1st Trimester Medication Abortion Methods
First Trimester Medication Abortion Up to 10 Weeks After the Last Menstrual Period (LMP) 5, 26 (PP.135-56), 30, 31, 32
This drug is now FDA (Food and Drug Administration) approved for use in women up to 70 days after their last menstrual period. 18 The new FDA-approved procedure usually requires one* office visit. On the first visit, the woman is given Mifeprex (mifepristone) that causes the death of the embryo. 24 – 48 hours later, at an appropriate location, she takes 800 mcg of misoprostol in the cheek pouch, which causes cramping that expels the embryo. 7-14 days after taking Mifeprex the woman follows up with the health care provider to ensure that the abortion is completed.
*The number of visits is determined by the abortion provider
Risks associated with medication abortion (Mifeprex/Mifepristone, RU-486 with Misoprostol):
- Bleeding: Vaginal bleeding lasts for an average of 9-16 days; 1 in 100 women bleed enough to require surgery (D&C) to stop the bleeding. 20
- Infection: According to the FDA, “Cases of serious bacterial infection, including very rare cases of fatal septic shock, have been reported.” 21 This means that some Mifeprex users have died as a result of total body infection. The FDA issued a health advisory July 19, 2005 and changed safety labeling to warn of the risk of this serious bacterial infection. 22,23
- Undiagnosed ectopic (tubal) pregnancy: The abortion pill will not work in the case of an ectopic pregnancy where the embryo lodges outside the uterus, usually in the fallopian tube. If not diagnosed early, there could be risk of the tube bursting, internal hemorrhage and death in some cases. 24
- Failed abortion: The FDA Labeling Information for Mifeprex states that the failure rate of medical abortion increases with advancing gestational age. 6 Mifepristone abortion at or below 49 days gestation causes complete abortion in 98% of cases, and 93% of the time when abortion occurs between 63-70 days gestation. 7 A surgical abortion is usually done to complete failed medication abortion.
- Risk of fetal malformations: Research associates the use of misoprostol during the first trimester with certain types of birth defects among medication abortion “failures”. 27
- Continuation of pregnancy: Women who change their minds after beginning a medication abortion and want to continue their pregnancies should immediately seek the help of an obstetrician. Learn more about the Abortion Pill Reversal here.
This drug is FDA-approved for treating certain cancers and rheumatoid arthritis, but is used “off-label” to treat ectopic pregnancies and to induce abortion. It works by stopping the growth of rapidly dividing cells. It is used up through 49 days of pregnancy and given orally or by injection. Three to seven days after methotrexate is taken, misoprostol (the second medication used in the RU-486 abortions) is used vaginally.
Side effects of methotrexate include mouth ulcers, low white blood cell count, nausea, abdominal distress, fatigue, chills, fever, dizziness, decreased resistance to infection and anemia. Severe, sometimes fatal, bone marrow suppression and intestinal toxicity have been reported. Liver toxicity and cancer may occur (usually after prolonged use.) Severe, occasionally fatal, skin reactions have been reported. 28
This form of medication abortion uses only the second drug given in the RU-486 method. It is typically inserted vaginally, requires repeated doses and has a significantly higher failure rate than the RU-486 method. It is associated with nausea, vomiting, diarrhea, and with potential birth defects (central nervous system and limb defects) in pregnancies that continue. 29
1st Trimester Surgical Abortion Methods
First Trimester Suction Abortion About 4-13 Weeks After the Last Menstrual Period (LMP)
5, 26 (PP.135-56), 30, 31, 32
This surgical abortion is done throughout the first trimester. Varying degrees of pain control are offered ranging from local anesthetic (typically) to full general anesthesia.
For very early pregnancies (4-7 weeks LMP), a long, thin tube is inserted into the uterus which is attached to a manual suction device and the embryo is suctioned out.
Late in the first trimester, the cervix needs to be opened wider because the fetus is larger. The cervix may be softened the day before using medication placed in the vagina and/or slowly stretched open using thin rods made of seaweed inserted into the cervix. The day of the procedure, the cervix may need further stretching by metal dilating rods. This can be painful, so local anesthesia is typically used. Next, the doctor inserts a plastic tube into the uterus and applies suction by either an electric or manual vacuum device. The suction pulls the fetus’ body apart and out of the uterus. The doctor may also use a loop-shaped tool, called a curette, to scrape any remaining fetal parts out of the uterus.
2nd Trimester Methods
The majority of second trimester abortions are performed using this method. The cervix must be opened wider than in the first trimester abortion because the fetus is larger. This is done by inserting numerous thin rods made of seaweed a day or two before the abortion and/or giving other oral or vaginal medications to further soften the cervix. Up to about 16 weeks gestation, the procedure is identical to the first trimester one. After the cervix is stretched open and the uterine contents suctioned out, any remaining fetal parts are removed with a grasping tool (forceps). A curette (a loop-shaped tool) may also be used to scrape out any remaining tissue.
After about 16 weeks, much of the procedure is done with the forceps to pull fetal parts out through the cervical opening, as suction alone will not work due to the fetus’ size. The doctor keeps track of what fetal parts have been removed so that none are left inside as this can potentially cause infection. Lastly, a curette, and/or the suction machine are used to remove any remaining tissue or blood clots, which if left behind could cause infection and bleeding.
This technique induces abortion by using medicines to cause labor and eventual delivery of the fetus and placenta. Like labor at term, this procedure typically involves 10-24 hours in a hospital’s labor and delivery unit. Digoxin or potassium chloride is injected into the amniotic fluid, umbilical cord or fetal heart prior to labor to avoid the delivery of a live fetus. The cervix is softened with the use of seaweed sticks and/or medications. Next, oral mifepristone and oral or vaginal misoprostol are used to induce labor. In most cases, these drugs result in the delivery of the dead fetus and placenta. The patient may receive oral or intravenous pain medications. Occasionally, scraping of the uterus is needed to remove the placenta.
Potential complications include hemorrhage and the need for a blood transfusion, retained placenta and possible uterine rupture (splits open).
Late-term Methods
This procedure typically takes 2-3 days and is associated with increased risk to the life and health of the mother. Because a live birth is possible, injections are given to cause the fetal death. This is done in order to comply with the federal Partial-Birth Abortion Ban Act of 2003 which requires that the fetus be dead before complete removal from the mother’s body. The medications (digoxin and potassium chloride) are either injected into the amniotic fluid, the umbilical cord or directly into the fetus’ heart. The remainder of the procedure is the same as the second trimester D&E. Fetal parts are reassembled after removal from the uterus to make sure nothing is left behind to cause infection.
An alternate technique, called “Intact D&E” is also used. The goal is to remove the fetus in one piece, thus reducing the risk of leaving parts behind or causing damage to the woman’s body. This procedure requires the cervix be opened wider; however, it is still often necessary to crush the fetus’ skull for removal as it is difficult to dilate the cervix wide enough to bring the head out intact.
Want to learn more?
Gateway Women’s Care provides one-on-one counseling, support and accurate information about all pregnancy options. We do not, however, provide or refer abortion services.
