What is the procedure for using the pregnancy termination pill, specifically mifepristone (Mifeprex) and misoprostol (Cytotec), for a medical abortion?

From the Guidelines

Medical abortion using mifepristone and misoprostol is a safe and effective procedure for terminating a pregnancy up to 7 weeks gestation, as supported by the European Society of Cardiology guidelines 1. The procedure involves a two-medication regimen, starting with 200 mg of mifepristone orally, which blocks progesterone and prepares the uterus for the abortion. Then, 24-48 hours later, the patient takes 800 mcg of misoprostol, usually by placing four 200 mcg tablets between the cheek and gum for 30 minutes before swallowing any remaining fragments, causing uterine contractions to expel the pregnancy tissue. Some key points to consider when using this regimen include:

• The patient should have access to emergency care and pain medication, such as ibuprofen, to manage any potential side effects.
• Sanitary pads should be available to manage bleeding, which typically starts within 1-4 hours after misoprostol and can last for several hours.
• A follow-up appointment 1-2 weeks later is necessary to confirm the abortion is complete.
• Warning signs that require immediate medical attention include soaking through more than two maxi pads per hour for two consecutive hours, severe pain unrelieved by medication, fever over 100.4°F lasting more than 24 hours, or foul-smelling vaginal discharge, as noted in general medical practice, although not explicitly stated in 1. It's essential to note that while the provided guideline 1 discusses various methods of pregnancy termination, it emphasizes the importance of individualized care and consideration of the patient's specific situation, highlighting the need for a thorough medical evaluation before proceeding with any abortion method.

From the FDA Drug Label

WARNING: TERMINATION OF PREGNANCY Mifepristone is a potent antagonist of progesterone and cortisol via the progesterone and glucocorticoid (GR-II) receptors, respectively. The antiprogestational effects will result in the termination of pregnancy. WARNING: TERMINATION OF PREGNANCY See full prescribing information for complete boxed warning. Mifepristone has potent antiprogestational effects and will result in the termination of pregnancy.

The procedure for using the pregnancy termination pill, specifically mifepristone (Mifeprex), for a medical abortion involves:

• Excluding pregnancy before initiation of treatment with mifepristone
• Using mifepristone as it has potent antiprogestational effects that will result in the termination of pregnancy 2 However, the provided drug labels do not include detailed information about the procedure for using mifepristone and misoprostol (Cytotec) together for a medical abortion. Misoprostol (Cytotec) is not mentioned in the provided drug labels for mifepristone. Therefore, no conclusion can be drawn about the specific procedure for using mifepristone and misoprostol together for a medical abortion based on the provided information 2

From the Research

Procedure for Using the Pregnancy Termination Pill

The procedure for using the pregnancy termination pill, specifically mifepristone (Mifeprex) and misoprostol (Cytotec), for a medical abortion involves several steps:

• Mifepristone is taken orally, typically 200 mg, to block the production of progesterone, a hormone necessary for pregnancy 3, 4, 5, 6, 7.
• Misoprostol is taken 24-48 hours after mifepristone, either orally or vaginally, to cause the uterus to contract and expel the pregnancy tissue 3, 4, 5, 6, 7.
• The dosage of misoprostol can vary, but common regimens include 800 mcg vaginally or 400-600 mcg orally 3, 4, 7.
• The patient may experience cramping, bleeding, and other side effects, such as nausea, diarrhea, and fever, which can be managed with nonsteroidal anti-inflammatory drugs or antiemetics 3, 4, 5, 6, 7.

Efficacy and Safety

The efficacy and safety of the pregnancy termination pill have been studied in several clinical trials:

• The combination of mifepristone and misoprostol has been shown to be effective in terminating pregnancy in 92-95% of women, with a low risk of serious adverse effects 3, 4, 5, 6, 7.
• The most common adverse effects include abdominal pain, nausea, diarrhea, and fever, which are usually mild and self-limiting 3, 4, 5, 6, 7.
• Rare but serious complications can occur, such as hemorrhage, infection, and ongoing pregnancy, which require prompt medical attention 3, 4, 5, 6, 7.

Gestational Age and Dosage

The gestational age and dosage of the pregnancy termination pill can affect the efficacy and safety of the procedure:

• Mifepristone and misoprostol can be used for medical abortion up to 77 days' gestation, with a higher efficacy rate for earlier gestations 5.
• The dosage of misoprostol may need to be adjusted for later gestations, and additional doses may be necessary to complete the abortion 4.
• Ultrasonography may be necessary to confirm gestational age and rule out ectopic pregnancy, especially in women with risk factors or uncertain gestational dating 5.