Is RU486 Safe After Pelvic Inflammation and Previous Abortions?

Is it appropriate to use RU486 for a subsequent pregnancy after experiencing pelvic inflammatory disease following an abortion?

Hello Doctor, I apologize for the lengthy message.
I became pregnant in March, but due to abnormal embryo development, the doctor administered a medical abortion using six doses of Cytotec.
Besides experiencing a fever of 38 degrees Celsius and severe abdominal pain on the night of the medication, the embryo was ultimately not expelled, leading to a dilation and curettage (D&C).
A few weeks later, I developed pelvic inflammatory disease, had a fever, and was hospitalized for a week to receive antibiotics.
Two months later, I became pregnant again, but due to certain factors, I cannot keep the baby.
My questions are:
1.
Given my previous experience with a medical abortion and my fear of it, and considering I have no significant medical history related to cardiovascular or coagulation disorders (I am currently 30 years old), aside from a history of pelvic inflammatory disease and recurrent candidiasis, would you still recommend using RU486 for a medical abortion?
2.
I previously treated my panic disorder with Prozac, and I stopped taking the medication about a month before discovering this pregnancy.
If I were to keep the baby, would there be any risk of long-term effects? (The reason for stopping the medication was a suspected allergy to Prozac, although I do not have a history of allergies.)
3.
I am currently approximately 3 weeks and 5 days pregnant.
I took a urine test that showed a faint line, but I suspect that an ultrasound may not detect anything yet, so I plan to wait until 6 weeks for a check-up (since I have previously given birth and know that it may be too early to see anything).
At this stage, is it normal to have a fever of 37.5 degrees Celsius? I am unsure why, but perhaps due to my age, my health has been poor this past year.
Additionally, as a working mother, I have to care for my two-year-old after work, which leaves me feeling exhausted and makes it difficult to find time to see a doctor.
I hope your answers can help me.
Thank you, Doctor.

Corinne, 30~39 year old female. Ask Date: 2016/06/22

Dr. Zhang Kunmin reply Obstetrics and Gynecology

Hello, based on your description, it is advisable to have an evaluation by an obstetrician-gynecologist to assess the situation and use medication for abortion in accordance with legal regulations.
Under normal dosage, Porzac is not expected to affect the fetus.
A pregnant woman with a temperature of 37.5°C can be monitored for now.
Thank you! Wishing you safety and health.
Dr.
Zhang.

Reply Date: 2016/06/22

More Info

When considering the use of RU486 (mifepristone) after experiencing pelvic inflammatory disease (PID) and previous abortions, it is essential to weigh the potential risks and benefits carefully. RU486 is primarily used for medical abortion and is generally considered safe when used under the guidance of a healthcare provider. However, your medical history, particularly the pelvic inflammation and complications from previous abortions, raises important considerations.

1. Previous Pelvic Inflammation and Abortions: Given your history of PID and the complications you faced during your last abortion, it is crucial to consult with a healthcare provider before proceeding with RU486. PID can lead to scarring and damage to the reproductive organs, which may complicate future pregnancies and abortions. The use of RU486 in individuals with a history of PID is not contraindicated, but careful evaluation is necessary. Your healthcare provider may want to conduct a thorough examination, including imaging studies, to assess the current state of your reproductive health before recommending RU486.

2. Concerns Regarding Prozac (Fluoxetine): You mentioned having taken Prozac for panic disorder and stopping it shortly before discovering your current pregnancy. While there is some concern about the effects of antidepressants on pregnancy, many studies suggest that the risks associated with untreated mental health conditions can outweigh the potential risks of medication. It is essential to discuss your concerns with your healthcare provider, who can help you weigh the risks and benefits of continuing or resuming treatment during pregnancy. If you decide to continue the pregnancy, your provider may recommend monitoring for any potential developmental issues, but many women have healthy pregnancies while managing their mental health conditions.

3. Current Pregnancy Symptoms: You are currently around 3 weeks and 5 days pregnant and have noted a slight fever (37.5°C). Mild fever can occur in early pregnancy due to various factors, including hormonal changes and the body's adjustment to pregnancy. However, if the fever persists or is accompanied by other concerning symptoms (such as severe abdominal pain, heavy bleeding, or unusual discharge), it is vital to seek medical attention promptly. Your plan to wait until 6 weeks for an ultrasound is reasonable, as this is typically when a heartbeat can be detected, but do not hesitate to reach out to your healthcare provider if you have any concerns in the meantime.

In summary, while RU486 can be a safe option for medical abortion, your specific medical history necessitates a careful evaluation by a healthcare provider. They can provide personalized advice based on your health status and help you make an informed decision. Additionally, addressing your mental health and any potential risks associated with medications during pregnancy is crucial for both your well-being and that of your baby. Always prioritize open communication with your healthcare provider to ensure the best outcomes for your health and your family's future.

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