Medication termination of early pregnancy

Pharmacodynamics and pharmacokinetics

Misoprostol is a synthetic derivative of prostaglandin E1 . It is capable of inducing contraction of the smooth muscles of the myometrium and dilation of the cervix, which facilitates the process of excretion of the contents of the uterine cavity. Due to its weak stimulating effect on the smooth muscles of the gastrointestinal tract, large doses inhibit the secretion of gastric juice , and the tablets act as an antiulcer agent .

Misoprostol as an active substance does not have a significant clinical effect on:

• prolactin;
• gonadotropin levels ;
• thyroid-stimulating hormones;
• growth hormones;
• thyroxine;
• cortisol;
• creatinine;
• platelet aggregation.

Pharmacokinetics

Oral administration leads to rapid absorption (max concentration - 6.08±1.64 mg/ml). When taken with meals, especially fatty ones, the bioavailability of the drug decreases without affecting the duration of absorption. In the walls of the gastrointestinal tract and liver, conversion occurs to the active diesterified metabolite - misoprostolic acid , the maximum concentration of which is reached after half an hour and is 499 mg/ml. The half-life is no more than 30 minutes; the substance does not accumulate in body tissues and is excreted primarily by the kidneys.

Indications for use

• erosions , as well as erosive and ulcerative lesions of the gastrointestinal tract due to therapy with other drugs and prevention of their ulcerogenic effects (for example, prevention and treatment of NSAID gastropathy );
• peptic ulcer of the duodenum and stomach , including exacerbations;
• for early pregnancy of amenorrhea ).

In what cases is it carried out?

Unplanned pregnancy, alas, is not always desired. In this case, the woman can decide to terminate it (abortion).

A revolutionary method of non-surgical abortion in the 21st century is medical abortion. He gained supporters all over the world.

Thus, in developed countries, the frequency of use of medical abortion in the structure of all methods of abortion ranges from 40-60% (European countries, USA) and up to 80% (Sweden, France).

The effectiveness of medical abortion is 95-98% in early pregnancy (42 days from the 1st day of the last menstrual period or 6 weeks of pregnancy).

The traditional method of terminating pregnancy is surgical abortion (up to 12 weeks) .

There are 2 types of surgical abortion:

• vacuum aspiration;
• scraping the walls of the uterine cavity using surgical instruments.

The complications that can arise when performing a surgical abortion are numerous. The most common ones are:

• mechanical trauma of the uterus and cervix;
• bleeding;
• remnants of the fertilized egg;
• inflammation of the uterus and appendages;
• risk of hepatitis and HIV infection.

In addition, long-term complications of surgical abortion may include the following:

• chronic inflammatory processes of the genital organs;
• ovarian dysfunction and menstrual irregularities;
• ectopic pregnancy;
• infertility;
• incompetence of the cervix (spontaneous miscarriage may occur in subsequent pregnancies);
• anomalies of labor.

However, in modern medicine, new technologies for terminating unwanted pregnancies have emerged that are more protective of women’s health. Their risk to women's health is significantly lower than that of traditional methods.

One of the main advantages of a medical abortion over a surgical abortion is that the health risk is significantly lower, does not affect a woman’s fertility (a woman can become pregnant in the 1st menstrual cycle after a medical abortion), is well tolerated and does not require a hospital stay.

Contraindications

• hypersensitivity to the drug, as well as to other prostaglandins and analogues;
• liver dysfunction;
• cardiovascular or endocrine diseases;
• diabetes;
• severe form of renal failure ;
• contraindications for the use of prostaglandins – bronchial asthma , glaucoma , arterial hypertension ;
• reception of VPZ ;
• inflammatory processes in the intestines , including enteritis ;
• pregnancy , suspected ectopic pregnancy , lactation (breastfeeding);
• age group up to eighteen years.

