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

Second Visit
  1. The patient will be examined to see if the embryo is still alive and if it has been expelled completely.
  2. If the embryo has not been expelled completely, a prostaglandin will most likely be given, usually two oral misoprostol tablets (brand name Cytotec) or misoprostol in a vaginal suppository.

    NOTE: The manufacturer of Cytotec (misoprostol) has warned doctors that it recommends this drug not be used for abortion. [View Manufacturer's Warnings]

  3. The provider may give a painkiller (or prescription for one) to help reduce the pain of uterine contractions misoprostol will cause.

  4. The FDA dropped a proposed requirement for prolonged, close observation after taking RU-486. However, in most countries where RU-486 is legally used (e.g., France, England, Sweden, and China) patients are kept under close medical supervision, generally for 4 - 6 hours after taking misoprostol.26 [More]

    One reason for mandatory observation in these countries is that allergic reactions to misoprostol "are not uncommon."27 [More]  
    Common allergic reactions to misoprostol are facial edema (swelling of the face), skin rash and itching, numbness of feet and hands, and allergic shock.29
    Another reason is that the drug can cause other medical emergencies (for example, hypotension leading to cardiac problems, hemorrhaging, etc.).28 [More]

  5. What happens next?
    Symptoms experienced after taking misoprostol
    • In addition to cramping from uterine contractions and bleeding,

    • "you may pass some blood clots. ... You may also have nausea, vomiting, diarrhea, fever or chills or feel tired. ... If you soak more than two maxipads an hour for two hours in a row, you should call your clinician."30

    • On average, women may continue to bleed or spot for 9 to 16 days. However, 9% of women in the U.S. trials bled for 30 days or more and 1% bled for over 60 days.31 A patient in the French trials continued to bleed for 69 days.32

26 In Sweden, women are "supervised by the midwife for 4 to 6 hours at the outpatient clinic" (M. Bygdeman et al., "Medical Termination of Early Pregnancy: The Swedish Experience," Journal of the American Medical Women's Assn., Supplement 2000, 55:3; 195, at 196.
  In France, the use of RU-486 is regulated by a 1990 directive jointly signed by the French Republic's Director General of Health, Director of Hospitals, and Director of Pharmacy and Medication, which states that whenever prostaglandins are given "in association with RU-486" the "following technical conditions ... are indispensable and are to be followed: ... b) The doctor must ensure that diagnostic instruments and machines are close by, such as electrocardiogram equipment and particularly resuscitative cardiopulmonary equipment (including nitrous oxide and injectable calcium antagonists and a defibrillator). ... c) [C]linical observations and blood-pressure readings every half hour are indispensable for several hours following the administration of these drugs. d) Whenever there is chest pain, an electrocardiogram should be taken on the suspicion of rhythm troubles and in case of significant lowering of blood pressure" (April 12, 1990 letter from the French Republic, Department of Solidarity, Health and Social Protection, "Amended Marketing Authorization for Mifegyne," April 13, 1990).
  In China "the emphasis on close medical supervision is well accepted. ... It is stressed that misoprostol should be taken in the clinic and followed by several hours of observation" (Wu, supra note 19, 197 and 199). The long observation is one reason staffs in some large hospitals in China are growing reluctant to prescribe the drug combination: "The number of medical abortions has decreased recently in some of the large hospitals. The staffs were too busy to handle the procedure (more counseling, more visits, and observation), and they also have to manage the referred cases with serious side effects and complications" (Id. at 199).
  In England, regulations concerning the use of RU-486 state: "The use of mifepristone must be followed, 36 to 48 hours later, by a prostaglandin analogue, [unless the abortion is already completed]. ... There is a risk of profound hypotension, related to the administration of prostaglandin, occurring during this period. Hence, the patient must be observed in the treatment centre for at least 6 hours or until any bleeding or pain have diminished to an acceptable level, whichever is the longer. It is imperative that suitably experienced medical personnel and resuscitation equipment are available during this period" (Mifegyne label, [United Kingdom]).

27 Wu, supra note 20, at 198: "The common complications of [RU-486] abortion are profuse bleeding and allergy. ... Allergic reactions to mifepristone and misoprostol were not uncommon, manifesting in facial edema [swelling of the face], skin rash and itching, numbness of feet and hands, and even a serious case of allergic shock. The potential for such reactions is one reason to keep clients for observation."

28 See note 26 supra.
   "In a large study in France, serious cardiovascular side effects following prostaglandin administration (sulprostone injection) were reported in 4 out of 16,000 women treated after sulprostone injection. (Ulmann et al., 1992). These included one acute myocardial infarction and three cases of severe hypertension. By now, over 60,000 women have used RU 486 for abortions. Two more myocardial infarctions have occurred, one of which was fatal. ... Roussel-Uclaf recommends that mifepristone plus any prostaglandin not be used in women who smoke over 10 cigarettes a day, who are older than 35, or who have any cardiovascular risks. ...
. . . . Although one patient death was reported during the first trial of mifepristone plus misoprostol (Aubeny and Baulieu, 1991), a much larger study has documented the safety of this protocol"
(Institute of Medicine, Clinical Applications of Mifepristone (RU 486) and Other Antiprogestins, 1993, at 27-28).

29 See note 27 supra.

30 National Abortion Federation, "Making Your Choice," available at http://www.earlyoptions.org.

31 I Spitz et al., supra note 2.

32 Mifeprex label, supra note 14.