Early Options: Module 2 - Expected Side Effects and Management of Complications in Medical Abortion

Early Options - A Provider's Guide to Medical Abortion

The on-line CME post-test will follow this module. However, we strongly urge you to print out the CME Post-Test Questions before starting this module to help guide you through the material.

This page contains the following sections:

Definitions: Side Effects Versus Complications
Patient Management - Counseling and Preparation

Objectives
Upon completion of this module, you should be able to:
1. Describe expected side effects and complications of medical abortion
2. Discuss the management of side effects and complications

Introduction
Since the early 1990s, millions of women in Europe, China, and North America have used mifepristone in combination with a prostaglandin analogue for early abortion. Danco Laboratories, LLC, the company that supplies mifepristone is the USA, estimates that more than 1.1 million women in the United States have chosen this option since it was approved by the FDA in September 2000.

In addition, medical abortion using either mifepristone or methotrexate followed by misoprostol is highly effective, achieving an aggregate success rate of approximately 95% in pregnancies ≤ 49 days' gestation.¹ (Note: Although numerous studies have established its safety and efficacy, the combination of methotrexate and misoprostol is not FDA-approved for medical abortion.)

As with all medical procedures, side effects and complications can occur with medical abortion. Some of the side effects, such as pain and bleeding, are associated with the process of aborting. Others, such as nausea and vomiting, are more likely to represent medication side effects.

In clinical studies, between 2% and 10% of women undergoing medical abortion ultimately required surgical aspiration for retained tissue or heavy or persistent bleeding, or to terminate a continuing pregnancy.¹ Serious complications, such as hemorrhage, are rare with medical abortion.

Surgical abortion is performed by a clinician in a short amount of time in a clinical setting. In contrast, medical abortion relies on a woman's sustained participation in a multistep procedure over a period of days, and the abortion may occur outside of a clinical facility. Therefore, education and counseling play a larger role in the care of women who choose medical abortion.

Definitions: Side Effects Versus Complications
"Side effects" can be defined as the effects of treatment, other than the intended outcome, that might include physiological or psychological consequences. Most side effects of medical abortion are minor and self-limited and require little or no intervention.

In contrast, "complications" are effects of treatment that have potentially serious clinical consequences and require medical intervention. The side effects and complications associated with medical abortion can be viewed as a continuum of adverse events. For example, heavy bleeding is an expected side effect that becomes a complication when a transfusion or surgical intervention becomes necessary.²

Similarly, short-term warmth and fever are common side effects of misoprostol, but sustained fever suggests the possibility of endometritis and requires evaluation. Click here to view Figure 1, which provides an overview of side effects and complications associated with medical abortion.

Patient Management - Counseling and Preparation
For safe and effective treatment, providers must understand the expected course of a medical abortion and convey this information to patients during the counseling process. Adequate counseling helps women anticipate and prepare for possible side effects. Women undergoing medical abortion also need to know when these side effects deviate from normal and, therefore, warrant a call to the provider (i.e., when a potential complication may be developing).

Counseling is not limited to face-to-face interactions at the clinical facility, as phone contact can play an important role in educating, assisting, and supporting women throughout the procedure.

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References for this module