Kobi Noe, MSN RN
Several studies show that patients either do not remember most of the medical information they are given by healthcare providers (HCPs), forgetting as much as half of what they are told. 1,2 Even the information they remember, they do not understand correctly, 1,2 often taking away the exact opposite meaning of the information that was actually given. 2 This misunderstanding often occurs because HCPs simply no longer recognize the jargon they use every day as such; medical language has become commonplace to them, so they forget what non-medical persons do and do not understand. So, let’s apply that to patients’ understanding of the abortion pill.
Potential Complications
If a non-medical person performs a google search asking, “is the abortion pill safe?” (the “abortion pill” being comprised of mifepristone and misoprostol), on many informational websites that person will see assurances like the following: “Medication abortion is very safe. In fact, it’s safer than many other medicines like penicillin, Tylenol, and Viagra3 ” or “What are the side effects? Most people will experience bleeding and cramping on the day they take the second medication. 4” However, that same non-medical person may not fully understand the serious implications of several health conditions often listed as possible complications of the abortion pill: hemorrhage, 3,5 sepsis, 3,5 and ruptured ectopic pregnancy. 5
Hemorrhage
Those taking the abortion pill are at risk for hemorrhage, 3,6,7 according to the Food and Drug Administration (FDA) drug label for mifepristone. 5 Hemorrhage is defined as acute blood loss, particularly of large amounts, 8,9 and among preventable deaths in the general population, is known to be one of the most common causes. 8,9 Although listed by many sources as an unlikely complication of using the abortion pill, patients considering use of the pill should still know that hemorrhage may occur. Failure of major organs, coma, seizures, and death can all occur, if hemorrhage is not treated quickly. 9
Sepsis
The other possible complication often listed for the abortion pill is sepsis, 3,6,7 and this information can also be found on the FDA drug label for mifepristone. 5 Sepsis is defined as an extreme bodily response to infection, 10,11,12,13 and, like hemorrhage, may lead to organ failure.11,12,13 Also like hemorrhage, sepsis is potentially fatal if not treated quickly. 10,11,12,13
Ruptured Ectopic Pregnancy
In addition to the risk of causing hemorrhage and sepsis, the abortion pill can cause an increased risk of ruptured ectopic pregnancy,5 another serious complication which can be life-threatening. A women may not be aware that her pregnancy is ectopic and therefore attribute the symptoms of ruptured ectopic pregnancy to “normal” side effects of the abortion pill. Unfortunately, this wrong assumption may delay her seeking care until the complications of the rupture are latestage and much more dangerous. 15,16,17 More women present to the ER with serious complications such as these three after having undergone medical abortion than after surgical abortion, and much of this is due to the fact that medical abortions can now be performed at home, without the close supervision of a HCP. 18 Women need to know about these complications, if considering taking the abortion pill.
Potential Failure
Besides the risk for life-threatening complications, there is a decent risk that medical abortions will not even be successful. As many as 50% of women do not accurately recall the date of their last menstrual period, 5 and these women may therefore be further along in their pregnancies than they estimate. This is critical to understand, since the abortion pill may be prescribed as late as 11 weeks into pregnancy, in some states. 3 As many as 0.3-8.4% of medical abortions fail if they occur after 9 weeks of pregnancy, 19 and if used as late as weeks 10 or 11 of pregnancy, as many as 13% of medical abortions may fail.3 Women need to know about the potential failure of medical abortion, if considering taking the abortion pill.
Women Need to Know What They Are Doing
The argument over the safety of medical abortions will likely go on as long as the human race continues to experience unwanted pregnancies. However, it is the responsibility of HCPs to provide clear, realistic facts about the risks associated with the medication, regardless of how small the HCP perceives those risks to be, and to explain those facts in non-medical jargon. Taking the abortion pill is no light thing, and women who are considering medical abortion need to know what they are doing.
References:
1- https://www.clinicaladvisor.com/features/patient-education-information/ 2- https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2799079 3- https://www.plannedparenthood.org/learn/abortion/the-abortion-pill/how-safe-is-theabortion-pill 4- https://www.aamc.org/news/what-medication-abortion-your-questions-answered 5- https://www.ncbi.nlm.nih.gov/books/NBK557612/ 6- https://my.clevelandclinic.org/health/treatments/21899-medical-abortion 7- https://www.poison.org/articles/what-are-abortion-pills 8- https://www.ncbi.nlm.nih.gov/books/NBK542273/ 9- https://my.clevelandclinic.org/health/diseases/hemorrhage 10- https://www.cdc.gov/sepsis/about/index.html 11- https://my.clevelandclinic.org/health/diseases/12361-sepsis 12- https://medlineplus.gov/sepsis.html 13- https://www.sepsis.org/sepsis-basics/what-is-sepsis/ 14- https://www.ncbi.nlm.nih.gov/books/NBK539873/ 15- https://lifelinepregnancyhelp.org/abortion-pill-ectopic/ 16- https://alcovehealth.org/abortion-pill-with-an-ectopic-pregnancy/ 17- https://www.medpagetoday.com/obgyn/abortion/102689 18- https://www.washingtontimes.com/news/2024/sep/5/three-quarters-of-women-seen-at-ersafter-taking-a/ 19- https://www.yalemedicine.org/news/medication-abortion-your-questions-answered