FACT SHEET
ABORTION WITH MIFEPREXTM (MIFEPRISTONE)
AND MISOPROSTOL

DESCRIPTION

MifeprexTM is a medication used to end an early pregnancy of up to 63 days (9 weeks). It works by blocking the action of progesterone, a hormone needed to sustain a pregnancy. This causes an early pregnancy to detach from the wall of the uterus. It is used in combination with misoprostol, a drug that causes the uterus to contract and expel the pregnancy. This method is known as a non-surgical abortion because it allows a woman to end a pregnancy without surgery, in other words, without putting instruments into her uterus.

MifeprexTM has been approved by the U.S. Food and Drug Administration (FDA) for early abortion when combined with misoprostol. Misoprostol is used in the United States to prevent stomach irritation and ulcers in people using aspirin or aspirin-like pain medicine. Studies have shown that these two medications, when used together, are approximately 94-98% effective in causing an abortion in early pregnancy.

PROCEDURE

The following procedure is an evidence-based regimen, rather than the FDA approved regimen. This is because it uses a 200 mg. dose of MifeprexTM and an 800 mcg. dose of vaginal misoprostol. The FDA approved regimen is 600 mg. MifeprexTM and 400 mcg. of oral misoprostol. Clinical trials in the United States and elsewhere have demonstrated that this alternative regimen is safe and effective and causes less stomach upset.

  1. A medical history will be taken. An ultrasound examination will also be done to determine the size of your pregnancy. The ultrasound will be done by putting a probe in your vagina or on your abdomen. A blood sample will be taken to check your RH status and to test for anemia.
  2. You will swallow one 200 mg. MifeprexTM tablet in the office. You will be given four 200 mcg misoprostol to insert into your vagina anytime between 6 and 72 hours later.
  3. You will insert misoprostol into your vagina at home. After washing your hands, use the inserter to place the tablets as deep into the vagina as possible. Insert all four tablets at once. After insertion, lie in bed to prevent the tablets from coming out. During the next 1-3 hours you will likely have cramping, heavy bleeding and clotting. This is the abortion. It is rare to have serious problems but, to be prepared, you should have someone with you.
  4. If you start to bleed heavily (similar to a period) before the time you plan to use the vaginal tablets, you should insert them when you start to bleed and disregard the 6-72 hour timeline.
  5. We have given you a prescription to help control pain. Please have this filled and plan to use it. It is very difficult to get through this procedure without medication for pain.
CALL THE OFFICE BETWEEN 9 AND 5 IF YOU EXPERIENCE ANY OF THE FOLLOWING PROBLEMS. AFTER HOURS, PAGE US IMMEDIATELY AT (301) 930-6016. DO NOT BLOCK YOUR NUMBER WHEN PAGING.
  • You soak 2 or more maxipads per hour for 2 consecutive hours.
  • You have a sustained temperature of 100.4O F or higher, or you begin to have a fever a few days after inserting misoprostol.
  • You have severe abdominal pain not helped by pain medication.
  • You have no bleeding within 24 hours after inserting misoprostol.
  • You have overall discomfort, including weakness, nausea, vomiting or diarrhea that begins more than 24 hours after using misoprostol.
  • You have vomited for more than 4 hours.

Follow-up Visit (on or about day 14)

It is essential that you return to the office for a follow-up visit. You must bring a sample of your first morning urine on the day of your appointment. During this visit, we will test your urine to confirm that you are no longer pregnant. If your abortion is complete, you will be discharged from care. If the pregnancy has grown beyond 63 days, you will need a surgical abortion. If the pregnancy is still in your uterus, but has not grown beyond 63 days, you may be given more misoprostol. You should not do a home pregnancy test prior to your follow up visit. It’s entirely possible that it will still remain positive even though you are no longer pregnant. There is no cost for this visit unless it has been more than 4 weeks and, in that case, the cost of the visit is $25.00.

RISKS OF A NON-SURGICAL ABORTION

Incomplete abortion: Some pregnancy tissue may remain in your uterus. If this happens, we will discuss a plan for care with you. This plan could include waiting one or more weeks to allow the medications more time to work; using more misoprostol, or having a surgical abortion. The risks of a surgical abortion include making a hole in the uterus, tearing the cervix, infection, excessive bleeding and failure to remove all of the tissue from the uterus.

Vaginal bleeding: You could experience extremely heavy bleeding and require a blood transfusion or a surgical abortion to curtail the bleeding. The risk of having bleeding this heavy after using MifeprexTM is about 1 per 100 (1%). The risk of needing a blood transfusion after using MifeprexTM is about 1 per 1000 (0.1%).

Continued pregnancy and birth defects: Your pregnancy may not end after receiving the medications. Deciding to continue the pregnancy to term is NOT AN OPTION as birth defects are possible. The abortion has begun when you swallow the MifeprexTM and the decision to terminate becomes irreversible at that time.

BENEFITS OF A NON-SURGICAL ABORTION

  • can be done early - treatment can be started as early as 5 weeks from last menstrual period
  • women feel more in control
  • the procedure is less invasive than surgery
  • feels more "natural"
  • may feel more like a miscarriage
  • may be done in the privacy of ones' home
  • partner can be involved

SIDE EFFECTS

Most women will experience cramping and bleeding, which usually means the method is working. Bleeding may be similar to or heavier than a normal heavy period. You may see blood clots ranging from quarter to lemon size. You may see tissue that comes from the uterus. This is an expected part of ending the pregnancy. After the abortion, light bleeding and/or spotting may continue for an average of 9-16 days. Other side effects may include diarrhea, fever, headaches, chills, nausea and vomiting. You may use the prescription, Tigan, that we provided to you during your visit for vomiting.

TO MINIMIZE COMPLICATIONS

Once the misoprostol tablets have been inserted into your vagina, please avoid the following:

  • lifting heavy objects over 25 pounds
  • tampons (use only sanitary napkins)
  • sexual intercourse
  • tub baths, swimming and douching
  • alcohol
  • strenuous activities

You may resume normal activity after your follow-up visit. You should not travel for at least 1 week after using Mifiprex.

ELIGIBILITY

Women considering non-surgical abortion with MifeprexTM and misoprostol should NOT have any of the following:

  • hemorrhagic disorder, or concurrent anticoagulant therapy
  • chronic adrenal failure
  • concurrent long-term systemic corticosteroid therapy
  • confirmed or suspected ectopic pregnancy or undiagnosed adnexal mass
  • inherited porphyrias
  • IUD in place - must remove before treatment
  • allergy to mifepristsone, misoprostol or other prostaglandin
  • unwillingness to undergo a surgical abortion (if indicated)
  • unwillingness to return to office for follow-up care

Women considering non-surgical abortion with MifeprexTM and misoprostol SHOULD:

  • have gestation no more than 63days from the first day of last normal menstrual period with and corresponding ultrasound.
  • be able to give informed consent, comply with treatment requirements and have access to emergency health care.
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