Abortion with medication

It is called medical abortion , medical abortion , abortion pills , chemical abortion , medical abortion or nonsurgical the induced abortion or IVE caused by the administration of drugs . 1 Reference drugs are mifepristone aided with misoprostol . 2 3 4 5 6

The World Health Organization maintains information on the uses and risks of medical abortion 7

Medication abortion is practiced both in countries where abortion is legalized and in which it is penalized. Medication abortion is considered the most effective and safe method for the life and health of women. In general, medical abortion is preferable to surgical abortion because it does not require anesthesia or surgical intervention . Requires medical surveillance to ensure success and prevent complications; often eliminating or evacuation is incomplete and requires the final intervention of a doctor . 8 4 1

Voluntary termination of pregnancy with medication is safe until the 12th week of pregnancy after the date of the last menstrual period . From week 13 of pregnancy onwards it is only safe if the abortion is performed in a hospital. Referring to Fig.

Mexico is the first country in Latin America to authorize the use of zacafemyl-mifepristone for voluntary termination of pregnancy until 12 weeks and legal discontinuation after 13 weeks of pregnancy. [ Citation needed ]

Some commercial names of mifepristone in the world are Zacafemyl, Mifeprex, Mifegyne and Myfegyn .

Protocol mifepristone + misoprostol

The reference protocol is the combination of mifepristone ( zacafemyl, mifeprex, mifegyne, myfegyn ) and, 2 or 4 days later misoprostol ( misive, cycotec , arthrotec , oxaprost , cyprostol , mibetec , misotrol ) , Denominated French, FDA and based on the evidence. 10 3

Comparison of mifepristone + misoprostol protocols

Steps and Directions French layout European Union – FDA Evidence-based scheme
Dose of mifepristone – day 1 600 mg . 600 mg. 200 mg.
Dose of misoprostol – day 2 to 4
or gemeprost
400 mcg (micrograms). Oral or
1 mg. Gemeprost vaginal
400 mcg. Oral or
400 mcg vaginal route 2
400 mcg. Oral or
600-800 mcg, vaginal route or 21
mg. Gemeprost vaginal
Gestational limit – 49/63 days Up to 49 days Up to 49 days Up to 63 days
Place of administration of misoprostol Doctor’s office or clinic Doctor’s office or clinic Doctor’s office or clinic or at home
Misoprostol administration day Day 2 or 3 Day 3 Day 2, 3 or 4
Day of review or follow-up Day 10-14 Day 14 Day 4 to 14
Medical or clinical consultations 3 or more 3 or more 2 or more

  • Mifepristone with misoprostol . Mifepristone along with misoprostol is the most common method of medication given up to the first 7 to 9 weeks of pregnancy (49 to 63 days). The method consists of administering mifepristone at high doses (600 mg according to FDA protocol) and, at two days, misoprostol (400 μg), which causes labor contractions. Mifepristone is an antagonist of progesterone , a hormone necessary for the continuity of gestation. Misoprostol is used to ensure expulsion. The protocol presentsvarious contraindications , for example with continued prior use of steroid-based therapies . 11 12

Other protocols

The World Health Organization maintains information on the use 7

Misoprostol alone

  • Misoprostol alone. As indicated by the prospectus of Misive : 2
    • Up to 49 days of gestation: 4 tablets of Misive 200 vaginally every 24 hours, and up to 3 times (when there is any contraindication or allergy to Mifepristone or access to it is absolutely impossible).
    • In pregnancies from 49 days to 20 weeks: 2 or 3 tablets of MISIVE 200 vaginally every 4-6 hours, respectively.
    • In pregnancies greater than 20 weeks, a dose of 2 tablets of MISIVE 200 every 4-6 hours or even less will be used in response. 2

Misoprostol with diclofenac

  • Misoprostol with diclofenac

According to protocol of the Latin American Federation of Obstetrics and Gynecology FLASOG 13 and WHO 14

  • Until the 12th week of pregnancy:
    • Vaginal route: 4 pills every 12 hours, 3 times

Methotrexate with misoprostol

  • Methotrexate with misoprostol . According to Misive ‘s prospectus :
    • Up to 49 days of gestation, 2 Misive 200 tablets are given vaginally 36-48 h after oral administration of Mifepristone (600 mg). 2
      • First methotrexate, which is given with an injection and affects the cells in proliferation of the embryo, causing the interruption of its development.
      • According to Misoprostol, a day and a half or two days after the administration of methotrexate is administered misoprostol, a semisynthetic analogue of prostaglandin PGE1 that stimulates contraction of the uterus , causes the expulsion of its remains. The procedure is contraindicated for patients with diseases such as renal failure .

Statistics in Europe and United States

The reference medicine in medical abortion, the mifepristone , is registered and available since 1988. It is currently approved for use in: Austria , Belgium , China , Denmark , Finland , United Kingdom , Greece , India , Israel , Luxembourg , Netherlands , new Zealand , Norway , Russia , South Africa , Spain , Sweden , Switzerland , Taiwan , Tunisia , Ukraine and the United States among others. fifteen

In the United States, it has been approved for use since September 2000. In Europe, the use of abortion with medication is unequal; in Portugal, this means 67% of IVEs ( voluntary termination of pregnancy ), 49% in France ; In England and Wales 40%, in Scotland and Finland 70%, in Spain only 4%, in Italy less than 4% since it began marketing in December 2009. In the United States, its use reaches 10% of Induced abortions. The abortion in Tunisia is carried out by 60 and 70% with medication. 12

References

  1. ↑ Jump to:a b Medical methods for abortion in the first trimester, BSR, The WHO Reproductive Health Library
  2. ↑ Jump to:a b c d e f Misoprostol – Prospectus of Misive 200 Micrograms-vaginal tablets of Misoprostol, sinaem, Ministry of Health, Spain
  3. ↑ Jump to:a b Prospectus Mifegyne , 200 mg mifepristone tablets , Spanish Medicines Agency, rev. 2008
  4. ↑ Jump to:a b Comparison of Surgical Abortion and Abortion by Pill, .fwhc.org
  5. Back to top↑ Medication Abortion, Mifepristone / Misoprostol Outline medicationabortion.com
  6. Back to top↑ Abortion with life saving pills for women in Women on Waves
  7. ↑ Jump to:a b World Health Organization (January 2004). “Medical methods for abortion in the first trimester” . The Reproductive Health Library . Accessed September 3, 2004 .
  8. Back to top↑ Gérvas J. Abortion at home. Health Act. 9/13/09 13/13/09
  9. Back to top↑ Various authors (2010). Everything you want to know about how to have an abortion with pills . The colective. P. 142. ISBN  978-987-1497-30-0 .
  10. Back to top↑ Mifepristone / Misoprostol Outline, http://www.medicationabortion.com/Spanish/index.html page managed by Ibis Reproductive Health
  11. Return to top↑ See general aspects of Mifepristone / Misoprostol Scheme
  12. ↑ Jump to:a b Spain, to the European tail in pharmacological abortion, Only 4% of the interruptions are done by this method, while in the EU they approach the half, 11/23/2010
  13. Back to top↑ Faúndes, Anibal. “Use of misoprostol in obstetrics and gynecology” . Archived from the original on November 23, 2015 . Retrieved on June 16, 2012 .
  14. Back to top↑ World Health Organization. «Abortion without risks. Technical and Policy Guidance for Health Systems ” . Retrieved on June 16, 2012 .
  15. Back to top↑ Mifepristone worldwide, in ‘Medication Abortion’, www.medicationabortion.com