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Medical (Non-Surgical) Abortion
Pennsylvania's Abortion Control Act
Prior to your procedure visit, the state of Pennsylvania requires you to comply with the Abortion Control Act. Under this law, each patient must receive state-mandated information from a physician at least 24 hours before the procedure starts. There are three ways to get this information: at a consultation visit in the office; speaking with one of our physicians by phone; or by asking your own doctor or clinic to give you the information.

When you call to make an appointment, our telephone counselors will give you more information about this process.
Screening & Eligibility
Because a medical abortion is a more involved process than a traditional surgical abortion, it is important for AWC to complete a careful screening with each interested patient. This includes a brief medical history and the determination that you will be less than 9 weeks (63 days) pregnant on the day of your appointment. Patients who wish to pursue a non-surgical abortion must meet the following criteria:

- Understand how the medical abortion process works. This includes an accurate expectation of bleeding and pain, as well 
  as possible side effects from the medications and failure rates.

- Have a safe place to stay during her medical abortion. A support person must be available to stay with the patient for the
  duration of the process.

- Be able to arrange for 1 - 3 days off from work / school and for assistance with childcare (if necessary).
- Be able and willing to make multiple visits to AWC. There is a mandatory follow-up visit 10 - 14 days after the medications
  are taken.

- Be willing to undergo a surgical abortion if the medical abortion fails.
- Be certain of her decision to terminate and exhibit an appropriate level of maturity about the treatment regimen.

GYNCorner1Explanation of the Procedure 
At your procedure visit, a technician will peform a transvaginal ultrasound. You will discuss your decision and options with a counselor and talk more about the medications, side effects, and risks outlined in the Medication Guide. You will read and sign the Patient Agreement and consents for medical abortion.

Next, a nurse or assistant will take your vital signs (blood pressure, heart rate, and temperature) and you will meet the physician. The physician will ask you about your decision and  answer any questions you may have. The physician will then give you one Mifeprex™ tablet (200 mg mifepristone) that you will take orally. If your blood type is Rh negative, a nurse will administer an injection of Rhogam in the recovery room. You will be given prescriptions for pain medication, antibiotics, and reminded about how to contact us in case of an emergency. The physician will also dispense a packet containing 800mcg of misoprotol to take home.

The misoprostol should be taken 24-36 hours after swallowing Mifeprex™ at AWC. Make sure you have plenty of maxi pads on hand. One half hour before you plan to take the misoprostol tablets, take 800mg of Ibuprofen (Advil, Motrin, Nuprin, etc.). The misoprostol is administered by inserting two tablets into your mouth, between your gum and cheek, on the left side and two tablets, between your gum and cheek, on the right side. All four pills should be left in the mouth for approximately 30 minutes to dissolve. You may not eat or drink anything while the pills are dissolving. Anything left in the mouth after 30 minutes should be swallowed. Contractions and bleeding will begin between 20 minutes and 4 hours after taking misoprostol. Occasionally cramping and bleeding will start before inserting the tablets.

What To Expect After Taking Misoprostol:

Fever: A temperature of 101°F or higher can be normal after taking misoprostol. Your temperature should return to normal about one hour after the bleeding starts. Monitor your temperature each hour over the next three hours. Drink lots of fluids. If your fever does not return to normal in three hours, call the clinic.

Nausea, Vomiting, and Diarrhea: Sometimes these symptoms can be a side effect of the·misoprostol tablets. If these symptoms occur 24 hours or more after you have taken misoprostol, it could be a sign of something more serious, such as Toxic Shock or infection. Call our office immediately if you experience flu-like·symptoms, with or without abdominal pain, and with or without fever, more than 24 hours after taking misoprostol.

Heavy Bleeding: You should expect very heavy bleeding and you may pass some large clots. Clots may look bigger in the toilet, so do not panic. If you are soaking* through 2 or more pads per hour for 2 hours in a row, call AWC immediately. Bleeding may continue off and on for several days or weeks and can range from a light flow or spotting to heavier, like a period. Your bleeding should slow down after you pass the pregnancy. If you do not begin bleeding within 24 hours, please call AWC immediately.
*Soaking = filling a pad with fresh, bright red blood from side to side and front to back (not including clots). If you hold up the pad, it will drip.

Significant Cramping: Cramping is an indication that the medical abortion is working and is normal with this type of abortion. Cramping can range from mild / moderate menstrual-type cramps to intense, early labor-like contractions. Please remember that all women's bodies are different and not everyone has the same experience with this method.

If you received a prescription for Tylenol with Codeine #3, you may take one when cramping begins and one every 4 hours thereafter. This medication may cause constipation and drowsiness. You may take 800mg of Ibuprofen (Advil, Motrin, Nuprin, etc.) every 6-8 hours. Please do not·take any additional medications without speaking to us first and do not take asprin.

About 90% of women complete the abortion within 4 - 24 hours of insertiing the misoprostol tablets, although for some women it may take longer. The embryo may be embedded in a blood clot or it may be more recognizable as a small white form about the size of a grain of rice.

Note: AWC uses a treatment regimen that differs from the FDA protocol. The FDA approved regimen consists of 600mg of mifepristone taken orally, followed by 400mcg misoprostol taken orally in the office 48 hours after mifepristone up to 49 days LMP. Evidence-based research has shown that 200mg of mifepristone taken orally followed by 800mcg misoprostol taken buccally at home 24 to 36 hours after mifepristone up to 63 days LMP is as safe and as effective as the FDA approved regimen, with fewer side effects.

The Follow-up Visit:

Approximately 10-14 days after your first visit you will return to AWC for a repeat vaginal ultrasound. Approximately 1% of women using this method will not end their pregnancies and 2-3% will have remaining prenancy tissue in the uterus at the time of the follow-up appointment. It is very important to understand that once Mifeprex™ is taken, the pregnancy termination must be completed. If the abortion is complete, you will discuss birth control options and future care. If you are still pregnant, you will most likely need surgery to complete the abortion. If you need surgery, there is a $100 additional charge and you will need to return for another follow-up exam in 3 - 4 weeks.

RESTRICTIONS:

Do not take aspirin because it will increase bleeding.
Do not use tampons. Use pads until your first period.
Do not douche or swim.
Do not take any prescription or non-prescription medications that AWC did not prescribe.
Do not have sexual intercourse until after your follow-up exam.
Avoid strenuous activity and heavy lifting until after your follow-up.