- Medical Abortion
- Indications: Primarily used for termination in the 1st trimester (<12 weeks gestation).
- Regimens:
- Mifepristone + Misoprostol: The most effective regimen.
- Mifepristone (RU-486): A progesterone receptor antagonist → decidual necrosis & detachment.
- Misoprostol (PGE1 analog): Induces cervical ripening and uterine contractions.
- Dosing (<10 weeks): 200 mg oral mifepristone, followed 24-48 hours later by 800 mcg misoprostol (buccal, vaginal, or sublingual).
- Methotrexate + Misoprostol: Less common; methotrexate is a folic acid antagonist that inhibits fetal cell division.
- Misoprostol only: Can be used when mifepristone is unavailable, but is less effective.
- Contraindications: Suspected ectopic pregnancy, IUD in place, adrenal failure, or hemorrhagic disorders.
- Side Effects: Uterine cramping, heavy bleeding, nausea/vomiting, fever.
- Surgical Abortion
- 1st Trimester (<14 weeks): Dilation and Curettage (D&C)
- Also known as suction or vacuum aspiration.
- The cervix is mechanically dilated, and a cannula connected to suction is used to evacuate the uterine contents.
- 2nd Trimester (14-24 weeks): Dilation and Evacuation (D&E)
- Requires greater cervical dilation, often achieved › 24 hours using osmotic dilators (e.g., laminaria) or misoprostol.
- Combines suction aspiration with the use of forceps to remove fetal parts and placental tissue.
- High-yield point: D&E is the most common method for 2nd-trimester termination.