Late Term Abortion Medication – Everything You Need To Know.

Medications can be used to perform Late Term Abortions. The Abortion Pill Procedure consists of combining Mifepristone (Mifeprex, RU 486, Mifegyne, French Pill) and Misoprostol to terminate pregnancies in the first trimester (3 to 14 weeks), second trimester 14.1 to 28 weeks) and late term abortions (>21 weeks).

How Is A Late Term Abortion Defined?

There is no exact definition of what a late term abortion is because it is not a medical term. In the medical literature, late term abortion is defined as starting at the 16th, 18th, 20th or at or beyond the 24th week of pregnancy.

Only 1.3% of abortions occur at 21 weeks or further. Viability (chance of infant living outside the womb) generally does not occur less than the 22nd week of pregnancy).

For this Blog, abortions that are performed at 21.3 weeks or further will be defined as late term abortions.

How Do The Late Term Medications Work?

Mifepristone:

It works by binding to the hormone Progesterone on its receptors on the Uterus. This in effect stops what Progesterone is primarily responsible for during pregnancy:

1. Maintains growth of the pregnancy
2. Prevents Uterine Contractions
3. Allows adequate nutritional nourishment and oxygen to flow from the placenta to the fetus
4. Prevents softening and opening of the cervix (portion that is lower part of Uterus)

Mifepristone Shortens The Induction To Delivery Time Of Late Term Abortions:

Giving Mifepristone 36 to 48 hours prior to starting Misoprostol reduces the average delivery time from 12 to 18 hours when using Misoprostol alone to 6 to 7 hours. This leads to the following:

• Using less dosage of Misoprostol which means less side effects
• Higher rate of successful deliveries
• Less chance of retained pregnancy tissue remaining inside the Uterus. This leads to reduced chance of:
  • Uterine infection
  • Pelvic infection
  • Heavy vaginal bleeding
  • Requirement for blood transfusion
  • Hospitalization

Misoprostol

It is a Prostaglandin E1 that works by causing Uterine contractions. This in turn causes the Uterus to expel (pass) the fetus and the other pregnancy tissue.

Late Term Medical Abortion And Fetal Viability:

With medical abortion after 21.3 weeks of gestation, the probability of delivering a fetus that may be born with signs of life (breathing, presence of fetal heartbeat, palpation of fetal pulse) even if only temporary is possible.

This causes anxiety, stress, guilt and anger to the patient, her family and the medical team.

Causing fetal demise prior to induction of premature delivery is recommended prior to the onset of the late term medical abortion process.

Producing fetal passing before medical abortion may shorten induction time.

Techniques used to cause fetal death are:

1. Intracardiac injection of potassium chloride(kcl), air through a syringe, 1% lidocaine and Digoxin causing immediate fetal demise.
2. Intrafetal (place needle anywhere inside the fetus) and Intraamniotic (sac surrounding the fetus) injection of Digoxin.
   1. May take up to 24 hours to stop fetal heartbeat.
3. After achieving adequate dilation (opening) of the Cervix, a forceps may be used to locate the umbilical cord and divide it.

What To Expect When Going To A Late Term Medical Abortion Clinic?

• Upon arrival one will check in at the front desk.
• Paperwork will be given to fill out that includes History, HIPPA, Counseling, Review of Consent forms for abortion and Birth Control
• Lab Work Obtained- Urine and Blood for pregnancy test, Rh testing and Blood Count (anemia).
• Sonogram (Ultrasound) – Pregnancy Dating.
• Counseling- Education session on benefits and risks of procedure, post procedure sheet directions reviewed, birth control benefits and risks discussed.
• Women are escorted to Private Exam Room by Assistant who will be present at all times. The Physician will go over sonogram and describe the process including the complications and side effects.

Patients are given the Mifepristone tablet in the presence of Physician and instructed on how, dosage amount, frequency and when to take Misoprostol tablets.

