Chapter 13 Summary: Medical or drug-induced abortion: how safe?

Medical (chemically-induced) abortion has become more widely practiced in recent years as an alternative to surgical abortion. Medical abortion takes longer, involves artificial labour, and ends in the delivery of a dead fetus.1 The failure rate of medical abortion ranges from 4 to 16 per cent.2 Currently, the most common drug regimens are: mifepristone (RU486) combined with misoprostol, methotrexate combined with misoprostol, and misoprostol alone.

A successful medical abortion is defined as a complete expulsion of the fetus without surgical intervention. Failure can result from: 1) an incomplete abortion; 2) severe bleeding; 3) ongoing pregnancy; or 4) the patient’s request for surgical abortion. Researchers have found higher failure rates in developing countries.3 They also note that the failure rate increases with gestational age.4

Medical abortion can have various negative effects. One study found a 29 per cent rate of adverse effects (compared to four per cent for surgical abortions), including nausea, vomiting, severe stomach pain and bleeding, infection, uterine perforation and uterine rupture.5 In addition, complications such as ectopic pregnancy can occur after medical abortion. One major study found that nine per cent of women who undergo medical abortion suffer emergency complications.6 Given the many complications associated with medical abortion, women clearly deserve to be informed of these risks.

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  • 1. Grossman D, Blachard K, Blumenthal P. Complications after Second Trimester Surgical and Medical Abortion. Reproductive Health Matters 2008; 16(31): p. 179.
  • 2. Jensen J, Astley S, Morgan E, Nichols M. Outcomes of Suction Curettage and Mifepristone Abortion in the United States. Contraception 1999; 59(3): pp. 153-9. See Complications: Abortion`s Impact on Women for full reference.
  • 3. Winikoff B, Sivin I, Coyaji K, et al. Safety, efficacy and acceptability of medical abortion in China, Cuba, and India: A comparative trial of mifepristone-misoprostol versus surgical abortion. AJOG 1996; 176(2): pp. 431-7
  • 4. Ibid.
  • 5. Grossman et al.
  • 6. Child TJ, Thomas J, Rees M, MacKenzie IZ. A comparative study of surgical and medical procedures: 932 pregnancy terminations up to 63 days gestation. Human Reproduction 2001; 16(1): pp. 67-71.