Reproductive · Year 2 · from Reproductive
Case 1: Medical Abortion with Mifepristone and Misoprostol
Clinical Image
Source: Wikipedia - Mifepristone - CC BY-SA 4.0
Case Presentation
A 26-year-old G2P1 woman presents requesting pregnancy termination. Her last menstrual period was 7 weeks ago, and she has a positive home pregnancy test. She has one child and is certain she does not want to continue this pregnancy due to personal circumstances. Transvaginal ultrasound confirms an intrauterine pregnancy at 6 weeks 5 days gestation with a yolk sac and embryonic pole measuring 5 mm without cardiac activity visualized. She has no contraindications to medical abortion (no suspected ectopic pregnancy, inherited porphyria, chronic adrenal failure, or concurrent long-term corticosteroid use). She is counseled about her options including surgical aspiration versus medication abortion. She prefers medication abortion due to its non-invasive nature and the ability to complete the process at home. She is prescribed mifepristone 200 mg orally, taken in the clinic, which competitively blocks progesterone receptors, leading to decidual necrosis and pregnancy detachment. She is instructed to take misoprostol 800 mcg buccally 24-48 hours later at home. Misoprostol causes uterine contractions. She is counseled about expected bleeding (heavier than a period with clots) and cramping, and provided with pain medication and a 24-hour contact number. She follows up 1 week later. Ultrasound shows an empty uterus, confirming complete abortion. Serum hCG has appropriately declined. She is counseled about contraception and chooses a hormonal IUD, which is placed at the same visit.
Key Learning Points
- Medical abortion using mifepristone (anti-progestin) plus misoprostol (prostaglandin) is highly effective (>95% complete abortion rate) for pregnancies up to 10-11 weeks gestation
- Mifepristone blocks progesterone receptors, causing decidual necrosis and detachment of the pregnancy; misoprostol causes cervical softening and uterine contractions to expel the pregnancy
- Contraindications to medical abortion include confirmed or suspected ectopic pregnancy, IUD in place, chronic corticosteroid use, inherited porphyrias, and allergy to the medications
- Follow-up to confirm complete abortion is essential; failure (ongoing pregnancy or incomplete abortion) requires repeat medication or surgical intervention