When a medical abortion is unsuccessful and a pregnancy continues, the teratogenicity of the drugs used becomes an important issue. To date, no evidence suggests that mifepristone is teratogenic. A 2-year study of more than 90,000 pregnancies in France revealed that none of the 3,452 fetal malformations occurred in women who had taken mifepristone.43
Methotrexate has been shown to be teratogenic following high-dose therapy (e.g., cancer chemotherapy). Currently, however, evidence is insufficient to determine whether the dose used in medical abortion is teratogenic.
Misoprostol has been associated with birth defects. Congenital anomalies have occurred when women administered this prostaglandin analogue during the first trimester to self-induce abortion. Although the doses taken in these reports were often high, some were in the range of those used in medical abortion regimens. Defects include skull anomalies, limb deformities, and the Mobius sequence (mask-like facies with bilateral cranial nerve palsies and, often, micrognathia).44
Because misoprostol is a medication common to both mifepristone and methotrexate regimens for medical abortion, patients should be informed of the potential for teratogenicity in ongoing pregnancies. They must be willing to undergo a surgical abortion whenever medical abortion is unsuccessful. Clinicians providing medical abortion services who do not provide surgical abortion must establish a referral relationship with clinicians who do provide this service.
 Proceed to Acceptability of Medical Abortion.
References for this module
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