Medical abortion
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{{AbortionMethods}}
A '''medical abortion''' is a type of non-surgical [[abortion]] in which a [[approved drug|drug]] is used to induce the abortion.{{Fact|date=May 2008}}
==Medical procedure==
{{Refimprovesect|date=May 2008}}
*Initial appointment, which includes [[pregnancy test]] by blood and/or [[ultrasound]], [[informed consent]] form, and [[STD]] tests if necessary.
*An injection of [[methotrexate]] or a dose of [[mifepristone]] in tablet form.
*A [[prostaglandin]] analog--a dose of [[misoprostol]] in tablet form, or [[gemeprost]]. [http://www.netdoctor.co.uk/medicines/100001155.html], taken within 72 hours of the previous medication.
*A follow-up appointment to make sure the abortion was complete.
==Mechanism of action==
{{Refimprovesect|date=May 2008}}
Each medical abortion drug has a unique mechanism of action.
*Mifepristone binds to the [[progesterone]] receptor to block progesterone. Progesterone is necessary for pregnancy maintenance. Mifepristone also softens and dilates the [[cervix]], and causes [[decidua]]l necrosis (which leads to [[placenta]]l detachment). In addition, it increases prostaglandin release from the [[uterine]] lining, increases uterine contractions, and enhances uterine sensitivity to prostaglandin.
*Methotrexate blocks an [[enzyme]] necessary for [[DNA]] synthesis, thus inhibiting the growth of rapidly dividing placental [[trophoblast]]ic cells.
Both mifespristone and methotrexate are followed up with a prostaglandin drug in medically approved medical abortion regimens--misoprostol or gemeprost.
*Misoprostol works by softening and dilating the cervix, and binding to myometrial cells to cause strong uterine contractions. Contractions cause expulsion of the embryo.
Misoprostol has been used alone for abortion since the 1970s. Alone, it has a higher rate of incomplete abortion than when combined with mifepristone or methotrexate. There have been reports of infections, such as [[toxic shock syndrome]], following medical abortions,{{Fact|date=May 2008}} but the risk of such infection is relatively rare.
==Availability==
In the US, medical abortion is available at women’s health care centers, private clinics, and Planned Parenthood . The price ranges from about $350 to $610, depending on which medical tests are required.
In Canada, availability is much the same, however in some provinces the procedure is fully covered by the provincial health care plan. Prices in areas where abortion is not covered by provincial health care usually range from $250 to $400.
==History==
{{Refimprovesect|date=May 2008}}
Mifepristone was first licensed in France in 1988. It is now approved in 29 countries, including Austria, Belgium, China, Denmark, Finland, Great Britain, Israel, Norway, Russia, South Africa, Sweden, and Taiwan. In 1993 President Clinton signed an executive order to encourage testing, licensing, and manufacturing of mifepristone in the United States. In 2000 the US Food and Drug Administration (FDA) approved the use of mifepristone for medical abortion in the United States.
It is currently possible to get mifepristone (the most common drug used in combination with a synthetic prostaglandin for medical abortion{{Fact|date=May 2008}}) in 60 clinics/centers in the United States.
Clinical trials of RU486 are currently being done in Canada in the cities of Edmonton, Winnipeg, Ottawa, Toronto, Montreal, Halifax and St. John's Newfoundland. The drug cannot be imported for personal use. However, medical abortions using Methotrexate and Misoprostol are available in Canada.
==See also==
* [[Abortifacient]] - a substance which induces abortion
==References==
<references />
*[http://www.who.int/bookorders/anglais/detart1.jsp?sesslan=1/&codlan=1&codcol=10&codcch=871 Medical Methods for Termination of Pregnancy] Report of a WHO Scientific Group Technical Report Series, No 871
*[http://www.who.int/reproductive-health/publications/medical_abortion/faq.pdf WHO FAQ on Medical Abortion]
*[http://www.cochrane.org/reviews/en/ab002855.html Medical methods for first trimester abortion] Cochrane Review on Methods Available for First Trimester Abortions
* {{cite web | title=Medication Abortion | url=http://www.ppgg.org/site/c.esJMKZPKJtH/b.1174369/k.F03A/Medication_Abortion.htm | publisher=Planned parenthood | accessdate=2006-11-23}}
* {{cite journal
|url=http://geopubs.wr.usgs.gov/open-file/of02-074/Resource_Geology/Resource_Geology.pdf
|last=Czamanske
|first=Gerald K. ''et al.''
|title=Estimating the efficacy of medical abortion | journal = Contraception | issue = 3 |author=Trussell J, Ellertson C | volume = 60 |pages=119–35 |year=1999 | month = Sep | pmid = 10640155 | doi = 10.1016/S0010-7824(99)00078-5}}
* {{cite journal
|url=http://geopubs.wr.usgs.gov/open-file/of02-074/Resource_Geology/Resource_Geology.pdf
|last=Czamanske
|first=Gerald K. ''et al.''
|title=Medical versus surgical abortion | journal = Int J Gynaecol Obstet | issue = |author=Cabezas E | volume = 63 Suppl 1 |pages=S141–6 |year=1998 | month = Dec | pmid = 10075224| doi = 10.1016/S0010-7824(99)00078-5}}
* {{cite web | title=Medical abortion | url=http://www.montrealmorgentaler.ca/index.php?page=medical&lang=_en | year=2005 | publisher=Montreal Morgentaler Clinic | accessdate=2006-11-23}}
*[http://acogjnl.highwire.org/cgi/content/abstract/89/5/790 Medical abortion in early pregnancy: a review of the evidence]
*[http://www.medicalabortionconsortium.org/articles/for-women/ Medical abortion information for women]
*[http://www.womenonweb.org/ Women on Web] Online medical abortion service - for women in countries where access to safe abortion is restricted
{{Birth control methods}}
[[Category:Methods of abortion]]
[[nl:Abortuspil]]
[[pt:Aborto médico]]
[[ru:Медикаментозный аборт]]