Mifepristone is an effective and safe drug for medical abortion.

Which method of abortion is less traumatic?

Three methods are used for artificial termination of pregnancy in Russia. The most common method is dilatation and curettage (curettage). The World Health Organization considers it the most dangerous, and therefore recommends its use in extreme cases. In second place is mini-abortion (vacuum aspiration), which has been used in our country since 1989. And only third place is occupied by medical abortion. But this is the most effective and safe method of terminating an unwanted pregnancy.

Medical abortion regimens and drug dosages were approved in most countries of the world in 2012. As a result of the use of drugs, the death and rejection of the embryo occurs.

The drug with the active ingredient mifepristone is generally accepted for medical abortion. The original drug Mifegin (mifepristone 200 mg) was officially registered and approved for use in the Russian Federation in 1999. Since then, mifepristone in combination with misoprostol has been successfully used for medical termination of pregnancy.

Of course, when a woman decides to have an abortion, she must understand that termination of pregnancy, in principle, cannot be absolutely safe. And there is nothing good in this action. But if such a need arises, you need to contact a gynecologist at the earliest possible date and choose a minimally traumatic method.

Can an abortion fail?

This situation occurs extremely rarely - only in 1.6% of cases. Moreover, the earlier the interruption was carried out, the higher the likelihood that it will be successful.

It is almost impossible to determine by external signs whether a medical abortion has occurred, therefore, after the termination is completed, an ultrasound diagnosis is required to make sure that the fertilized egg has been completely released.

Unfortunately, it is impossible to create a pregnancy that is not terminated after taking the pills. Mifepristone and Misoprostol have a negative effect on the fetus and can lead to the development of severe congenital anomalies. Therefore, the pregnancy will have to be terminated in any case.

Characteristics of the drug Mifepristone

Contains the active ingredient mifepristone. Release form: tablets containing mifepristone 200 mg, 3 pcs. Registration certificate holder: Nizhpharm JSC, Russia. Manufacturer: JSC Obninsk Chemical and Pharmaceutical Company, Russia. Clinical and pharmacological group: antigestagen.

A drug that increases the activity and tone of the myometrium. Pharmacotherapeutic group: antiprogestogen. Pharmacological action: synthetic steroid antigestagenic drug. Does not have gestagenic activity. Blocks the action of progesterone at the receptor level. It is an antagonist of glucocorticosteroids (GCS) due to competition at the level of connection with receptors.

Stimulates the release of interleukin-8 in choriodecidual cells and increases the sensitivity of the myometrium to prostaglandins, resulting in increased myometrial contractility. As a result of the action of the drug, desquamation (falling off) of the decidua and expulsion of the fertilized egg occurs. Used in combination with a synthetic prostaglandin analogue.

Dosage regimen and regimen for use of Mifepristone for medical termination of pregnancy

For medical termination of pregnancy in the early stages, Mifepristone is prescribed in a dose of 600 mg (3 tablets) once.

Features of taking the drug:

• used only in specialized licensed medical institutions with the necessary equipment;
• taken orally 1-1.5 hours after eating a light meal, washed down with 100 ml of boiled water;
• it is necessary to monitor the absence of vomiting, as this will lead to malabsorption and a reduction in dosage;
• the patient should be under the supervision of medical personnel in a medical facility for at least 2 hours after taking the drug. Since the maximum concentration of Mifepristone in the blood is reached 1.3 hours after administration, this is necessary to provide emergency medical care in the event of an allergic reaction.

36-48 hours after taking Mifepristone, the patient should come to the hospital for an ultrasound examination of the uterine cavity. At the same time, she takes a second drug - misoprostol at a dosage of 400 mg. Misoprostol stimulates contraction of the smooth muscles of the uterus and dilates the cervix, increasing the frequency and strength of myometrial contractions. As a result of the combination of two drugs, bleeding, rejection of the fertilized egg and termination of pregnancy occur.

Ultrasound examination of the uterine cavity

After 10-14 days, a clinical examination and repeated ultrasound control are repeated; if necessary, the level of hCG (chorionic gonadotropin) is determined to confirm spontaneous abortion. If the examination results indicate that an incomplete abortion has occurred or the pregnancy continues, fetal tissue is removed using a vacuum aspirator.

