Other Risks

NAUSEA, VOMITING & DIARRHEA

What complications may be associated with nausea, vomiting and diarrhea?

Typically, nausea, vomiting, and diarrhea are self-limited and of mild severity.⁽¹⁾

Symptoms of serious medical abortion complications can include persistent vomiting or diarrhea for more than the day on which misoprostol was administered. ⁽¹⁾

A patient with preexisting severe pregnancy-related nausea or vomiting may do better with vacuum aspiration curettage. ⁽²⁾

Some women have requested surgical curettage to alleviate unusually severe nausea, vomiting, and pain. These symptoms were more severe than the expected side effects of the treatment. ⁽³⁾

Patients should contact her provider immediately if more than 24 hours has passed after taking misoprostol and she begins to experience: ^{(2) (4)} (See BOXED WARNINGS)

• nausea, vomiting or diarrhea, and/or
• feels other “flu-like” symptoms, such as weakness, with or without abdominal discomfort or pain

These symptoms, even without a fever, may be the sign of a serious infection or another problem (including an ectopic pregnancy, a pregnancy outside the womb). ⁽⁵⁾ (See MEDICATION GUIDE)

DAMAGE TO THE UTERUS

How can medical abortion cause damage to the uterus?

A potential risk of medical abortion with mifepristone and misoprostol is damage to the uterus during the course of the treatment, and in some patients other internal organs may be affected. ^{(6) (7)}

Mifepristone is used in conjunction with misoprostol, a prostaglandin analogue, available in the United States under the brand name Cytotec® (misoprostol), when administered orally, sublingually, or vaginally, stimulates uterine contractions that expel the embryo and placental tissue. ^{(8) (9)}

Misoprostol was initially approved for use as a drug approved by the U.S. Food & Drug Administration (FDA) for the purpose of reducing the risk of NSAID (nonsteroidal anti-inflammatory drugs, including aspirin)–induced gastric ulcers. ⁽¹⁰⁾

Misoprostol is used “off-label” for medical termination of pregnancy. ⁽¹¹⁾

Misoprostol has been reported to cause the uterus to rupture (tear) when given after the eighth week of pregnancy. Rupture (tearing) of the uterus can result in severe bleeding, hysterectomy, and/or maternal or fetal death. ⁽¹⁰⁾ (See Cytotec (misoprostol) BOXED WARNINGS)

Serious complications and teratogenicity can occur with unsupervised use of misoprostol. ⁽⁹⁾

INDUCED ABORTION & AUTOIMMUNE DISEASE

How can induced abortion be linked to autoimmune disease?

Recent data in the scientific and medical literature indicates some of the autoimmune diseases show a predilection for women in their child-bearing years and beyond are linked to fetal microchimerism from previous pregnancies. ⁽¹²⁾

Fetal microchimerism is increased in women who had a termination of pregnancy and may be associated with the development of autoimmune disease later on in life. ⁽¹²⁾

Women who had an elective abortion in either the first or second trimester have a greater risk for fetal microchimerism and the risk of developing an auto-immune disease for the rest of their lives. Fetal loss in elective abortions is accompanied with the loss of suppression of the maternal immune system which may be another factor in the setting the stage for the future development of autoimmune disease. ⁽¹²⁾

The consistently rising incidence of autoimmune diseases in women over the past four decades may be attributed to the increase in the utilization of abortion. ⁽¹²⁾

MEDICAL ABORTION & FUTURE PREGNANCY

What factors related to medical abortion can increase the risk of future pregnancy complications?

A 2008 research study of 9856 women in China explored the effect of first-trimester mifepristone-induced abortion on placental complications in subsequent pregnancy. ⁽¹³⁾

Factors related to mifepristone medical abortion such as a gestational age that is greater than 6 weeks at abortion, a surgical curettage after abortion, and a longer interpregnancy interval—may increase the risk of abruptio placenta. ⁽¹³⁾

Abruptio placenta occurs when the placenta peels away from the inner wall of the uterus before delivery — either partially or completely. ⁽¹⁴⁾

MIFEPRISTONE-INDUCED TTP

What is mifepristone-Induced Thrombotic Thrombocytopenic Purpura (TTP) after medical abortion?

Thrombotic thrombocytopenic purpura (TTP) is a rare blood condition. It causes blood clots to form in small blood vessels throughout the body. The blood clots can cause serious problems if they block the blood vessels and limit blood flow to the brain, kidneys, or heart. ⁽¹⁵⁾

Foreign Country – Medical Abortion Death: A 2007 Taiwan case study of a 31-year-old woman presented for medical termination of early pregnancy at 5 weeks from her last menstrual period describes, for the first time known in literature, the correlation between mifepristone and Thrombotic Thrombocytopenic Purpura (TTP) as straightforward and well-documented. ⁽¹⁶⁾

After mifepristone treatment, the patient presented with intermittent vaginal bleeding and worsening of dizziness, headache, and vomiting. Ultrasonography revealed no retained gestational tissue in the uterus and massive intrauterine hemorrhage. ⁽¹⁶⁾

Due to evidence of microangiopathic hemolytic anemia, thrombocytopenia and neurologic symptom of conscious stupor, thrombotic thrombocytopenic purpura (TTP) was considered. ⁽¹⁶⁾

The 31 year-old patient eventually died after loss of consciousness and intracranial hemorrhage with diffuse brain swelling. ⁽¹⁶⁾ 
(See DEATH)