"An unwanted pregnancy can be interrupted in our country until 12 weeks of pregnancy, or 14 weeks of amenorrhea." In this approach, the woman has the free choice of whether or not to keep the pregnancy, and that of the method, to provided that it is in the period concerned, "says Professor Philippe Descamps, gynecologist-obstetrician, in his book" Doctor, I still have a question ".
In this article, he tells us all there is to know about the voluntary termination of drug pregnancy.
What is a drug-induced abortion?
Drug-induced abortion is a voluntary termination of pregnancy with the help of medication.
Two drugs are then used: one to stop pregnancy (mifepristone / mifegyn) and the other to cause bleeding from the uterus and evacuate its contents (misoprostol).
What are the deadlines to respect?
Women use it if the pregnancy is recent, up to 9 weeks of amenorrhea (the weeks of amenorrhea are the weeks since the first day of the last menstrual period but on average, the duration of the pregnancy is two weeks lower compared to weeks of amenorrhea).
If the wish is expressed for a drug-induced abortion, it is checked that the term of the pregnancy is compatible and that there is no medical contraindication.
As with all requests for abortion, a first medical consultation is necessary to perform an ultrasound that will date the end of the pregnancy. The psychological and social aspect is also discussed. We will be seen by doctors but also by marriage counselors and family (this interview is mandatory for underage patients, for major patients, it is proposed but not mandatory).
Since 2016, there is no more time for reflection between the request for abortion and its implementation (previously it had to last 7 days).
But beware, this does not mean that an abortion can be performed immediately, the places where it takes place to do according to the constraints of their schedules.
Where can this method be used?
Up to 7 weeks of amenorrhea, the medication may be interrupted either in a planning center, in a health facility (hospital, clinic, family planning), or in a city medical office ( in a doctor or midwife) semi-outpatient. From 7 to 9 weeks of amenorrhea, it requires a few hours of hospitalization and must therefore take place in a hospital, a clinic or an approved center.
In the case of semi-ambulatory drug-induced abortion, the first medication takes place in the hospital, then a second at home. In this case, there are very important criteria to take into account: the woman must not be alone at home on the day of taking the drugs, she must live within 40 kilometers of a hospital, enjoy sanitary conditions satisfactory, and above all be ready and well informed of the process, especially bleeding, which in some may be abundant. The more informed a woman is, the better she can manage her abortion.
How is a drug-induced abortion performed?
The medicated IVG takes place in 2 stages:
1. Taking mifepristone (mifegyne / RU 486). This molecule can "counter" pregnancy hormones, and thus stop pregnancy. It causes dilatation of the cervix. 1 to 3 tablets are delivered (this can vary according to the centers of abortion but does not change its efficiency) after signing a consent that the woman has understood that this is the beginning of the process (in case change of mind, the medical team could not then decide on the future course of pregnancy). The taking takes place in general 48h before the continuation of the process.
A prescription of analgesic and anti-nausea drugs is then delivered to the patient. Indeed, it is possible, after 36 hours, to feel nauseous, that bleeding or uterine pain appear.
2. Taking prostaglandins. 48 hours after taking mifegyne taking misoprostol that will cause contractions of the uterine muscle. In general, 4 tablets are ingested in half a day. This will trigger bleeding, sometimes more than menstruation, or the appearance of clots for a few hours. It is within these bleeds that the contents of the uterus will be expelled.
Namely: the younger the patient, the more likely the medication will be painful.
Most patients do not "see" the pregnancy expelled (I specify because many women are afraid). To find out if the method worked well, wait a little, ideally 14 days, then perform a blood test or an ultrasound to attest to the effectiveness of the process.
Particular vigilance is then given to contraception. Depending on the choice of the contraceptive method of the patient, it will be used from the day of taking misoprostol or in the following month (during the control visit for example).
What are the risks ?
The main risk of this method is its failure, about 3 to 4%. The failure can be partial, that is to say that the pregnancy does not evolve but is not completely evacuated. In this case, the doctor discusses with the woman what is most desirable for her: she can take back medication or prefer the practice of curettage, that is to say aspiration of the contents of the uterus .
The complete failure of the method is much rarer. In this case, the pregnancy has evolved and the medical choice is directly on the realization of a gesture of uterine aspiration.
* Doctor author , I still have a question , Editions Larousse.
