Is RU486 Treatment a Failure? Your Concerns

Taking RU486, does that count as a failure?

Hello Doctor, I found out I was four weeks pregnant during my visit to the obstetrics and gynecology department on March 25.
My last menstrual period was from February 21 to February 27.
After discussion, I took the first dose of medication at the clinic around 7 PM on March 27.
After taking it, I felt a bit dizzy and nauseous, but there was no bleeding.
Two days later, on March 29, around 10:30 AM, I took the second dose of three pills on an empty stomach.
About ten minutes after taking them, I started to feel nauseous and had abdominal pain, but I managed to hold it in and did not vomit.
After that, I experienced some bleeding.
An hour later, the nausea and urge to vomit subsided, but the abdominal pain continued intermittently.
However, I noticed that the amount of bleeding was not significant; by around 2 or 3 PM, I realized there was hardly any bleeding, and by 11:30 PM on March 29, it was still just a small amount of light bleeding.
I would like to ask if this could indicate a failed miscarriage? I am prepared to return to the clinic for an examination, but I am still very worried.
If it is a failure, is it possible that the embryo has not passed? Or could it just be that blood clots are not being expelled? In such cases, would they typically recommend surgery right away, or would they ask me to take the medication again? Thank you, Doctor.

bb, 20~29 year old female. Ask Date: 2019/03/29

Dr. Huang Jianzhong reply Obstetrics and Gynecology

On March 25, I visited the obstetrics and gynecology department and was confirmed to be four weeks pregnant.
My last menstrual period was from February 21 to February 27.
After discussion, on March 27 around 7 PM, I took the first dose of medication, which consisted of one pill.
After taking it, I felt a bit dizzy and nauseous, but there was no bleeding.
Two days later, on March 29 around 10:30 AM, I took the second dose of medication on an empty stomach, which consisted of three pills.
About ten minutes after taking it, I started to feel nauseous and had abdominal pain, but I managed to hold it in and did not vomit.
After that, I experienced some bleeding.
An hour later, the nausea and urge to vomit subsided, but the abdominal pain continued intermittently.
However, I noticed that the amount of bleeding was not significant.
By around 2 or 3 PM, I realized that there was hardly any bleeding, and by 11:30 PM on March 29, I was still experiencing only minimal spotting.
I would like to know if this could indicate a failed miscarriage.
I am prepared to return to the clinic for an examination, but I am still very worried.
If it is a failure, is it possible that the embryo has not passed, or could it just be that blood clots are not being expelled? In such cases, would they typically recommend surgery directly, or would they ask me to take the medication again?
Answer: An ultrasound examination can determine whether the embryo has been expelled.

Reply Date: 2019/03/29

More Info

The concerns you have regarding the use of RU486 (Mifepristone) for medical abortion are quite valid, and it is important to understand the process and what to expect. RU486 is commonly used in combination with another medication, Misoprostol, to terminate a pregnancy. The regimen typically involves taking Mifepristone first, followed by Misoprostol 24 to 48 hours later.
From your description, it appears that you followed the protocol correctly by taking the first dose of Mifepristone on March 27 and then the Misoprostol on March 29. The side effects you experienced, such as nausea and abdominal pain, are common reactions to these medications. The bleeding you observed is also a typical response, as the medications work to induce a miscarriage by causing the uterus to contract and expel its contents.

Regarding your concern about the amount of bleeding, it is important to note that the amount of bleeding can vary significantly among individuals. Some may experience heavy bleeding, while others may have lighter bleeding. The key indicators of a successful medical abortion include the presence of bleeding and cramping, which suggests that the uterus is expelling its contents. However, the absence of heavy bleeding does not necessarily indicate a failure of the procedure.

It is crucial to follow up with your healthcare provider as planned. They may perform an ultrasound to check for the presence of any remaining tissue in the uterus. If there is retained tissue, they may recommend additional medication to help expel it or, in some cases, a surgical procedure known as a dilation and curettage (D&C) to ensure that the uterus is clear.

In terms of your worries about a potential failure of the abortion, it is important to remember that while medical abortions are highly effective (over 95% successful), there is a small percentage of cases where the procedure may not be fully effective. If the abortion is incomplete, it can lead to complications, including infection or heavy bleeding, which is why follow-up care is essential.

If you find that you are still experiencing symptoms of pregnancy, such as nausea or breast tenderness, or if you have any concerns about your health, it is imperative to reach out to your healthcare provider immediately. They can provide reassurance, perform necessary evaluations, and discuss the next steps based on your individual situation.

In summary, while your experience with RU486 may raise concerns about the effectiveness of the treatment, it is essential to follow up with your healthcare provider for a thorough evaluation. They will be able to determine whether the abortion was successful and what further actions, if any, are necessary. Remember, it is always better to communicate openly with your healthcare provider about your concerns and symptoms to ensure your health and well-being.

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