A 25-year-old woman, G1P0, presented at 46 days since the start of her last menstrual period. The gestational age of the pregnancy was confirmed sonographically. She received mifepristone followed 48 hours later by administration of oral misoprostol. At her follow-up visit on day 16, she reported that she had not experienced any bleeding. The ultrasound performed at that time revealed continued growth of the gestational sac and an embryo with cardiac activity.
Resolution of Case 6
Upon learning that the medical abortion was unsuccessful, the patient became discouraged and anxious. With empathetic counseling and reassurance that she would continue to receive optimal care, the patient expressed relief and a renewed sense of control over the situation. (See the module titled "Counseling for Medical Abortion" for a discussion of counseling issues.)
The patient asked if she could wait another 2 weeks to see if the medications would "take effect." The clinician advised her that this approach was unlikely to succeed and reminded her about the risk of birth defects associated with the medications used in medical abortion.
The clinician reiterated the strong recommendation discussed during their initial counseling session that the patient undergo a surgical abortion if the pregnancy continued 2 weeks after the initiation of the medical abortion. The patient underwent an uneventful manual vacuum aspiration at the time of her follow-up appointment. Her physician confirmed that the procedure was successful through visual inspection of the aspirate.
Return to Complications of Medical Abortion.
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