Generality
With pharmacological abortion we mean the interruption of pregnancy carried out through the use of specific drugs.
Also known as a medical or chemical abortion, this treatment is considered the first-choice method for terminating a pregnancy within the first few weeks of gestation.
To be performed, pharmacological abortion requires the administration of an abortive drug - responsible for detachment of the embryonic sac - and a prostaglandinic analogue, necessary to induce uterine contractions in order to favor the expulsion of the embryo, the sac and amniotic fluid, as well as the initial placenta formed.
In the course of the article the main characteristics of the pharmacological abortion will be analyzed and the cases in which it can be used, the possible side effects which can be met and the contraindications to the implementation of this particular treatment.
Did you know that ...
Pharmacological abortion is often referred to as " contragestione ".
What is that
What is Pharmacological Abortion?
Pharmacological abortion is the interruption of pregnancy carried out through the administration of a specific abortion drug, followed by the administration of a drug capable of inducing uterine contractions to favor the expulsion of the embryo.
In Italy, pharmacological abortion is a medical treatment that must be implemented in authorized hospitals or clinics. Consequently, the drugs used to carry it out are for hospital use only and must be prescribed and administered only by medical personnel specialized in this area.
Hints on the Legislative Aspects of Abortion
The voluntary interruption of pregnancy - by resorting to pharmacological and non-pharmacological abortion - in our country, is allowed and regulated by law 194 . However, doctors opposed to this type of practice can appeal to conscientious objection, refusing the prescription and the administration of the drugs necessary for the interruption of gestation.
Despite this, the Court of Cassation ruled out the possibility of raising conscientious objection during the expulsion phase of the embryo, during which the doctor - even if a conscientious objector - is obliged to provide relief to the patient as it involves medical assistance provided after pregnancy termination.
Simplifying, if a woman has already taken the drugs necessary for pharmacological abortion or has already undergone surgical abortion, the medical personnel present at the moment in which the expulsion of the embryo and of the material contained in the uterus and present in the phases following the removal of the embryonic sac is obliged to provide health care, even if a conscientious objector.
Indications
When can Pharmacological Abortion be practiced?
The use of pharmacological abortion can be practiced in cases where it is desired or necessary to interrupt an ongoing intrauterine pregnancy, provided that the treatment is carried out within 7-9 weeks and, more precisely, not later than the forty-ninth (7 weeks) or sixty-three (9 weeks) day after the first day of the last menstrual cycle.
In some cases, pharmacological abortion can also be used to perform therapeutic termination of pregnancy (therapeutic abortion) beyond the third month of gestation .
Clearly, given the delicacy of this medical procedure, the doctor will have to inform the patient about all the potential existing risks and, before proceeding with the treatment, will have to make sure that there are no contraindications or restrictions of any kind on the use of the drugs that will be used to use.
drugs
Drugs used to perform Pharmacological Abortion
The drugs used to induce pharmacological abortion are essentially of two types:
- An abortion drug ;
- A similar drug of a prostaglandin .
Abortion drug
The abortion drug used to complete the termination of pregnancy is mifepristone (Mifegyne®). Also known as " abortion pill " and with the abbreviation " RU486 ", mifepristone is a synthetic steroid with antiprosgestin activity .
Did you know that ...
Mifepristone is not only used to interrupt a pharmacological type of pregnancy, but also in the following situations:
- To dilate the cervix in preparation for surgical abortion;
- To induce labor in the event of intrauterine fetal death.
However, the anti-progestin action of mifepristone is exercised by interacting with progesterone receptors : mifepristone binds to them, competing in this way with progesterone and hindering its activity.
Progesterone plays a fundamental role in the early stages of pregnancy, because:
- It makes the endometrium suitable for receiving the embryo and allowing it to develop;
- Promotes myometrial relaxation during gestation;
- Increases the nutritional capacity of blood vessels present in the uterus and deputies to nourish the embryo.
With the assumption of mifepristone, the aforementioned mechanisms are lacking, in this way the growth of the embryonic sac is blocked and its detachment is "en bloc".
Please note
The mifepristone abortion pill should NOT be confused with the morning after pill, which instead represents an emergency contraceptive method.