How Does One Describe The Late Term Abortion Medical Abortion Procedure?

• After the instillation of Digoxin is given to stop the fetal heartbeat, the Patient is discharged with explicit instructions on when to return to the office.
• Upon return, Misoprostol is given.
  • Uterine cramps can begin within 15 to 60 minutes of taking the first Dose of the medication.
  • Bleeding begins shortly after cramping starts.
  • Just prior to passage of the fetus the bleeding gets heavier and the pain becomes worse.
    • Over 90% of patients do not need any pain medications or only require over-the-counter pain medication (Tylenol, Ibuprofen, etc).
• Only 1% of women require surgical instrumentation of the Uterus after passage of the fetus.
• Patients go to the recovery room where vital signs and vaginal bleeding are monitors.
• Over 99% of patients are discharged within the hour of delivery.

What To Expect After Taking The Late Term Abortion Pill?

The most common side effects that occur after taking Misoprostol are:

• Headaches.
• Shivering.
• Chills.
• Mild rash.
• Itch palms.
• Nausea.
• Vomiting.
• Lower back and abdominal pain.

Other Side Effects May Include The Following:

• The procedure fails.
• Incomplete Abortion.
• Temperature greater than 100.4 for 24 hours.
• Pelvic infection.
• Heavy Bleeding (Use more than 2 pads for 2 hours in a row).
• Severe Pain- unable to do routine things that is not improved with pain medications.

Recovery After The Late Term Abortion Medication Procedure:

• Rest the remainder of day.
• Monitor for heavy bleeding.
• Antibiotics taken as instructed.
• Most women are able to return to school or work the following day.
• No tampons, insertion of diaphragm, cervical cup, foreign objects or penis for 3 to 5 days.
• Call off for severe pain, heavy vaginal bleeding or temperature greater than 100.4 that lasts for more than 24 hours.

Is The Late Term Medication Abortion Unsafe?

The Late Term Medication Abortion is 11 to 14 times safer than delivery of a term infant.

It has less morbidity than getting a shot of Penicillin, taking Viagra or having a wisdom tooth pulled.

Are There Any Health Risks Involved With Using The Late Term Abortion Medication Method?

There are health risks that are associated with any medical procedure:

• Maternal Death occurs in approximately .00075 procedures.
• Chronic Pelvic Pain.
• Infertility.
  • The latter two are due to scarring of the Uterus and Fallopian Tubes due to an untreated pelvic infection.
  • In modern day medicine, statistically this does not happen.

Late Term Medical Abortion Follow-up:

Women are asked to return to the office in 3 to 4 weeks to assure that there are no side effects or complications related to the abortion procedure are not ongoing.

This is also an important time to discuss birth control.

Are Late Term Medical Abortions Performed In The US?

Late Term Medical Abortions have been performed in the US since the mid 90’s when using Misoprostol alone.

It is a highly safe and efficient procedure with complications or side effects occurring less than 1% of the time.

Late Term Medical Abortion Cost

The cost of Late Term Medical Abortions range from $0 to $35,000.

This is due to the following:

• Geographical location.
• The number of weeks pregnant. The further the number of weeks, the higher the cost.
• Elect to have VIP and Exclusive appointments due to the ultimate in privacy.
• Private donors and non-profit organizations help towards the procedure, travel, room and board expenses.

In Summary:

It goes without saying that reproductive health decisions should not be taken lightly. Healthcare professionals, loved ones and advocates alike can provide valuable guidance and resources in order to reach a path that is most comfortable for all involved.

No matter what path unfolds, late term abortion will remain a challenging topic –one which requires both sensitivity and respect from all sides of the conversation.

Women who are carrying a child with fetal abnormalities, congenital anomalies, maternal medical indications (psychological or physical, teenagers, poor women and blacks are all reasons why women should have access to Late Term Abortion Procedures.

Dr James S Pendergraft | Orlando Women’s Center | Abortion Clinic Orlando