Special instructions for the use of Mifepristone for medical termination of pregnancy
:

• if a woman has a negative blood type, and the partner from whom conception occurred is positive, she is recommended to administer anti-Rh immunoglobulin to prevent the development of Rh conflict in the next pregnancy;
• Women with artificial heart valves or infective endocarditis should receive prophylactic antibiotic therapy when using Mifepristone;
• it is necessary to inform the patient that the pregnancy must be terminated in another way if there is no effect from the use of the drug on days 10-14, since there is a risk of congenital malformations in the fetus;
• within 8-12 days after taking the drug, it is necessary to avoid taking non-steroidal anti-inflammatory drugs; for pain relief it is allowed to take antispasmodics;
• it is necessary to inform the patient about the decrease in the effectiveness of the method as the woman’s age increases;
• it is necessary to warn about the possibility of prolonged bleeding from the vagina, lasting on average about 12 days, sometimes more. A woman should receive clear instructions that if severe bleeding occurs, with or without pain, she must go to the clinic;
• The decision to use the drug for women with hemostasis disorders and anemia is made together with a hematologist and after his consultation.

Misoprostol – why take it and what sensations it causes

2 days after taking Mifepristone, the patient is given another hormonal drug, Misoprostol, which causes uterine contractions. Its task is to separate the fertilized egg from the uterine wall and remove it. If this is not done, an incomplete abortion will occur. The dead embryo will remain inside the uterus, leading to bleeding and a purulent process.

Misoprostol is taken in a dosage of 400 mcg. Its effect begins quite quickly - the woman begins to experience spotting, which intensifies to the intensity of menstrual bleeding. Sometimes the volume of blood can be greater than during menstruation - it all depends on the individual characteristics of each woman and the duration of pregnancy.

If bleeding has not started 4 hours after taking the first two tablets, the woman is given another 400 mcg of the drug for medical abortion. In this case, the total dose is 400 mcg

Against the background of bleeding, the fertilized egg is released, looking like a round red formation. After this, all unpleasant sensations subside. This condition resembles a miscarriage, so a medical abortion, even the first one, does not cause as serious consequences as a surgical termination.

The release of the fertilized egg may be accompanied by cramping pain in the lower abdomen, radiating to the sacrum, coccyx, groin area, and lower back. Severe pain is usually observed during a medical abortion during the first pregnancy in a nulliparous woman.

Causes of pain during medical abortion:

• Late interruption period, approaching the limit of 7 weeks.
• Individual characteristics of a woman’s reproductive system – congenital anomalies (bicornuate, saddle-shaped uterus, presence of intrauterine septa), displacement of the uterus.
• Inflammatory processes of the genital area.
• Recent uterine manipulation (surgery, curettage).
• Low pain threshold

In this case, you can take painkillers prescribed by your gynecologist.

Drug interactions

Interaction studies have not been conducted with mifepristone. However, it must be taken into account that cytochrome P4503A4 (CYP3A4) is involved in the metabolism of mifepristone. Cytochrome P450 dependent monooxidases (enzymes) catalyze many reactions involved in the metabolism of drugs. Specifically, CYP3A4 is responsible for the metabolism of drugs and steroids. Therefore, it is possible that grapefruit juice, ketoconazole, itraconazole, erythromycin, when used together with mifepristone, can increase its concentration in the blood plasma.

Dexamethasone, preparations of St. John's wort, phenytoin, phenobarbital, carbamazepine, rifampicin, when used together, can reduce the concentration of mifepristone in the blood plasma.

Caution should be exercised when concomitantly using mifepristone with drugs that are CYP3A4 substrates, including drugs for general anesthesia. With the simultaneous use of Mifepristone and glucocorticosteroids, it is necessary to increase the dosage of GCS.

Contraindications to the use of Mifepristone

• ectopic pregnancy;
• pregnancy for more than 42 days, as well as not confirmed by clinical studies;
• pregnancy during the use of intrauterine contraceptives or after discontinuation of hormonal contraception;
• inflammatory diseases of the female genital organs;
• smoking in women over 35 years of age without prior consultation with a physician;
• adrenal insufficiency;
• acute or chronic renal and/or liver failure;
• porphyria;
• long-term use of glucocorticoids;
• anemia;
• impaired hemostasis (including previous treatment with anticoagulants);
• the presence of severe extragenital pathology;
• a history of hypersensitivity to Mifepristone and/or auxiliary components.

