Medical abortion seems like such a simple procedure that it is not clear why the doctor is here. Can’t you just buy and take the pills according to the instructions? Why do you have to go to the clinic and get tested? This is a fairly common question that requires a serious answer.

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A little history

The idea of the “pregnancy pill” is wonderful. The doctor writes a prescription, the patient buys the medicine at the pharmacy and quietly at home interrupts an unwanted pregnancy, without any intervention.

In the 1970s, a large-scale research program was launched in France to study hormonal and antihormonal drugs. As early as 1980, a drug was synthesized that worked as antiprogesterone.

How it works

The developed drug blocks the effect of progesterone at the receptor level. Deprived of its beneficial effects, the endometrium ceases to feel pregnant and is rejected along with the fetal egg. After the first successes, they thought of supplementing the action of the drug with the use of prostaglandins. Prostaglandins help soften the cervix and stimulate contractions facilitating the expulsion of the fetal egg.

In 1988, the method was approved by WHO, and France was the first country licensed to use this combination for early pregnancy abortion. In Russia the method came in 1999, the FDA in the USA approved medical abortions in the year 2000.

It would seem that the dream of a safe abortion has come true. But, alas, life has shattered those fantasies.

The Pill Kills Too

The first case occurred in France in April 1991. A woman died as a result of a medical abortion. As it turned out, she had a combination of alarming factors.

But the drug proved to be dangerous even for those with no apparent contraindications4, 5. In September 2001, a woman in Canada died of septic shock. The cause was infection of the uterus, most likely from parts of the embryo remaining in it. Another woman suffered a severe heart attack, but fortunately survived.

Septic shock, caused by Clostridium sordellii, was not a frequent but almost 100% fatal complication of medical abortion. The disease develops lightning-fast and has a mild to moderate course. By 2013, U.S. regulatory agencies (FDA) had collected information on 15 such cases.

On September 12, 2001, a 38-year-old woman from the United States died 5 days after taking the drug. The clinic where the medical abortion was performed did not see a fetal egg on the preliminary ultrasound, but decided it was not a big deal because the pregnancy was still short. At home, the patient developed severe abdominal pain and bleeding. The woman called the clinic several times, where she was assured “everything is OK, it’s supposed to be like this. When the unfortunate woman was brought to the clinic and operated on, it turned out that the pregnancy was ectopic. The tube rupture caused massive intra-abdominal bleeding.

Ectopic pregnancy is a contraindication for medical abortion. In extrauterine pregnancies, the doctor should be patient and wait for an opportunity to see the fetus in the uterine cavity. A couple of years ago, we had a case of a patient with a combination of uterine and ectopic pregnancy. Medical abortion almost killed her. The patient was saved only by close medical supervision and timely aid.

In 2003, 18-year-old Holly Patterson died in the United States after taking the drug. Death was caused by an incomplete abortion. Fetal fragments lingering in the uterine cavity led to septic shock and death of the young woman. In the same year, Rebecca Tellberg, 16, from Sweden, died of hemorrhage eight days after a medically assisted abortion performed in a specialized clinic and strictly according to the instructions. Her body was found in the shower. The investigators concluded that the doctors had acted correctly, just that the patient had not sought help in time.

In 2004, the FDA reported 17 fatal situations related to medical abortion. Bleeding lasted about 1 month in 8 percent of the cases, and 72 percent needed a blood transfusion. Seven patients developed life-threatening sepsis. Fortunately, we were able to save all of them.

That is why in most countries of the world, including Russia, the United States and the European Union, medical abortion is performed only by doctors. Not nurses, not physician assistants, not midwives. Only highly qualified specialists.