Side effects

In relation to various organs and systems, Misoprostol can cause the following adverse reactions:

• Gastrointestinal organs: abdominal pain , dyspepsia , flatulence , nausea , vomiting , diarrhea or constipation .
• Genitourinary system: various disorders of the menstrual cycle, postmenopausal bleeding from the vagina, hypermenorrhea , dysmenorrhea , heavy uterine bleeding , pain in the lower abdomen , most often caused by contractions of the myometrium. In the pre- and postmenopausal period - convulsions .
• Cardiovascular system: hypo- or hypertension .
• Skin: rash , itching .
• Allergic reactions and angioedema .
• Other reactions: dizziness , headaches , asthenia , changes in body weight, hyperthermia and/or chills .

How the procedure itself is carried out

After receiving the examination results, in the absence of contraindications to termination of pregnancy and written confirmation of consent to this service, you take the Mifepreston tablet (trade name Mifegin, Miropriston, Mirolian) in the presence of a doctor. This drug blocks receptors in the uterus for progesterone, a hormone that promotes the development of pregnancy. Mifepreston also increases the sensitivity of the uterus to contractile agents, primarily to prostaglandins (Mirolyut, Topogin, Misoprostol).

Some women experience spotting on the 1st day after taking Mifeprestone, and 5% of women may experience a complete abortion.

Visit 2

The action of Mifepreston reaches its maximum effect 36–48 hours after the first visit to the doctor . Your return visit to the clinic is scheduled for this period.

Under the influence of Mifepreston, the fertilized egg peels off from the walls of the uterine cavity. The next stage is its expulsion from the uterine cavity.

For this purpose, the clinic will give you a drug (“Mirolyut”). This drug is a prostaglandin: it causes uterine contractions. After taking Mirolut, most women begin to experience bleeding from the genital tract, the onset of which may be accompanied by symptoms that are predictable and remediable:

• Pain : Complaints of pain vary greatly among women, depending on their personality type and pain threshold. For severe pain, it is allowed to use analgesics (paracetamol, analgin, etc.).
• increased body temperature and chills . Prostaglandins are sometimes the cause of increased body temperature. Typically, such an increase does not exceed 38 * C and lasts no more than 2 hours. The use of paracetamol eliminates these symptoms.
• nausea and vomiting. In patients coming for a pharmacological abortion, nausea may be associated with the pregnancy itself. However, abortifacient drugs can also cause nausea and, rarely, vomiting. Usually these symptoms go away on their own, and antiemetic drugs can also be used.
• diarrhea (loose stools) . The occurrence of diarrhea is associated with taking drugs to contract the uterus. This symptom is rare, short-term in nature, and goes away on its own. There is no need for treatment.
• bleeding _ Termination of pregnancy is accompanied by bleeding, similar to menstrual or more abundant. Such spotting rarely leads to a decrease in hemoglobin and/or requires any treatment. This is the normal course of a pharmacological abortion. You need to know that bleeding is considered heavy if 2 sanitary pads of the maximum size are completely saturated with blood within an hour, and this continues for 2 hours in a row or more. In this case, you should immediately contact your doctor.

Visit 3

(on the 14th day after the first)

A third visit to the clinic is necessary to assess the effectiveness of medical termination of pregnancy: complete abortion, incomplete abortion, continuing pregnancy.

The effectiveness of the method is 95-98%. If the method is ineffective, assessed on the 14th day after taking Mifeprestone, the woman completes the abortion surgically.

Both drugs used to terminate pregnancy are not hormonal.

Already in the 1st cycle after a pharmacological abortion, the woman’s fertility is restored, i.e. she can get pregnant again. Therefore, you should definitely discuss the issue of contraception with your doctor.

There are contraindications to medical termination of pregnancy, which can be found out at your doctor’s appointment.

Instructions for Misoprostol (Method and dosage)

Misoprostol for abortion in combination with Mifepristone is taken according to the following scheme:

• 3 tablets (600 mg) of Mifepristone - orally on an empty stomach or two hours after a meal.
• After 36–48 hours - 2 tablets on an empty stomach. (400 mcg) Misoprostol.

