There have been numerous studies and articles written in medical literature regarding medical abortion in the first nine weeks of pregnancy. Prior to medical abortion, the most common method of performing a termination of pregnancy required undergoing a Suction D&C (Dilatation and Currettage).
The manner in which a Suction Currettage is carried out for patients 12 weeks or less, is to position the patient as if she is to undergo a routine Pap Smear or Pelvic Exam. As long as they have someone to drive them home, patients who do not want to remember or feel any discomfort while undergoing the surgical procedure, can be given Intravenous (IV) Sedation in doses that will generally last the length of time required to carry out the abortion procedure process.
A vaginal speculum is then placed inside the cleansed vagina and the cervix (lower part of womb) is anesthetized (numbed). The cervical os is then dilated (opened) with serial dilators until it is adequately dilated enough to allow for the appropriately sized sterile currette to be placed inside the uterus. A manual vaccum or suction tubing is attached to the end of the currette and the gestational (pregnancy) tissue is gently removed from within the intauterine cavity. The patient is then sent to recovery where she can rest comfortably while her vital signs (blood pressure, heart rate, respirations, temperature) and vaginal bleeding will be monitored. Most patients are ready to be discharged (sent home) within 15 to 30 minutes after the procedure has been performed.
Most women do not want to undergo surgery, they want the abortion process to be more private, to be able to have a support person with them, and want the abortion procedure performed as early as three to four weeks in pregnancy without having to wait additional weeks. This resulted in the advancements of early surgical abortions (3 to 6 weeks) which are now carried out routinely.
Prior to a decade ago, most Physicians would not perform abortions that early for fear of retained tissue, uterine perforation, and cervical tears. For almost 30 years, the medical abortion procedure has become very popular. The RU 486 Pill (Mifeprex) was developed and popularized in France in the late 1970′s and early 80′s. Over 50% of French women who are less than 9 weeks pregnant use RU 486 along with a second pill (misoprostol) to undergo the abortion process. RU 486 is a anti-progesterone which is the primary female hormone needed to maintain pregnancy by preventing the uterus from contracting and expelling (push out) its content before time (full term pregnancy and labor).
Giving RU 486 increases uterine tonus (pressure), necrosis (loss of blood flow) to the gestational (pregnancy) tissue, and causes the cervix to soften. Misoprostol is a prostaglandin which causes uterine contractions. By taking it 48 hours later, it causes the uterus to expel its contents, thus completing the abortion process. This abortion method is effective 92 to 98% of the time between 3 to 9 weeks gestation. If less than 6 weeks, there is close to a 100% success rate with this method.
There are several different methods being used to carry out the abortion process using the Abortion Pill method. Various studies have suggested giving misoprostol the same day, 24 hours, and 48 hours later. Overall, the studies show that there is less chance of failure with giving the misoprostol 48 hours after giving the RU 486 pill except in the subset of patients less than 6 weeks pregnant. There are studies that show giving the RU 486 in combination with misoprostol taken immediately, or giving misoprostol alone results in nearly a 100% success rate of terminating pregnancies less than 6 weeks. In conclusion; patients less than 6 weeks gestation, can undergo an Abortion Pill procedure by taking misoprostol alone on their first visit with near a 100% success rate. With the Abortion By Pill method, patients no longer have to endure surgical abortion procedures with prolonged recovery times; waiting until they several weeks pregnant; and can choose this more private, early option.
