Medical abortion Complications | Treatment of therapeutic abortion with misoprostol
Complications from medical abortion are significantly reduced compared to surgical abortion. The transvaginal bleeding that occurs during a medication abortion is usually heavier than that of regular menstruation and is generally not different from the bleeding that occurs in early miscarriage.
According to studies, excessive bleeding is considered when the patient reports changing two completely saturated sanitary pads in less than 1 hour and 2 consecutive hours.
If due to method failure, the pregnancy continues, it is not recommended that the method be continued. Abortion services that use a pharmacological protocol
The medical practitioner or doctors who employ him should also facilitate and provide patients with the teratogenic risk curettage service.
Prolonged or heavy bleeding is the most common complication and occurs in approximately 1 in 100 women. Complete non-surgical evacuation of the products of conception (complete abortion) is defined as successful. Failure is defined as the failure to completely expel the products of conception and, therefore, the need for a curettage.
Abortion drugs have unwanted effects that, for the most part, do not lead to major medical or surgical complications, and largely disappear within the first 24 hours after taking the drugs. Vaginal bleeding and cramping are effects that are present in medical abortion and are an indication that the product is producing effective uterine contractions.
It should be noted that cramping is linked to cervical dilatation and expulsion of the product of conception (uterine evacuation), as occurs in miscarriage. This should be made known to the patient so that she does not become worried and anxious and consider it a complication. Colicky abdominal pain is reported to be present in 85% of patients.
Common side effects are nausea, vomiting, and diarrhea. These gastrointestinal manifestations are present, regardless of the dose and route of administration; they usually disappear after the expulsion of the product. Gastrointestinal effects are more severe,
when the route used is oral or sublingual.
The use of ibuprofen or dipyrone is recommended to counteract pain.
Treatment of therapeutic abortion with misoprostol
Taking into account the results of multiple studies with more than 5 000
cases are recommended:
- 1- For therapeutic abortion, doses of 800 μg (micrograms) every 6-12 h by vaginal route until completing 3 doses, in pregnancies under 12 weeks. Expulsion is achieved in the first 24 hours of administration of the drug, with a success rate above 90%. It can also be administered, by sublingual route, 800 μg every 3-4 h, until completing 3 doses, in pregnancies under 9 weeks.
- 2- In the second trimester, 400 μg can be used as an initial dose between 13 and 15 weeks by the vaginal route. Also, 200 μg can be used between 16 and 20 weeks, vaginally, and repeat doses during 6-12 h, if there was no response.
- 3- If it is an incomplete abortion, a dose of 600 μg should be administered orally or 400 μg sublingually as the only dose and control should be carried out in 7 days.
- 4- In the anembryonic egg, a single dose of 800 μg is used vaginally. It is also suggested that the tablets should be moistened, which favors a greater absorption and a faster passage to the bloodstream of the drug, it should also make a previous cleaning of the vagina with water and soap.
- 5- Adverse reactions will be present after the first dose of the drug is applied, so the frequency will not increase secondary reactions.
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