Anemia

Early 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.

Complications after taking Mifepristone

It is important not to confuse the concept of a side effect of a drug and complications after taking it. A complication is a pathological process that is attached to the underlying disease or develops as a result of therapeutic or diagnostic measures. Complications arise when the rules for taking the medication or regimen are violated, as well as due to the pathological reactivity of the body.

To prevent the development of complications during medical termination of pregnancy using Mifepristone, it is very important to examine the woman, determine the presence of diseases, contraindications for the procedure, the exact duration of pregnancy, and check the rules of admission. The main condition for a favorable outcome of a medical abortion is that it is carried out by specialists in a medical institution.

One possible complication is bleeding. If the bleeding is heavy, more than 2-3 pads in one hour, accompanied by severe intolerable pain, you should immediately consult a doctor. Significant blood loss requires medical intervention. To stop, vacuum aspiration or curettage and blood transfusion are performed. Without going to the clinic, the risk of death as a result of heavy bleeding increases.

In some cases, the fertilized egg does not completely leave the uterine cavity. In the case of an incomplete abortion, the remains of the embryo cause an inflammatory process, intoxication of the body, the spread of infection can lead to blood poisoning and the death of the woman. Emergency medical care is required - curettage of the uterine cavity after an ultrasound examination, a course of detoxification and antibacterial therapy in a hospital setting.

Partial or complete absence of abortion occurs in 5-15% of women, due to the individual reaction of the body and depends on the duration of pregnancy (the longer the period, the higher the risk). If, after taking Mifepristone, pregnancy continues to develop (incorrect dosage of the drug and late term), termination of pregnancy is necessary, since the risk of having a child with serious malformations is very high.

When does Mifepristone begin to act and what does a woman feel at this time?

The time it takes for the first medication abortion pill to take effect may vary. Sometimes its effect begins to appear after 3-4 hours, and sometimes after 12 hours. The temporal variation in the effect is due to metabolic characteristics, which are individual for each woman.

• As a rule, no negative changes in well-being are felt on the first day of a medical abortion after. Sometimes you may experience a nagging pain in the lower abdomen and mild nausea.
• Patients who have experienced toxicosis begin to feel its weakening. Nausea, vomiting, pain in the mammary glands disappear, and the general condition improves. This is due to the cessation of the development of pregnancy, which had a negative effect on the body.

Often, when carrying out a medical abortion, bloody discharge is observed after taking the first pill, which, as a rule, is not accompanied by any subjective complaints. This is understandable, since the medicine only causes the termination of pregnancy and the death of the embryo, which remains in the uterine cavity. The uterus does not contract.

Therefore, very often after using the first tablets there is nothing. In this case, there is no need to worry - after taking Misoprostol, discharge will appear and the fertilized egg will come out.

Overdose

Taking Mifepristone in a dosage of up to 2 g does not cause an undesirable reaction in the body. There is no specific antidote. In cases of drug overdose, adrenal insufficiency may develop. In case of suspected development of acute adrenal insufficiency, the use of dexamethasone is recommended (at the rate of 400 mg of mifepristone - 1 mg of dexamethasone).

The high effectiveness and safety of medical abortion using the drug Mifepristone has been proven. The recommended regimen for using Mifepristone in combination with misoprostol is widely used not only in Russia, but throughout the world and has the following advantages:

• high efficiency 96-99%;
• minimal risk of developing serious complications;
• no surgical intervention or general anesthesia is required;
• there is no risk of infection and development of the inflammatory process;
• completely eliminates the risk of infection with hepatitis B and C, HIV;
• psychologically well tolerated.

Time-tested experience with the use of Mifepristone proves its good tolerability and effectiveness.

MAKE AN APPOINTMENT

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Abortion and contraception clinic in St. Petersburg - department of the medical gynecological association "Diana"

Make an appointment, tests or ultrasound via the contact form or by calling +8 (812) 62-962-77. We work seven days a week from 09:00 to 21:00.

We are located in the Krasnogvardeisky district, next to the Novocherkasskaya, Ploshchad Alexander Nevsky and Ladozhskaya metro stations.

The cost of a medical abortion in our clinic is 3,300 rubles. The price includes all pills, an examination by a gynecologist and an ultrasound to determine the timing of pregnancy.

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 .