An RU-486/misoprostol abortion usually takes between 2 days to two weeks, but can take three to four weeks. It requires at least three visits to the doctor.17

[First Visit]   [Second Visit]   [Third Visit]

First Visit

The first visit has four steps:
   1) learn about the procedure, side effects and risks
   2) sign patient agreement form
   3) pelvic exam
   4) take RU-486 pills
  1. Learn about the procedure, side effects and risks.
    Patients planning to take RU-486 must read an FDA- approved Mifepristone Medication Guide.

    The Guide explains the common symptoms, such as
    • severe cramps
    • nausea
    • vomiting
    • dizziness
    • diarrhea and
    • heavy bleeding

    It explains what to do "if you need emergency care to stop heavy and possibly dangerous bleeding."18 [More]

    It stresses the importance of returning to the abortion facility on Day 3 for misoprostol and on Day 14 to ensure the abortion is complete and there is no infection or excessive bleeding. [More]

  2. Sign a Patient Agreement.
    After reading this Guide and discussing it with the provider, patients are asked to sign a Patient Agreement form approved by the FDA,19 agreeing that they have been informed of all risks, side effects, emergency contact information and instructions, and promising to return for the second and third follow-up visits.

  3. Pelvic Exam.
    The provider will perform a physical exam to ensure that it has been no more than 49 days since the start of the last menstrual period, and that the embryo is growing in the womb, and NOT in the tubes that connect the ovaries and womb or elsewhere (an "ectopic" pregnancy). RU-486 will not abort an ectopic pregnancy.20  
    Note: The FDA does not require the provider to perform an ultrasound examination, even though this is the most accurate way to determine the embryo's gestational age and location. An ectopic pregnancy can result in the mother's death.21 [More]


  4. Take RU-486 pills.
    If there are no serious medical reasons why RU-486 should not be taken, the patient will then be given three tablets (200 mg each) of "Mifeprex" (RU-486) to take immediately.

    What happens next?
    About half of women begin to bleed the next day,22 but very few (3-6%) will have a completed abortion in the next 48 hours.23

    "[P]rolonged or heavy vaginal bleeding is not proof of a complete expulsion,"24 so patients must return to the doctor for an examination and prostaglandin about 48 hours after taking RU-486.
     
    Notice to women who smoke cigarettes:
    Patients in U.S. trials were informed that they should not smoke during the two days after taking RU-486 and on the day that they were given misoprostol.25




17 Kaiser Family Foundation, "Issue Update: Mifepristone: An Early Abortion Option," July 2001.

18 For example, the FDA advises those who have taken RU-486 to "contact your provider right away if you bleed enough to soak through two thick full-size sanitary pads per hour for two consecutive hours or you are concerned about heavy bleeding."

19 Danco Laboratories, LLC which distributes RU-486 in the U.S. has posted a sample Patient Agreement form on its website, http://www.earlyoptionpill.com.

20 O. Avrech et al., "Mifepristone (RU 486) alone or in combination with a prostaglandin analogue for termination of early pregnancy: a review," Fertil. Steril. 1991; 56:385-393.

21 S. Wu, "Medical Abortion in China," Journal of the American Medical Women's Assn. [JAMWA], Supplement 2000, 55:3, 197, 198-199; R. Hatcher et al., Contraceptive Technology, 17th rev. ed. New York: Ardent Media, Inc. 1998, at 649; F. Gary Cunningham et al., "Chapter 34: Ectopic Pregnancy," Williams Obstetrics, supra note 13, 885-886.
    Regarding the use of ultrasound in China, Dr. Wu writes:
"According to the SFPC [State Family Planning Commission]-recommended protocol, ultrasound scanning should be performed before administering mifepristone to confirm gestational age. It is not performed in all cases in practice, however, because there is not enough equipment, even in most of the large hospitals. ...
"Some recent adverse events resulting from ectopic pregnancies have led providers to pay more attention to ultrasound examination. ... One study found that 84% of providers in Beijing used ultrasound routinely, but only 57% in Hunan Province did."
Wu, at 197.


22 Kaiser Family Foundation, "Issue Update: Mifepristone: An Early Abortion Option," July 2001, at 2.

23 R. Glasow, The RU 486 Report, Aug. 1995, at 2; I. Spitz, et al., supra note 2.

24 Mifeprex label, supra note 14.

25 Medical Officer's Review, supra note 8, at 9.



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