The medical abortion PILL.

MIFEPRISTONE (Trade name Mifegyne) & MISOPROSTOL (Trade name Cytotec)

This regime (combination of medicine) can be used for pregnancies up to 9 weeks.

THE MEDICAL ABORTION PILL.

HOW DOES MIFEPRISTONE WORK?

·         Stops the pregnancy from growing

·         Softens the cervix

·         Makes the uterus more likely to contract and cause bleeding

PROCEDURAL INFORMATION.

WHAT WILL HAPPEN AFTER TAKING MIFEPRISTONE?

·         Most clients will not experience any effects.

·         A small number of clients will abort after taking the Mifepristone.

·         A small number of clients may experience light bleeding, cramping or nausea.

HOW DOES MISOPROSTOL WORK?

·         Ripens the cervix.

·         Facilitates expulsion of the pregnancy (promotes uterine contractions)

WHEN IS MISOPROSTOL TAKEN?

The professional nurse will instruct the client to take the Misoprostol within 24-48 hours of taking the Mifepristone at the centre. All 4 tablets will be taken 24-48 hours later at the same time: 2 under the tongue and 1 tablet in each cheek.

WHAT WILL HAPPEN IF THE MISOPROSTOL IS PUT UNDER THE TONGUE AND ON THE INSIDE OF THE MOUTH (BETWEEN THE TEETH AND CHEEK)?

·         The drug will be absorbed fairly quickly.

·         The client will experience cramps and bleeding, this may be heavy and include clots. This will normally happen within the first 4 hours but may begin as early as 30 minutes after taking the Misoprostol.

·         Some clients may also experience short term fever or chills, nausea, vomiting and diarrhea.

·         MSMP is a process and can take 14 days to complete.

·         Once the pregnancy has been expelled, pain and heavy bleeding should subside. Lighter bleeding will continue for 2 weeks and very rarely lasts up to 3 weeks.

FOLLOW UP:

A follow up visit to the centre must be undertaken 3 weeks after taking the misoprostol medication. If needed more medication may be administered with another follow up visit 24 hours later.

PAIN MANAGEMENT:

Counseling and reassurance is crucial to managing pain. Some cramping occurs in most clients undergoing a medication abortion. In the event that the client experiences pain, they are advised to:

·         Take pain killers such as “B” Dol as needed every 4-6 hours. This will be provided by the clinic on the 1^st visit.

·         Use hot packs.
 

WHEN CAN A  WOMAN START BREASTFEEDING AGAIN?

She can start breastfeeding again 24 hours after taking Mifepristone and 24 hours after taking the Misoprostol.

DISCHARGE INSTRUCTIONS;

The client must receive verbal and written instructions in a language she can understand. These instructions should be given to the client during the first visit. They should cover the following:

·         The side-effects a client can expect after taking the medication.

·         24 hours contact number must be given along with a MSMP Aftercare Sheet.

·         She will be given 4 pain tablets and 4 Misoprostol tablets to take home.

·         The need to abstain from sex for 2 weeks.

·         When Family Planning must be initiated.

WARNING SIGNS OF POSSIBLE COMPLICATIONS:

The client should return to the center immediately or seek medical attention if she has:

·         Heavy vaginal bleeding- soaking 2 or more maxi pads or 3 small pads in an hour for 2 consecutive hours.
·         Heavy vaginal bleeding with clots and severe cramping that lasts for more than 2 days.
·         Any abnormal vaginal discharge.
·         Fever, chills or malaise lasting more than 6 hours.