CNN
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Mifepristoneone of two medications used in medical abortion, can continue to be mailed to patients without an in-person visit with a doctor yet The US Supreme Court dismissed the lawsuit The challenge of regulating abortion pills.
“While many women get Medical abortion “From the clinic or their obstetrician, others get the pills on their own to self-induce or self-manage a miscarriage,” said Dr. Daniel Grossman, a professor of obstetrics, gynecology and reproductive sciences at the University of California, San Francisco. Francisco.
“A growing body of research suggests that self-induced abortion is safe and effective,” he said.
Mifepristone blocks the progesterone hormone needed to maintain pregnancy. The medicine is The pregnancy has been approved for termination within 10 weeks of pregnancy, i.e. “70 days or less since the first day of the last menstrual period,” According to the US Food and Drug Administration.
In the case of a medical abortion, a second drug, misoprostol, is taken within the next 24 to 48 hours. Misoprostol causes the uterus to contract, causing cramping and bleeding. It is approved for use in other conditions, such as preventing stomach ulcers, and the drug has been available in pharmacies for decades.
Together, the two drugs are known as the “abortion pill,” which are now used in more than half of all abortions in the United States. According to the Guttmacher Institutea research group that supports abortion rights.
“Some people do it because they can’t get to a clinic — especially in states with legal restrictions on abortion — or because they prefer self-care,” said Grossman, who is also director of the Center for Abortion Management. Developing new standards in the field of reproductive health, A research group that evaluates the pros and cons of reproductive health policies and publishes studies on them How does miscarriage affect women’s health?.
What happens during a medical abortion? To find out, CNN spoke with Grossman. This conversation has been condensed and edited for clarity.
CNN: What is the difference between medical abortion in the first trimester of pregnancy and Vacuum ambition In terms of what women suffer from?
Dr. Daniel Grossman: Vacuum aspiration is most commonly performed under a combination of local anesthetic and oral pain medications or local anesthetic with intravenous sedation, or so-called conscious sedation.
An injection of local anesthetic is given to the area around the cervix, and the cervix is gently dilated or opened. Once the cervix is opened, a small straw-like tube is inserted into the uterus, and a gentle vacuum is used to remove the pregnancy tissue. Contrary to what some say, if the procedure was done nine weeks or so ago, There is nothing in the tissue that is recognizable as part of the fetus.
The suction process only takes a few minutes. The person is then monitored for an hour or two until any anesthesia wears off. We also monitor each patient for very rare complications, such as severe bleeding.
Medical abortion is a longer process. After taking the pills, bleeding and cramping can occur over a period of days. The bleeding is usually more severe when the actual pregnancy is expelled, but this bleeding usually subsides within a few hours. On average, people have some light bleeding for about two weeks or so, which is a little longer than what happens after vacuum aspiration.
Nausea, vomiting, fever, chills, diarrhea, and headache can occur after using abortion pills, and everyone who has had a successful medical abortion usually experiences some pain.
In fact, the pain of a medical abortion can be very intense. In studies that looked at it, the average maximum pain level people reported was about seven to eight out of 10, with 10 being the highest. However, people also say that the pain can be short, peaking once the pregnancy is gone.
The level of cramping and pain can depend on the length of pregnancy as well as on whether or not the woman has given birth before. For example, a medical abortion at 6 weeks or less of pregnancy is usually less painful and cramping than an abortion performed at 9 weeks. People who have given birth usually experience less pain.
CNN: What can be done to help ease the pain of a medical abortion?
Grossman: There are certainly things that can be used to help relieve the pain. Research has shown that ibuprofen Better than acetaminophen in treating the pain of medical abortion. We typically advise people to take 600 milligrams every six hours or so as needed.
Some people take Tramadol, a narcotic analgesic, or Vicodin, a combination of acetaminophen and hydrocodone. Recent research I was involved in on medications like Tramadol can be beneficial if taken prophylactically before pain begins.
Another successful regimen we studied combined ibuprofen with a nausea medication called metoclopramide that also helped relieve pain. Unlike ibuprofen, these medications require a prescription.
Another study found that a TENS device, which stands for transcutaneous electrical nerve stimulator, helps relieve the pain of medical abortion. It works through pads placed on the abdomen that stimulate nerves through mild electrical shocks, thus interfering with pain signals. This is something people can get without a prescription.
Pain can be an overlooked issue with medical abortion because, quite frankly, as doctors, we’re not there with the patients when they’re at home going through this. But as we do more research on people’s experiences with medical abortion, it’s becoming quite clear that pain control is really important. I think we need to do a better job of treating pain and making these options available to patients.
CNN: Are there health conditions that make using medical abortion unwise?
Grossman: It can be dangerous to undergo a medical abortion if the pregnancy is ectopic, meaning the fetus develops outside the uterus. It is rare, occurring in about 2 out of 2 cases Every 100 pregnancies – and it appears to be even rarer among people seeking a medical abortion.
People who have previously had pelvic, fallopian tube or abdominal surgery are at greater risk of ectopic pregnancy, as are those with a history of pelvic inflammatory disease. Some sexually transmitted infections can increase your risk, as can smoking, history of infertility, and use of infertility treatments such as in vitro fertilization.
If a person is taking anticoagulant or blood-thinning medications or has a bleeding disorder, medical abortion is not recommended. Long-term use of steroids is another contraindication to the use of abortion pills.
Anyone using an intrauterine device, or IUD, should remove it before taking mifepristone because it may be partially expelled during the procedure, which can be painful.
People with chronic adrenal insufficiency or who have inherited a rare disorder called Porphyria They are not good candidates.
CNN: Are there any signs of a problem that a woman should watch for after undergoing a medical abortion?
Grossman: It may be common to develop a low-grade fever in the first few hours after taking misoprostol, the second drug in medical abortion. If someone has a low-grade fever — 100.4 degrees to 101 degrees Fahrenheit — that lasts more than four hours, or has a high fever of more than 101 degrees Fahrenheit after taking medications, they need to be evaluated by a health care provider.
Heavy bleeding, which may result in soaking two or more thick, full-sized pads every hour for two hours in a row, or foul-smelling vaginal discharge should also be evaluated.
One of the warning signs of an ectopic pregnancy is severe pain in the pelvis, especially on one side of the abdomen. The pain can also spread to the back. Another sign is feeling dizzy or faint, which may indicate internal bleeding. These are all very rare complications, but it is wise to be informed.
We usually recommend that a person undergoing a medical abortion be accompanied by another person for the first 24 hours after taking misoprostol or until the pregnancy ends. Many people specifically choose to have a medical abortion because they can be surrounded by a partner, family, or friends.
Most people know that a miscarriage is complete because they stop feeling pregnant, and symptoms such as nausea and breast tenderness go away, usually within a week of the pregnancy passing. A home urine pregnancy test may remain positive even four to five weeks after a successful medical abortion, if only because the pregnancy hormone takes so long to disappear from the bloodstream.
If a woman still feels pregnant, she is not sure whether the pregnancy has fully passed or the pregnancy test is positive After weeks of taking mifepristone, you should be evaluated by a doctor.
People should know that they can ovulate as soon as two weeks after a medical abortion. Most birth control options can be started immediately after a medical abortion.
