Big sizes scare us. Big bears, big discounts (ofcourse, imagine the crazy crowd), big guns, big buns and big bumps, specially baby bumps. So when you cross the 4th month on the calendar and begin to prepare yourself for the blade, you tend to underestimate the power of small.  Like a small tablet. A slightly bulkier baby bump doesn’t always need a blade to deflate it. Maybe a few grams heavy pill could do the job for you.

So do women running in their second trimester of pregnancy have options under medical abortion available? A definite yes.

Let us explore your options here one by one.

  • Prostaglandins (PG’s) :

Prostaglandins are a group of fat derived active compounds that are not exactly hormones but have actions similar to them. They are found in almost all tissues and cells of the body and they have different types. Different types for different cells and different actions. We here, are concerned with only two types – PGE and PGF.

Both these types have an interesting job to do at the time of labour. They basically shake  the uterine  walls up, like an earthquake, that forces the baby out of it’s cosy little crib. They cause  the uterus walls to contract vigorously, and ofcourse our baby doesn’t like that intervention. This is exactly what we plan to exploit.

We use analogues (compounds that pretend to be prostaglandins but are not entirely like them) that work in the same manner as PG’s, just more efficient. Most often we prefer PGE analogues (like Misoprostol, gemeprostol, etc) over PGF analogues (carbaprostol) because of their higher efficacy.

  • Misoprostol :

It increases the frequency of uterine contractions and also ripens the cervix. Cervical ripening means softening of the cervix, that leads to its dilatation thereby providing a wide passage for the embryo to flow through. The same action is also used prior to the surgical methods for abortion. We shall be talking about that more in the subsequent articles. From administration of tablet to abortion, the time period is about 11-12 hours.

Protocol : 400-800 microgram given vaginally at an interval of 3-4 hours.

A lot of patients ask us as to why the vaginal method of administration is preferred. Because travelling is expensive. When the drug travels from your mouth to the uterus via blood, it’s availability reduces; we get much less drug than we administered. On the other end, however, closer down to the uterus, we lose only a negligible amount of drug to the blood, thereby increasing availability and efficacy.

This is not to say that oral methods of administration are not available. 400 microgram of Misoprostol kept under the tongue every 3 hours for a maximum of 5 doses has shown to have a 100% success rate in second trimester abortion.

  • Gemeprostol :

This analog is used as a vaginal pessary of 1mg every 3-6 hours for five doses in 24 hours. It will be anywhere between 14-18  hours from that point onwards for you to abort your pregnancy.

  • Mifepristone and Misoprostol :

This magic combination works for second trimester pregnancies as well. With little tweaks in the dosage and dosage interval, it has been found to have a success rate of over 97%. 200mg of mifepristone is given orally followed 36-48 hours later by 800 microgram of Misoprostol vaginally. Misoprostol is then given in a dose of 400 microgram orally 3 hourly for a maximum of four doses. The magic in the combination lies in the mifepristone contracting the induction – abortion interval to 6.5 hours.

Benefits :

  • Simple, easy and noninvasive procedure
  • Safe and effective
  • Pocket friendly

Word of caution : The after experience of Misoprostol administration would remind most people of sitting for their high school examinations after having bad street food  maybe. Nausea, headache, cramps, diarrhoea and constipation are side effects reported at an incidence slightly greater than 1%.

They are however to be used with caution in people with history of any cardiac disease or known allergy to Prostanglandins.

  • Oxytocin :

Chances are that this word must have come across your eyes in those popularly shared “The science of love- your amazing brain” articles on social media. But it took no time for the science fraternity to look into the veracity of these claims in a popular study “The orgasmic history of oxytocin : Love, Lust and Labour”. This hormone better known by quirky names like the “cuddle hormone” or “love hormone” is also known for it’s milk ejection action on the breast during breast feeding post delivery.

Interestingly, this hormone is secreted from the pituitary gland in the brain but acts all the way downtown on the uterus and cervix. It causes the uterine walls to contract vigorously while it softens and dilates the cervix. In low doses, it acts at the time of delivery to give birth to your baby. In high doses however, it’s action results in a diametrically opposite result of abortion. With vigorous contractions of the uterus, the capillaries supplying the fetus rupture, and is expelled out through a dilated cervix.

Protocol : Used as a drip at a rate of 50 milliunits per minute, it has a success rate of over 80%. High doses up to 300 units in 500ml are used to augment the process of labour.

Benefits :

  • Simple, easy, non invasive procedure
  • Safe and effective
  • A Cheaper option

Word of caution : The risks that most websites on the Internet popularise for oxytocin happens to be uterine rupture if a scar from a previous surgery is present. That, is only partly true. It has been reported in cases where oxytocin was administered vaginally. In cases where it is administered via an intravenous line ( a drip), the side effects experienced by women were found to be excessive pain and  irregular bleeding for the following 2 weeks.

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