Early Medical Abortion
Management of side effects and complications in medical abortion,☆☆

https://doi.org/10.1067/mob.2000.107946Get rights and content

Abstract

Side effects are an expected part of medical abortion; some, such as pain and bleeding, result from the abortion process itself and are generally managed with orally administered analgesics and counseling. True medication side effects most commonly include nausea, vomiting, diarrhea, and warmth or chills. Complications of medical abortion usually represent an extreme or severe side effect. Large series have reported transfusion rates of <1%. Because of the infrequency of uterine instrumentation, postabortal endometritis appears to be rare with medical abortion. As with early surgical abortion, the clinician must remain aware of the possibility for ectopic pregnancy. Overall approximately 2% to 10% of patients will require surgical intervention for control of bleeding, resolution of incomplete expulsion, or termination of a continuing pregnancy. Understanding the types of side effects and complications that can occur will enable the clinician to counsel patients properly as well as to understand when medical intervention is necessary during the medical abortion process. (Am J Obstet Gynecol 2000;183:S65-S75.)

Section snippets

Comparison of Complications Between Medical and Surgical Abortion

In a report of 170,000 first-trimester surgical abortions performed by experienced abortion providers in the United States the overall complication rate among women with follow-up was 9 events/1000 procedures.2 Although rare, some of the most serious complications associated with surgical abortion, such as uterine perforation or complications of anesthesia, result directly or indirectly from the need to instrument the uterus. Successful medical abortion avoids these types of complications; in

Pain

Pain derives from noxious sensory stimulation at its site of origin but is moderated significantly by other factors, including fear and anxiety. Individual and cultural variations affect pain thresholds and the experience and expression of pain. Some women seeking abortion may have underlying emotional pain associated with an unintended pregnancy and its ramifications. Provision of full preliminary information helps patients to manage their pain response. Women who receive a description of the

Follow-up

After initiation of medical abortion treatment, follow-up is necessary to ensure complete abortion. Studies demonstrate that women may be unable to judge correctly on the basis of symptoms whether abortion has occurred. In clinical trials with methotrexate and misoprostol only about half of the women who thought that abortion had occurred actually had completed abortions at that time.11 Moreover, women may have symptom resolution consistent with a complete medical abortion yet still have a

Comment

Any medical procedure will have side effects and complications. Medical abortion, like surgical abortion, is a safe option for women with an unwanted pregnancy. Approximately 2% to 10% of women who have a medical abortion will require a surgical procedure for completion because of a continuing pregnancy, incomplete abortion, or the need for hemostasis. Although gastrointestinal and thermoregulatory side effects may occur, they generally are tolerable and short in dura-tion. Clinicians providing

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    The opinions expressed in this article do not necessarily reflect those of Planned Parenthood Federation of America, Inc.

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