Abortion Procedures
Early Medical Abortion / Medical (Nonsurgical) Abortion

Methods of Non-surgical Abortion

Medical abortion is a way to end a pregnancy by using abortion inducing drugs as an alternative to surgical procedures.  This procedure is administered up to 49-63 days (7 – 9 weeks) after the first day of the last menstrual period, depending on the medicines and protocols that are followed. 

In Oklahoma, only a physician licensed to practice medicine in Oklahoma can provide medicines for the purpose of inducing an abortion (Title 63 O.S. §1-729a).  The physician administering the medical abortion must: 

1. Have the ability to assess the duration of the pregnancy accurately
2. Have the ability to diagnose ectopic pregnancies
3. Have the ability to provide surgical intervention in case of an incomplete abortion or severe bleeding, or has made plans to provide such care through other qualified physicians
4. Be able to assure patient access to medical facilities equipped to provide blood transfusions and resuscitation, if necessary

The physician who provides mifepristone for the purpose of inducing an abortion must also:

1. Provide you with a copy of the drug manufacturer’s medication guide
2. Fully explain the procedure to you, including explaining whether the physician is using the drug in accordance with the U.S. Food and Drug Administration protocol or an evidence-based protocol.  If the physician is using an evidence-based protocol, they must provide you detailed information on the protocol being used
3. Provide you with a copy of the drug manufacturer’s patient agreement, which you must sign

The physician who provides medical abortion services must be in the same room as you are when the medicines are administered.

Common Medical Abortion Medications

Mifepristone.  Mifepristone (known as RU-486) is a pill taken by mouth.  It works by blocking the hormone progesterone.  Without this hormone, the lining of the uterus breaks down and the embryo detaches, causing the pregnancy to end.  It causes the cervix (opening of the uterus or womb) to soften and dilate. 

Methotrexate.  Methotrexate can be given by injection or taken by mouth.  It primarily affects rapidly dividing cells.  Methotrexate stops the ongoing process of implantation in the uterus of the embryo. 

Misoprostol.  Misoprostol tablets may be placed either into the vagina, between the cheek and gum, or swallowed.  Taken within a few hours or days, after taking mifepristone or methotrexate, it causes the uterus to contract and expel the embryo.

Common Evidence-Based Procedure

In 2000, the Food and Drug Administration approved a procedure for medical abortion with Mifepristone/ Misoprostol (RU-486), however, clinical studies have produced several variations in the protocol for medical abortions.  In all of the variations, there are generally three steps to the process:
Step One (at the physician’s office or clinic)

• Laboratory tests are performed to confirm the pregnancy, test for Rh status, and test for anemia and red blood cell count
• A medical and obstetrical history, including a history of allergies and all current medications is recorded
• An ultrasound may be performed to confirm how far along the pregnancy is
• The clinician will educate the patient about the medical abortion process, side effects, and clear instructions for assessing emergency services
• If eligible, for medical abortion, the woman swallows the mifepristone pills or receives a methotrexate injection or pills

Step Two (at the office/clinic or at home depending on the treatment regimen)

• This step takes place within 6 – 48 hours of step one
• Misoprostol tablets may be swallowed, placed between cheek and gum, or inserted into the vagina, depending on the treatment regimen

Step Three (at the office or clinic)

• This step takes place approximately 11-17 days after step 2.
• The clinician checks the woman to confirm a complete abortion.  It is essential for women to return to the office/clinic to confirm that the abortion is complete.
• If there is an ongoing pregnancy, a surgical abortion should be provided.
• If there is an incomplete abortion, the clinician will discuss possible treatment options with the woman.  These may include waiting and re-evaluating for complete abortion in a number of days, taking an additional dose of misoprostol, or performing a surgical abortion.

Side Effects and Complications of Medical Abortion

It can take anywhere from about a day to 3-4 weeks from the time a woman takes the first medication until the medical abortion is completed. 

• Bleeding – On average, women may expect to have bleeding and/or spotting for 9-16 days, but the range is from 1 to 45 days.  The bleeding may be heavier than a normal period and may include blood clots.  A small percentage of women will need a suction aspiration because of heavy or prolonged bleeding.  Rarely, a blood transfusion might be required to treat very heavy bleeding.
• Abdominal Pain and Cramping – The majority of women experience some cramping; for most it is like an intense menstrual period.  In rare cases, one-sided, severe lower abdominal pain, with dizziness, shoulder pain or shortness of breath could be a complication due to the rupture of an undiagnosed ectopic pregnancy (pregnancy outside the uterus).  In this case, the patient needs to access emergency medical treatment.
• Other – Side effects may include headache, nausea, vomiting, diarrhea, fever, chills, or fatigue.
• Incomplete abortion or ongoing pregnancy – Rarely, the medications do not work and the embryo continues to grow.  In these cases, a surgical abortion must be done to complete the abortion.
• Infection – Rare fatal infections have been reported.  Symptoms seen with these infections include weakness, nausea, rapid pulse, vomiting or diarrhea with or without abdominal pain that persists after the abortion is complete.
• Uterine Rupture – In rare cases, women with prior uterine surgery (primarily cesarean sections) have had uterine rupture.
• Death – Serious infection has resulted in death in very rare cases.

Who should not have a medical abortion?

Some women are not good candidates for a medical abortion.  Some women may not be suitable candidates for a medical abortion if:

• More than 49-63 days since last menstrual period began
• An IUD (Intrauterine Device) is inserted
• Confirmed or suspected ectopic pregnancy (a pregnancy outside the uterus)
• Have problems with adrenal glands (chronic adrenal fatigue)
• Take medicine to thin blood
• Have a bleeding problem
• Take certain steroid medications
• History of allergy to mifepristone, methotrexate, misoprostol, or other prostaglandin
• Unwillingness to undergo a surgical abortion if medically indicated
• Unwilling to return for follow up appointment
• Cannot easily get emergency medical help

It is important to tell provider about all medical conditions.