Attention! If after taking there is no bleeding for 2 days, then taking the pills on your own is prohibited. To prescribe an additional dosage, you should consult a doctor - visit an obstetrician for 2-3 days.

Instructions for the use of Misoprostol as an antiulcer drug involve taking the tablets orally with meals. Dosage: 200 mcg 3-4 times a day, a single dose in the range of 200-400 micrograms, if the patient has hypersensitivity or renal failure - the dose is 100 micrograms. How to take it and for how long should be calculated depending on the indications and the observed clinical picture of treatment.

Consultation with a psychotherapist (at the patient’s request)

After the fact of pregnancy is confirmed, the obstetrician-gynecologist will definitely offer you a consultation with a psychotherapist. This consultation before termination of pregnancy is recommended as a prevention of the psychological consequences of abortion.

Psychological counseling for women planning artificial termination of pregnancy will help to adequately assess possible risks and consequences, as well as understand whether a conscious decision was made. The purpose of the consultation is not to dissuade a woman from having an abortion; it is carried out with the intention of supporting the patient during a difficult period of life.

After a conversation with a specialist, you are given 2 days to think about it, after which, if your decision to terminate the pregnancy remains firm and unshakable, you sign an informed consent to the subsequent procedure at the clinic and, under the close supervision of a gynecologist, proceed to the next stage .

During pregnancy and lactation

Based on the type of effect on the fetus, the drug is classified in category (according to the FDA) - X.

Misoprostolic acid can pass into breast milk. Despite the fact that there is no information on the development of any adverse reactions in children, it is recommended to use Misoprostol during lactation with caution.

If the drug is used as:

• Gastroprotective agent: pregnancy or planning it is unacceptable, since increased uterine tone can cause miscarriage . The drug can be prescribed only after pregnancy test Taking Misoprostol is usually started 2-3 days after the start of the menstrual cycle ; a prerequisite is the use of reliable methods of contraception , for example, barrier ones.
• Uterotonic: use for the purpose of termination of pregnancy, otherwise the drug is contraindicated in case of planned pregnancy.

Stages of medical abortion

A medical abortion requires 3 visits to the doctor.

Visit 1

On the day of treatment, the obstetrician-gynecologist talks, examines the patient, and gives her:

1) Ultrasound for the purpose of:

• confirm pregnancy;
• establish that pregnancy develops in the uterus;
• establish the duration of pregnancy (no more than 6 weeks or 42 days from the first day of the last menstruation).

2) minimal examination, which includes:

• taking a smear on the flora;
• referral for a blood test (for syphilis, AIDS, hepatitis; determination of blood type and Rh factor).

Then, during the first consultation, the doctor will tell you in detail how the procedure should be carried out and indicate the order of repeat visits, as well as inform you about what the symptoms may be and how to behave in such cases.

The doctor will definitely warn you that in a small number of cases (2-5%) the method may be ineffective, and then you will have to terminate the pregnancy surgically.

Reviews of Misoprostol

Reviews about Misoprostol can be found absolutely varied. Many note the drug as an effective means for terminating pregnancy, although they complain about side effects and negative consequences after use.

Pencrofton and Misoprostol are used in combination for medical abortion , but it must be supervised by medical staff and supervised by a doctor. In addition, medical specialists usually prescribe Misoprostol for the treatment of erosive and ulcerative lesions of the gastrointestinal tract and to prevent the ulcerogenic effects of other drugs.

Prices in ViTerra

Medical abortion is a method of terminating pregnancy caused by medications ( prescribed exclusively by the attending physician - obstetrician-gynecologist and used under the personal supervision of a specialist in the clinic ). This method of non-surgical termination of pregnancy is the safest and most gentle modern method, which does not require hospitalization of the patient and is better tolerated psychologically.