Typical process for a medical abortion
This is an example of how a medical abortion using the U.S. Food and Drug Administration (FDA) approved regimen may progress. The FDA regimen is oral mifepristone (600 mg) with oral misoprostol (400 ug) given 3 or 4 days later.
First visit
During your first visit to a health professional about possible pregnancy, you'll have a blood or urine pregnancy test, pelvic examination, and physical examination. Your blood will also be tested to determine your blood type and whether you are Rh-negative or have low iron (anemia). You may have a vaginal ultrasound to make sure you don't have a tubal (ectopic) pregnancy. (An ectopic pregnancy can become life-threatening and requires emergency treatment.)
After a pregnancy in the uterus is confirmed, you'll receive counseling about your abortion options and sign an informed consent form. Because you are at home during some of a medical abortion process, it's important that you fully understand how a medical abortion is done, possible side effects, and when to call if problems occur. During this discussion, ask as many questions as you can think of.
Be sure you know how to contact your health professional if you have questions or problems later.
To start a medical abortion process, you are given 3 tablets of oral mifepristone (200 mg, for a total dose of 600 mg), and specific instructions to follow at home. Before you leave the doctor's office, you will also schedule your next visit. Treatment schedules vary: some providers will schedule your second visit 2 days after the first visit, while others will see you 3 or 4 days later.
It is possible that this first medicine step will end the pregnancy. (Up to 6% of women have a successful medical abortion before the second medicine, misoprostol, is given.1) This may cause you to pass (expel) some or all of the pregnancy-related tissue before your next visit.
Second visit (3 to 4 days after first visit)
During this visit, you may be checked with an ultrasound to see whether the mifepristone has already ended the pregnancy. If it has, you won't take the second medicine, misoprostol.
If you are Rh-negative, you will receive a shot of Rh immune globulin to prevent possible Rh sensitization, should the embryo have Rh-positive blood. For more information, see the topic Rh Sensitization During Pregnancy.
The second medicine step consists of misoprostol tablets, taken orally or inserted vaginally (200 mg , for a total dose of 400 mg ). You may also receive medicine to prevent pain, nausea, and diarrhea that can result from the misoprostol. Some clinics may have you stay for 4 hours after misoprostol is given, because if serious side effects occur, they most likely occur in this time period and can be treated right away. The pregnancy may end in the clinic or later at home. (Over 50% of women will pass pregnancy-related tissue within the first 4 hours of receiving misoprostol.1) Some health professionals allow their patients to take misoprostol at home and then the pregnancy ends (like a miscarriage) at home.
Before leaving your appointment, you will schedule your follow-up visit. Be sure that you understand all of the information given to you about pain, bleeding, side effects of the medicine, and what to expect over the next 2 weeks.
Third visit (12 to 20 days after second visit)
This visit is important for making sure that the pregnancy has in fact ended and that you are recovering well. The termination of the pregnancy is confirmed using ultrasound or a blood test to check human chorionic gonadotropin levels, which go up during pregnancy and drop after a pregnancy. Your health professional will want to know about any bleeding or other symptoms and to discuss your planned method of birth control. This is a key element of the follow-up visit, because you will ovulate and be capable of pregnancy again before you have your next menstrual period.
| Author: | Healthwise Medical Writer | Last Updated: October 6, 2006 |
| Medical Review: | Joy Melnikow, MD, MPH - Family Medicine Lori A. Boardman, MD, ScM - Obstetrics and Gynecology | |
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