rh negative women. The second visit of the woman should definitely be after 48 hours of the first visit when she is given the medicine to expel the foetus and should remain in the clinic for at least 4 hours. She should not leave station for 15 days following this so that any complications arising can be dealt with.
The disadvantages compared to surgical termination are the woman should be committed to follow up as the procedure takes longer interval from start to finish. Nausea vomiting and diarrhea with severe abdominal cramps often happen on the day of active abortion or expulsion of the fetus along with diarrhea, headache and sometimes dizziness and fatigue. However if bleeding persists and/or woman is dizzy she should report. Severe bleeding necessitating a surgical curettage occurs in 1% patients and if pregnancy fails to terminate the need for surgical evacuation in up to 5% of patients could occur.
Women, who smoke, are anaemic or have blood clotting disorders, high blood pressure or heart, liver, kidney or pulmonary disease or have suspicion of ectopic pregnancy, should never opt for this method of abortion. Besides these contraindications women who have a scar in the uterus or large fibroids or are on anti TB medicines may have more difficulties by this method of abortion.
True drug failure is presence of cardiac activity after 2 weeks. Occurs in 1% and pregnancy should be terminated by evacuation because of the risk of abnormalities in the baby.