She Used Pills to Medically Abort — But Had a Dangerous Ectopic Pregnancy Instead – Consumer Health News


Thursday, Jan. 19, 2023 (HealthDay News) — Several states increasingly restrict access to surgical abortion after the U.S. Supreme Court reverses Roe v. Wade in June 2022 has led many women to seek medical abortion. .

But the case of a 22-year-old who took mifepristone and misoprostol purchased over the internet to terminate a pregnancy serves as a lesson.

She was approximately 6 weeks pregnant based on her last menstrual period and developed severe abdominal cramps 6 days after taking mifepristone.

What she thought was a “normal” pregnancy, but after increasing pain and two emergency room visits, doctors diagnosed her with a life-threatening ectopic ruptured pregnancy. An ectopic pregnancy occurs when a fertilized egg grows outside the uterus, usually in a fallopian tube. Immediate surgery is required.

The danger is that in the early stages when abortion drugs are indicated, women may not know their pregnancy is ectopic.

Fortunately, this woman was treated without complications.

Although rare, such situations could become more frequent because of abortion restrictions, said Dr. Isabel Beshar, co-author of a study describing the case in the January 19 issue of the journal. says. New England Journal of Medicine.

“Self-administered abortions have been shown to be safe and effective, but do not include similar safety checks for rare but potentially serious complications such as ectopic pregnancy.” said Beshar, a resident at the Stanford University School of Medicine. in California.

Medical abortion includes two drugs, mifepristone and misoprostol, that can terminate an early pregnancy.Mifepristone blocks progesterone, the hormone necessary for pregnancy, and misoprostol causes cramps and bleeding to empty the uterus.. According to the Guttmacher Institute, a research group that supports abortion rights, more than half of abortions in the United States are now performed using pills rather than surgery.

Access to medical abortion increased following Dobbs, which overturned Roe v. Wade. Retail pharmacies such as CVS and Walgreens can now fill prescriptions for mifepristone, and the US Postal Service will continue to deliver these drugs to people with prescriptions. Recent studies show that medical early pregnancy abortion is safe and effective.

Bechar said Google searches for drug-induced abortions spiked after Dobbs’ decision. “In the future, more people will choose to manage their pregnancies outside the formal health care system.

“The health care system has not yet adapted to this paradigm shift and this case reflects the current uncertainty around management. I expect that we will be able to evaluate it comfortably.”

Risk factors for ectopic pregnancy include a history of a previous ectopic pregnancy, a sexually transmitted disease, or previous surgery on the fallopian tubes (the two tubes that connect the ovaries to the uterus).

People with these risk factors should consider speaking with a doctor before self-administering an abortion.

Outside experts agree that the incident serves as a lesson.

This story is “just one of the reasons why abortion bans and restrictions are so harmful,” says Dr. Jen Villavicencio. She is the Equity Transformation Leader at the American College of Obstetricians and Gynecologist.

“Medical abortion is safe and effective, but it may be contraindicated or another treatment protocol may be more appropriate,” she said.

“This patient did the right thing by going to see a doctor when she felt something wasn’t right. Too many patients either don’t get the chance or will be penalized for doing so.” said Villavicencio.

signs of ectopic pregnancy

It can be difficult to tell the difference between symptoms of an ectopic pregnancy early on and those of a typical pregnancy, Villavicencio said. May include mild pain in the abdomen or pelvis, or mild cramps on one side of the pelvis.

“If an ectopic pregnancy continues untreated, it can lead to more serious symptoms such as sudden severe pain in the abdomen or pelvis, shoulder pain, weakness, dizziness and fainting,” Villavicencio said. If this happens, go to the emergency room, she said.

“Dobbs’ decision will result in more patients being denied access to abortion and gynecological and obstetric care,” Villavicencio said. “The data show that restricting abortion does not reduce the rate of unwanted pregnancies and may force more people to self-manage abortions.”

Dr. Eran Bornstein agreed. He is the assistant chief of obstetrics and gynecology at his Hill Hospital in Lenox, New York City.

“While this is a rare scenario overall, efforts to minimize such cases are important given the potentially devastating consequences of an undiagnosed ruptured ectopic pregnancy.

“A clinical scenario in which a pregnant person, especially one with potential risk factors for ectopic pregnancy, self-administers an abortion without confirmation of an intrauterine pregnancy. [a normal pregnancy inside the uterus] As the authors presented, it is likely that more complications arise from undiagnosed ectopic pregnancies.

Women who are at high risk of developing an ectopic pregnancy should have an ultrasound early to confirm the location of the pregnancy and make sure it is not an ectopic pregnancy, he said.

“We recommend taking the pill only after an intrauterine pregnancy ultrasound to avoid possible complications from misdiagnosis and incorrect treatment,” Bornstein said.

For more information

The American College of Obstetricians and Gynecologists details ectopic pregnancy.

Source: Isabel Beshar, MD, MPH, Resident, Stanford University School of Medicine, Stanford, CA. Eran Bornstein, M.D., Vice Chair of Obstetrics and Gynecology, Lenox Hill Hospital, New York City. Jennifer Villavicencio, MD, MPP, Reid, Equity Transformation, American College of Obstetricians and Gynecologists, Washington, DC. New England Journal of Medicine19 January 2023



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