An unwanted pregnancy – alarm bells start sounding ! Panic buttons set and there is a need to immediately terminate the pregnancy .
Is there a right way to do this ?
The answer is yes .
Instead of hurrying to the nearest chemist shop and buying the kit over the counter , often with no instructions or half baked instructions of the pharmacist , which often leads to disastrous consequences it’s best to meet your gynaecologist . And why is that ?
Let’s go over the correct way of a medical abortion using pills .
The pregnancy must first be confirmed , initially with a urine pregnancy test or a serum B HCG test and then with an ultrasound . The ultrasound confirms an early pregnancy as also it’s location . Sometimes the pregnancy may be lodged in the tubes , called an ectopic pregnancy and at other times a molar pregnancy may be diagnosed ( grape like growths which develop in the uterus instead of an embryo ) In both cases if the abortion kit is used without supervision there may be life threatening risks . Medical abortion kits are recommended for intrauterine pregnancies upto 8 weeks , not more as there are higher chances of failure and heavy bleeding due to the procedure . That’s the reason an early pregnancy inside the uterus must be confirmed on ultrasound . Contraindications to use of medicine include asthma and severe respiratory disease , allergy to the medicine , adrenal disorders , long term corticosteroid use, porphyria, known blood thinning or anticoagulant therapy . This method is also undesirable for people who will not be able to understand or to follow instructions about use and risks and for those who can’t be in regular follow up with their gynaecologists or registered medical practitioners . So that’s a huge check list of people who are eligible or ineligible for the medical abortion kit .
Once you are eligible to use the medical abortion kit by a proper history , examination and ultrasound examination , you are counselled on how to take the medicine , the procedure , side effects and follow up . You are made to sign a consent form and asked to be in touch with your doctor in case there is the slightest problem during the course of this treatment which is somewhat long drawn and not always fool proof in terms of a complete abortion .
What to expect during the course of a medical abortion and what can go wrong ?
Once you are given the pills by specific protocols , you can expect to have severe cramping in the abdomen and heavy bleeding . This bleeding is initially heavier than a normal period and may be accompanied by fleshy pieces which are products of conception along with clots . This bleeding usually may become a little less in the following days but typically remains for 7-10 days or slightly longer . Other side effects of the medicine include headache , vomiting , diarrhoea , chills , fever , dizziness and lightheadedness .You are asked to get an ultrasound on day 10-14 of the procedure to see if the abortion is complete or if there are residual products of conception which may required to be removed by another medicine or a surgical aspiration or cleaning .
Now what can go wrong ?
There may be severe bleeding that is precipitated due to the abortion pills . If you soak more than one maxi pad completely in one hour for 2 successive hours it implies you are bleeding heavily . Moreover bleeding slightly more than normal may also be relatively heavy for a patient with low haemoglobin levels or anaemia . This heavy bleeding may be life threatening as it leads to hemorrhagic shock and may require to be stopped by a surgical evacuation and even blood transfusion in around 0.1 % of medical abortions . Imagine if you are sitting at home while this happens ; the events are horrific .
In case you’ve taken the medicines without ruling out an ectopic pregnancy , that could rupture leading to severe internal bleeding , shock and collapse . And in case any eventuality like this happens , who will be held responsible ? Certainly not the chemist who sold and prescribed the medicine because according to the MTP act , an abortion can only be done by a qualified gynaecologist or an experienced registered medical practitioner .
However this does not mean you will be in hospital for the entire course of a medical abortion . Your doctor will prescribe the medicine and you will be at home under her / his care and supervision just in case anything goes wrong . Also remember , though rare , medical abortions may lead to infertility due to infections of the genital tract ; hence proper screening , evaluation and follow up is of vital importance .
Unwanted pregnancies are definitely bothersome but remember contraception and prevention is the key . However should they happen always remember to take medical abortion kits in the right way and under supervision , equipped with all the knowledge ( not with Google or your peers) and with all the choices available .
Medical abortion kits used at home without medical supervision can indeed be disastrous and sometimes life threatening so choose to be safe and sensible . Talk to your doctor right away !
By
Dr Shelly singh
Gynaecologist and obstetrician
At rosewalk hospital
New Delhi
