Frequently Asked Questions About Medical abortion

1) Medical Abortion

For termination of First trimester pregnancy which of the following medicine is used?

a) Prostaglandin inhibitor

b) Anti-progesteronec) Beta sympathomimetic agonistd) Synthetic estrogene) Medroxyprogesterone

Correct Answer: b) Antiprogestin – Mifepristone, is a type of hormone antagonist in which that antagonizes or suppresses the actions of progesterone in the body. An example of an antiprogestogen is mifepristone. Medical abortion using mifepristone plus prostaglandin is the most effective method of abortion at gestations of less than 7 weeks.

Mifepristone is an antiprogestin that is licensed for pregnancy termination in many countries. Taken orally during pregnancy, mifepristone blocks progesterone receptors, making the endometrium unable to sustain a growing embryo. Mifepristone also triggers an increase in prostaglandin levels and dilates the cervix, facilitating abortion. Although abortion is illegal in many developing countries, abortion in India is legal.

2) Medical Abortion for Unwanted Pregnancy

Medical abortion (non-surgical abortion in which abortifacient pharmaceutical drugs are used to induce abortion) can be done upto —-

a) 5 weeks (≤35 days)

b) 7 weeks (≤49 days)

c) 9 weeks (≤63 days)

d) 12 weeks (≤84 days)

e) 20 weeks (≤140 days)

Correct Answer: c) 9 weeks (≤63 days). Medical abortion (non-surgical abortion in which abortifacient pharmaceutical drugs are used to induce abortion) can be done upto 9 weeks (≤63 days). (Ref: WHO) Medical abortion in India is approved only up-to 7 weeks (49 days) of pregnancy.

3) Methotrexate for medical abortion

Methotrexate can be used for medical abortion, if mifepristone is not available or if methotrexate is preferred because of its lower cost (Ref: WHO) for pregnancies upto —-

a) 5 weeks (≤35 days)

b) 7 weeks (≤49 days)

c) 9 weeks (≤63 days)

d) 12 weeks (≤84 days)

e) 20 weeks (≤140 days)

Correct Answer: b) 7 weeks (≤49 days). Methotrexate 50 mg/m2 (of body surface area) by either the oral or intramuscular route, followed by a single vaginal dose of 800 µg misoprostol at any time between 3 and 7 days later. If the fetus is not expelled within 24 hours of misoprostol administration, a second virginal dose of 800 µg of misoprostol may be administered. (Ref: WHO)

4) Antibiotic for Medical abortion

Combination of Mifepristone and Misoprostol is used for Medical abortion. Which antibiotic should be prescribed along with to avoid infection?

a) Amoxycillin

b) Cefixime

c) Ciprofloxacin

d) Amox-Clav

e) No antibiotic is required

Correct Answer: e) No antibiotic is required. All women having surgical abortion, regardless of their risk of pelvic inflammatory infection, should receive appropriate prophylactic antibiotics pre- or peri-operatively. For women having medical abortion, routine use of prophylactic antibiotics is not recommended.

5) Therapeutic Abortion is indicated in

a) Uterine fibroid

b) Maternal pulmonary hypertension

c) Placenta previa

d) Maternal blood sugar >12 mmol/L

e) Triplet pregnancy

Correct Answer: b) Maternal pulmonary hypertension. Women with pulmonary hypertension should be advised against pregnancy. Maternal death occurs because of pulmonary hypertensive crises, pulmonary thrombosis, or refractory right heart failure. This occurs even in patients with little or no disability before or during pregnancy. Even moderate forms of pulmonary vascular disease can worsen during pregnancy as a result of the decrease in systemic vascular resistance and overload of the right ventricle, and no safe cut-off value is known.

6) Oral Route for Medical Abortion

For women with a pregnancy of ≤ 49 days (7 weeks) who prefer the oral route of administration, misoprostol may be administered as a ——– oral dose 2 days after mifepristone.

a) 200-µg

b) 400-µg

c) 600-µg

d) 800-µg

Correct Answer: b) 400-µg. For women with a pregnancy of ≤49 days who prefer the oral route of administration, misoprostol may be administered as a 400-µg oral dose 2 days after mifepristone.
Misoprostol 800 µg sublingually 2 days after mifepristone is another option for women who prefer to avoid vaginal administration, but they should be counselled about increased side-effects. (Ref: WHO)

Medically reviewed by Dr. Niraj Mahajan