Medical abortion is a way to end pregnancy without surgery. It is done at AWC with medication up to 63 days (9 weeks) after the the last period begins. AWC is the only abortion provider in Northeast Pennsylvania offering the most effective method of non-surgical abortion using a pill called Mifeprex™.

Consultation and Screening

First, you will speak with a telephone counselor who will talk to you about your options and help you figure out which type of abortion will work best for you and your situation. She will assess if you are eligible for this type of abortion and take you through a careful screening process.

The telephone counselor will schedule an appointment for you to either come into the office for a consultation visit or talk with one of our physicians via phone about both surgical and medical abortion, at least 24 hours before you take Mifeprex™. This is required by a Pennsylvania law called the Abortion Control Act.

Medical Abortion with Mifeprex™ and Misoprostol (the "abortion pill")

Visit One - Day 1
First, you will need to give us a urine sample so we can check glucose and protein levels. You will fill out a medical chart, get blood work drawn via a finger stick, and 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. After payment, you will schedule your return appointment to the clinic.

Next, a nurse or assistant will take you to a pre-operation room where you will wait and she will take your vital signs (blood pressure, heart rate, and temperature). She will then take you to a private room where you will meet the physician and he will examine you. The physician will ask you about your decision and if you have any questions. The physician will then give you one Mifeprex™ tablet (200 mg mifepristone) that you will take orally.

In recovery, you will receive a packet containing 800mcg of misoprotol to take home. The misoprostol should be taken 24-48 hours after swallowing Mifeprex at AWC. The misoprostol is administered using the buccal method. The buccal method means 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. Anything left in the mouth after 30 minutes should be swallowed. This medication is necessary to complete the abortion and expel the pregnancy. About 90% of women complete the abortion within 4-24 hours of insertiing the misoprostol tablets, although for some women it may take longer. If you have any questions, please contact us.

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 vaginally at home 24 to 72 hours after mifepristone up to 56 days LMP is as safe and as effective as the FDA approved regimen, with fewer side effects.

If you are Rh Negative: A nurse will give you and injection of Rhogam if your blood type is Rh negative. You will be given a prescription for pain medication and reminded about how to contact us in case of an emergency.

Follow-Up Visit - Day 4-14
Approximately 7-10 days after your first visit you will return to AWC for a repeat vaginal ultrasound. If the abortion is complete, you will meet with a counselor to 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 2-3 weeks. YOU MUST KEEP YOUR FOLLOW UP APPOINTMENT!!

IT IS VERY IMPORTANT THAT YOU UNDERSTAND THAT ONCE Mifeprex™ HAS BEEN TAKEN, THE PREGNANCY TERMINATION MUST BE COMPLETED. About 2-3% of women using method will require a surgical procedure, mostly for retained pregnancy tissue, and MUST undergo completion by the standard suction aspiration method. The drugs used in this type of abortion may cause birth defects. If the pregnancy is not expelled, surgical abortion must be performed.

HOW TO USE MISOPROSTOL AND WHAT TO EXPECT

Make sure you have plenty of maxi pads on hand. Keep your body hydrated by drinking plenty of fluids (water and juice). One half hour before you plan to insert the misoprostol tablets into your mouth, take 800mg of Advil, Motrin, or Ibuprofen.

1. HOW TO INSERT TABLETS BUCCALLY: Place two tablets on the right side of your mouth between the gum and cheek. Then place two tablets on the left side of your mouth between the gum and cheek. Leave all 4 tablets in place for 30 minutes. After 30 minutes, swallow anything in the mouth that has not been dissolved.
2. Cramps and bleeding will begin 2-4 hours after inserting the tablets. Occasionally cramping and bleeding will start before inserting the tablets.
3. During this time period, continue to drink plenty of fluids and eat lightly.
4. 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. DO NOT take any additional or alternative pain medications without speaking to us first.
5. Pregnancy tissue: You should pass the pregnancy tissue in the next 4 - 24 hours. The embryo may be embedded in a blood clot or it may be more recognizable as a small white form the size of a grain of rice or smaller.

Side Effects of Medical Abortion

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 and can range from a light flow or spotting to heavier, like a period. DO NOT USE A TAMPON OR TAKE A BATH WHILE YOU ARE BLEEDING. Your bleeding should slow down after you pass the pregnancy. If you do not begin bleeding within 24 hours, please call AWC immediately. If you do not get a normal period within 8 weeks after the abortion, call us.

*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.

Cramping: Cramping is an indication that the medical abortion is working and is normal with this type of abortion. Cramps may at times be quite painful and much worse than a period. You may take 800mg of Ibuprofen (Advil, Motrin, Nuprin, etc.) every 6-8 hours and 1 tablet of Tylenol with Codeine every 4 hours as needed. If nothing helps, call our office. DO NOT TAKE ASPIRIN.

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 symptoms of nausea, vomitting, or diarrhea and weakness with or without abdominal pain, and with or without fever, more than 24 hours 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. If you get a fever of above 100.4°F after day 4, please call our office immediately.

**Call us---even if you have already had a follow-up--If you experience "flu-like" symptoms or are generally "not feeling well" after your medical abortion, even if it is a few weeks later.**

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.