precautions for abortion pills misoprostol and mifepristone

 Termination of pregnancy- Abortion is the termination of a pregnancy, before the period of maturity. Excluding a few instances, in most of the cases, it is an outcome of unwanted pregnancy. 

In India, abortion facility is available legally under the MTP act, 1971. Despite this, women who want to terminate a pregnancy often ignore the legal status of abortions and have unsafe abortions. 

The WHO defines unsafe abortion as a procedure for terminating an unwanted pregnancy either by persons lacking the necessary skills.

The World Health Organization's (WHO) recommendations on medical abortion are restricted to the early first trimester (up to 63 days since the first day of the last menstrual period).

Antiprogesterone drugs have been approved by the United States Food and Drug Administration for medical abortion.  

As per the Medical Termination of Pregnancy (MTP) Act of India, this can only be administered by gynecologists and registered medical practitioners (RMP).

recognized for performing MTPs up to 49 days since the first day of LMP (last menstrual period). 

Medical abortion carries a very high success rate of 93–98 % if it is used judiciously, that is, after properly assessing the gestational age as well as the health of the patient.

 mifepristone and misoprostol :

mifepristone is a steroidal antiprogestin and anti glucocorticoid acting at the receptor level. It is used in combination with a prostaglandin such as misoprostol for termination of pregnancy.



 uses of mifepristone:

The uses of mifepristone are as follows.

1. Termination of early pregnancy in combination with prostaglandins.
2. Termination of pregnancy during trimester 2 and 3 (less than 49 days under the MTP act 1971)
3. Induction of labor in the case of fetus mortality.
4. immediate post-coital emergency contraception.
5. contraception with continuous/intermittent administration.
6. progesterone-dependent malignancies, breast cancer, meningioma.
7. endometriosis, uterine leiomyoma induction of normal labor.
8. extrauterine pregnancy.
9. induction of menses.

Dosage: 

For termination of pregnancy (49 days or less duration)

Oral: 600 mg (three 200 mg tablets ) -as a single oral dose followed two days(48 hours) later by 400 mcg (two tablets of 200 mcg ) of misoprostol as a single oral dose.

For cervical ripening: preoperative treatment with mifepristone 50-600 mg, 24-30 h before surgery.
postcoital contraception: Oral: a single dose of 600 mg within 72 hours of unprotected intercourse.

contraceptive: 2-5 mg per day for 30 days inhibits ovulation and delays menstruation.

once a month contraceptive pill: oral: a single dose of 200 mg taken the second day after the mid-cycle.



side effect: the side effect of mifepristone is as following.

1. Excessive vaginal bleeding.
2. tiredness.
3. weakness.
4. uterine cramping.
5. back pain.
6. diarrhea.
7. dizziness.
8. headache.
9. nausea.
10. vomiting.
11. dyspepsia.
12. anxiety.
13. belching.
14. cough.
15. fever.
16. flu-like symptoms.
17. heartburn.
18. increased clear or white vaginal discharge.
19. itching of the vagina or genital area.
20. fatigue.
21. pain during sexual intercourse.
22. pain or tenderness around eyes and cheekbones.
23. pale skin.
24. shortness of breath.
25. insomnia.
26. the tightness of the chest or wheezing unusual bleeding or bruising sinusitis uterine hemorrhage, vaginitis.

Special precautions :

1. In some cases, excessive bleeding may require treatment.
2. the patient should be followed up after 14 days for the confirmation of termination of pregnancy.
3. women with cardiovascular, hepatic, renal, hypertensive should be treated with caution.
4. women above 35 yrs and who smoke should be treated with caution.

REFERENCE:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5306099/