Analogs of prostaglandins
Prostaglandin analogues are usually administered 36-48 hours after mifepristone intake. Generally, misoprostol is used, but gemeprost can also be used in the context of pharmacological abortion. Misoprostol is administered orally in tablet form; while gemeprost is administered vaginally in the form of eggs.
The task of prostaglandins consists in inducing uterine contractions to favor the expulsion of the embryo, the sac and the amniotic fluid and the initial placenta.
How it is performed
How is Pharmacological Abortion carried out?
As mentioned, pharmacological abortion must take place in a hospital setting, or in any case in authorized clinics and requires the administration of drugs whose use is reserved only within the aforementioned health facilities. Naturally, the administration of the medicines necessary for the execution of the pharmacological abortion must be carried out by specialized medical personnel.
However, the main phases of the treatment in question are the following:
- After excluding the presence of contraindications of any kind, we proceed with the administration of the mifepristone based abortion pill . The drug is in tablet form and should therefore be taken orally. The doses administered are 200-600 mg.
- After a period of time varying from 36 to 48 hours, it is possible to proceed with the administration of the prostaglandin necessary to stimulate uterine contractions to allow the expulsion of the embryonic sac. The prostaglandins most commonly used in pharmacological abortion are:
- Misoprostol (Misoone®) is available in tablet form to be taken orally. The usual dose is 400 micrograms.
- Gemeprost (Cervidil®), is available in the form of vaginal ovules. The dose used corresponds to 1 gram of active ingredient.
After the administration of both drugs, the healthcare personnel must provide the woman with all the necessary assistance.
Outcome
The outcome of the pharmacological abortion is checked through an ultrasound that must be performed 14 days after the treatment .
From the studies carried out and the data collected so far it has emerged that pharmacological abortion is effective in 95.5% of cases .
However, in the uncommon eventuality that the expulsion of the embryonic bag does not take place completely, it is necessary to resort to curettage .
Side effects
What are the side effects that can occur during pharmacological abortion?
The side effects of pharmacological abortion are closely related to the drugs given to the patient.
However, the most common side effects of the pharmacological abortion procedure are:
- Abdominal pain of different intensity (it is due to uterine contractions and is, for this reason, considered normal);
- Nausea and vomit;
- Diarrhea;
- Vaginal bleeding that can continue even for several days from the end of the treatment;
- Gastrointestinal cramps;
- Headache;
- Dizziness;
Other possible side effects of greater seriousness that, in reality, could be considered as complications of the treatment, consist in:
- Metritis;
- Pelvic inflammatory disease.
Clearly, those listed above are just some of the side effects that can occur after the administration of the abortion drug and the prostaglandin analogue. Furthermore, it should be pointed out that the type and intensity of the side effects may vary according to the week of gestation during which the drugs are taken, depending on the individual sensitivity of each woman to the medicines administered and, even, depending on the conditions emotional and psychological in which the patient finds herself.
Please note
Given the delicacy of the situation and the emotional and psychological implications that pharmacological abortion may have on women, families, partners and healthcare professionals, they should provide all the necessary support and support, both before and during and after treatment.
Contraindications
When Pharmacological Abortion Should Not Be Practiced
The use of pharmacological abortion should not be made in the following cases:
- In case of known allergy to any of the active ingredients or excipients contained in the drugs used for this type of treatment;
- In case of extrauterine pregnancy (the pharmacological treatment for this condition involves the use of another type of drug);
- In patients with hereditary porphyria;
- In patients suffering from coagulation disorders;
- In case of ongoing anticoagulant therapy;
- In patients suffering from adrenal insufficiency;
- In patients with diabetes;
- In women suffering from severe asthma;
- In case of use of intrauterine spiral (IUD).
Safety
Is Pharmacological Abortion a Safe Procedure?
From the evidence and data collected so far it has emerged that - if carried out in accordance with the law at authorized facilities and by competent and specialized doctors - pharmacological abortion can be considered a safe treatment and, undoubtedly, less invasive than surgical abortion. Clearly, as with any other type of medical treatment, side effects and complications cannot be ruled out which, however, are quite rare.
