Medical Management of First Trimester Abortion

Question 1

FDA-approved medical abortion regimen

Answer 1

mifepristone 600 mg + misoprostol 400 mg orally, 48 hrs later

Question 2

Mechanism of action of mifepristone

Answer 2

binds to progesterone receptor more strongly than progesterone without activating it, and acts as an antiprogestin

• Causes cervical softening, increased uterine contractility, decidual necrosis, and prostaglandin sensitivity

Question 3

Mechanism of action of misoprostol and routes of administration

Answer 3

prostaglandin E1 analogue

- Can be given orally, buccally, vaginally, and sublingually

Question 4

Mechanism of action methotrexate

Answer 4

blocks dihydrofolate reductase, prevents thymidine synthesis
- inhibits the cytotrophoblast rather than the embryo

Question 5

Efficacy of FDA-approved regimen

Answer 5

92% at up to 49 days gestation

Question 6

Evidence-based medical abortion regimen

Answer 6

200 mg of mifepristone followed by 800 mg of misoprostol vaginally, 6 hours or later afterwards
- Can be used up to 70 days gestation

Question 7

Adverse effects of mifepristone

Answer 7

Nausea, vomiting, diarrhea, dizziness, headache and thermoregulatory effects

Question 8

Pain management in medical abortion

Answer 8

ibuprofen isn’t contraindicated because it just blocks the formation of new prostaglandins, and doesn’t interfere with administered prostaglandins
- should be used as first-line therapy

Question 9

Goal of ultrasonographic follow-up

Answer 9

To detect a gestational sac; hyperechoic foci are norma and represent clots, etc.

Question 10

Failure of medical abortion

Answer 10

If gestational sac is still present at 1 wk, another dose of misoprostol can be given, but isn’t necessary
- After that aspiration should be used.

Question 11

Regimens for twin gestation

Answer 11

same as with singleton

Question 12

Contraindications to mifepristone

Answer 12

confirmed or suspected ectopic pregnancy (should be excluded in high-risk women by ultrasound), IUD in place, long-term systemic corticosteroid use, chronic adrenal failure, coagulopathy or anticoagulant use, allergy, or other severe medical problem

Question 13

Is asthma a contraindication to misoprostol

Answer 13

No, its a weak bronchodilator

Question 14

Are antibiotics indicated for medical abortions?

Answer 14

No

Question 15

Follow-up methods for medical abortion

Answer 15

Office visit, beta HCG levels 1 week after (should show decrease of 80% at least)

Question 16

Teratogenic effects of misoprostol

Answer 16

limb anomolies and abnormal facies