Miscarriage and Abortion

Miscarriage and Abortion

First-Trimester Procedure
Medical Abortion
Second-Trimester Procedure

Medical Abortion

Medical abortion in the first trimester, also known as non-surgical abortion, uses medications to end an early pregnancy at home. It's an option up to nine weeks from your last menstrual period. Some women choose medical, rather than surgical abortion, for the following reasons:

• Can be performed at home in the earliest weeks of pregnancy
• Requires no surgery
• Requires no anesthesia
• Has the potential for greater privacy
• May give some women a sense of greater control over their bodies
• May feel more "natural"

Others prefer surgical for the following reasons:

• Requires fewer office visits
• Takes less time
• Less risk of an incomplete procedure
• No heavy bleeding at home

Specialists at the UCSF Women's Options Center can help you decide which procedure is best for you.

Medications used for medical abortion at our center are mifepristone and misoprostol. Medical abortion is not emergency contraception, also known as the "morning-after pill."

Emergency contraception (EC) is the use of hormones to prevent a pregnancy. Once pregnancy has occurred, EC is not an option.

A medical abortion involves at least two visits to our clinic. Occasionally, extra blood tests are required to confirm a drop in pregnancy hormone.

Medical abortion is about 95 percent to 98 percent effective in completely passing the pregnancy without the need for uterine aspiration. In comparison, uterine aspiration is about 98 percent effective the first time.

Special Requirements

When you call our clinic to schedule a medical abortion, our practice assistant will ask you some health questions to make sure that medical abortion is an appropriate option.

Patients choosing medical abortion should do the following:

• Don't leave the Bay Area for two weeks after your initial visit to the UCSF Women's Option Center

• Have a support person with you during the entire day that you insert the medication in your vagina

• If you care for an infant or young children, have someone watch them when you place the medication vaginally

• If you're breastfeeding, don't breastfeed for several days after administering the medication

Medications

Mifepristone, also known as "Mifeprex" or "RU-486," blocks the action of the hormone progesterone on the uterus and stops the growth of the pregnancy. This medication is taken orally.

Misoprostol, also known as "Cytotec," causes the cervix to soften and the uterus to cramp, bleed and expel the pregnancy. This medication is inserted in your vagina.

Process

Day 1 — At the UCSF Women's Option Center, you'll meet your doctor and receive health education and detailed instructions in a private room. You'll take 200 milligrams (mg), or one tablet, of mifepristone. The office visit typically takes two to 2.5 hours.

Day 2, 3 or 4 — At home, place four tablets, or 800 micrograms (mcg), of misoprostol in your vagina. It can take about five to seven hours for your body to pass the pregnancy, with vaginal bleeding and possible large blood clots, and cramping. You'll receive detailed instructions including what to expect and how to care for yourself.

Day 7 to 14 — Return to the UCSF Women's Option Center for an exam to confirm the abortion is complete. Follow-up visits may be scheduled.

Safety and Effectiveness

Mifepristone has been studied for more than 20 years. Millions of women worldwide have used mifepristone and misoprostol, or similar medications, for abortion. All studies have shown that it is safe and effective.

Short-term side effects may include:

• Diarrhea
• Fever and chills
• Mild to strong cramps
• Moderate to heavy vaginal bleeding, including possible blood clots
• Nausea and vomiting

Little is known about the effect of mifepristone on a developing embryo.

Misoprostol has been associated with birth defects when given in early pregnancy so you should have a surgical abortion if a medical abortion fails. There's no evidence that these medications will have any effect on future pregnancies.

Although rare, possible complications can include:

• Excessive bleeding requiring uterine aspiration, or in rare cases, a blood transfusion
• Failure to end the pregnancy
• Incomplete expulsion of pregnancy tissue requiring uterine aspiration
• Uterine infection, usually treatable with antibiotics

In extremely rare instances — as with miscarriage, uterine aspiration and giving birth — death may occur. Reports of death after medical abortion are very rare, less than 1 in 100,000 cases, a rate comparable to that for early uterine aspiration and miscarriage. Some data suggest that there might be slightly lower risk of death with uterine aspiration compared to medical abortion.

Reviewed by health care specialists at UCSF Children's Hospital.
Last updated December 9, 2008