Expert: Doctor Early Options - 10/20/2008

Question
I made the very difficult decision to have a medical abortion at roughly 7 weeks after my husband left me. The pregnancy partially passed, but upon my follow up appointment it was determined through both a urine pregnancy test and an ultrasound that I was still pregnant. There was no  heartbeat. The clinic gave me a second set of mifeprosone and there was no result when I took this - no bleeding. I am deathly afraid to return to the clinic and have vacuum aspiration. I purposely chose medical abortion because the vacuum part scares me, I am afraid it will affect my ability to have a child in the future. I am considering going to my ob/gyn and asking if I am still pregnant or if he can perform a D&C.

Any help you can provide is really appreciated. I am frightened about the thought of infection, ectopic pregnancy, all of the unknown reasons why the termination did not complete.

Thank you.

Answer
Dear Sarah,
I'm sorry you are having this problem with the abortion pill.  It is hard enough to end a pregnancy, and then to have to go through these difficulties.  Unfortunately it is fairly common (95-99%), and it does not mean there is anything wrong with you, except some bad luck.  This will not affect your future ability to be pregnant.

You have a few options.
1) watch and wait.  If the pregnancy is not viable, it will eventually pass on its own.  There is no increased risk of infection with this.  The most common treatment of known early miscarriage is to let women pass it on their own without intervention.
2) Take more Misoprostol (not mifepristone).  You can repeat this up to 3 times, 24 hours apart.  
3) Get a manual aspiration procedure.  This is a simple gentle method that does not utilize scraping or a vacuum machine.  Unfortunately it is difficult to find doctors who do this - you can find doctors on earlyabortion.com and see if there is one near you.
4) Get the D&C.  The D&C is very safe.  You can ask them not to scrape or use the curette with it, to make it even safer.  If you do not use the curette, there is no risk for future pregnancies.

I hope this is helpful, and good luck
Doctor Joan
EarlyAbortionOptions.com
New York City