RU486: Concerns and Questions About Medical Abortion - Obstetrics and Gynecology

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RU486, also known as Mifepristone, is a medication used for medical abortion. It is important to understand the process, potential complications, and follow-up care associated with its use, especially for women who have not previously given birth. Here, I will address your concerns regarding the use of RU486, the timeline for its effectiveness, and the potential risks involved.

1. Effectiveness and Completeness of Abortion: For women who have never given birth, there is a concern about whether the abortion will be complete after taking RU486. Studies indicate that the effectiveness of RU486 is generally high, but there is a small percentage (around 5%) of cases where the abortion may not be complete, leading to the need for further medical intervention. This is particularly relevant for women who have not had a previous pregnancy, as their uterine tone and response to the medication may differ.

2. Timeline for Abortion Completion: After taking RU486, the process typically unfolds over a few days. Most women will experience bleeding within a few days, and the complete expulsion of the pregnancy tissue can take anywhere from a few days to a couple of weeks. It is essential to follow up with your healthcare provider approximately 3-6 days after taking the medication to ensure that the abortion is complete. If the ultrasound shows retained tissue, further treatment, such as additional medication or a surgical procedure (aspiration), may be necessary.

3. Discomfort and Follow-Up Procedures: It is not uncommon for women to feel discomfort during follow-up procedures, especially if suction aspiration is required. This discomfort can be exacerbated by anxiety about the procedure itself. If the healthcare provider indicates that the abortion is not complete, it is crucial to follow their recommendations for further treatment to avoid complications such as infection or prolonged bleeding.

4. Risk of Infection: The risk of infection following a medical abortion is relatively low, especially when the procedure is performed under medical supervision. However, if there is retained tissue, the risk of infection can increase. Signs of infection include fever, severe abdominal pain, or foul-smelling discharge. If any of these symptoms occur, it is essential to seek medical attention promptly.

5. Nutritional Considerations: Regarding the recommendation for folic acid, it is generally advised for women of childbearing age to take folic acid supplements, especially if they are planning to conceive in the future. Folic acid is essential for fetal development and can help prevent certain birth defects. The mention of cold hands and feet may not be directly related to folic acid but could be a sign of other underlying issues, such as circulation problems or anxiety.

6. Need for Additional Medical Care: If you are experiencing prolonged symptoms or complications, it may be beneficial to seek care at a larger hospital or a specialized clinic. They can provide more comprehensive care and support, especially if complications arise.

7. Retained Tissue Concerns: If ultrasound results indicate that there is retained tissue, it is crucial to address this promptly. While some women may pass retained tissue naturally, others may require medical intervention. Leaving retained tissue can lead to complications, including infection or heavy bleeding.

8. Emotional and Physical Well-being: It is also important to consider the emotional and psychological aspects of undergoing a medical abortion. Many women experience a range of emotions, and it can be helpful to seek support from healthcare providers, counselors, or support groups.

In summary, while RU486 is a safe and effective method for medical abortion, it is essential to follow medical advice closely, attend all follow-up appointments, and communicate any concerns or symptoms to your healthcare provider. If you feel that your care has not met your expectations, seeking a second opinion or consulting with a different healthcare provider may provide you with the reassurance and support you need.