International Journal of Reproduction, Contraception, Obstetrics and Gynecology

Munshi KS et al. Int J Reprod Contracept Obstet Gynecol. 2018 Jan;7(1):205-209

www.ijrcog.org pISSN 2320-1770 | eISSN 2320-1789

DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20175846
Original Research Article

Self-medication of abortion pills and its complications: an

observational study
Kavina S. Munshi, Rajal V. Thaker*, Jagruti M. Shah, Bhavna N. Mewada

Department of Obstetrics and Gynecology, Smt NHL Municipal Medical College, SCL Hospital, Ahmedabad, India

Received: 26 October 2017

Accepted: 25 November 2017

*Correspondence:
Dr. Rajal V. Thaker,
E-mail: drrajalthaker@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: Medical termination of pregnancy has been legalized in India since 1971. Medical abortion pill is well
effective in early weeks of pregnancy. It is safe only when it is used under medical supervision. This study was
carried out to analyse the complications following self-medication of abortion pills and to suggest measures to prevent
such practice.
Methods: This was a retrospective observational study conducted at our hospital from March 2017 to July 2017.
Results: In present study 30 (75%) patients were in age group of 20-30 years. Illiterate patients were 22 (55%). Half
of the patients, 20 (50%) were having three or more than three children. Majority of women 30 (75%) had consumed
the abortion pills 1-10 days before coming to the hospital and 14 (35%) of patients had come with complain of
excessive bleeding per vagina. Incomplete abortion was present in 32 (80%) of patients. Instrumental evacuation was
required in 28 (87.5%) patients. Laparotomy for ruptured ectopic and rupture uterus was performed in 1 (2.5%) of
each patient. 6 (15%) patients were severely anaemic. Transfusion of blood was required in 9 (22.5%) of patients.
Conclusions: Medical abortion is effective and safe when carried out under medical supervision. Unsupervised use of
medical abortion pills was associated with many complications like incomplete abortion, rupture ectopic and ruptured
uterus. So, over the counter sale of medical abortion pill should be restricted.

Keywords: Abortion pills, Medical abortion, Self-medication

INTRODUCTION Services for the medical termination of intrauterine

pregnancy (MTP) for up to 63 days gestation.2 Federation
Medical abortion is a safe method of termination of of Obstetrics and Gynecological Societies of India
pregnancy when performed as per guidelines with (FOGSI) recommends close monitoring of distribution of
success rate of 95 to 99%.1 Commonly used drugs for drugs that are used for medical abortion and that the
medical methods of abortion are a combination of medical profession and pharmaceutical industry should
mifepristone and misoprostol. Drug Controller General of exercise due diligence in the promotion and usage of
India approved the use of Mifepristone (in April 2002) drugs that are used for medical abortion.3 As per the MTP
and Misoprostol (in December 2006) for termination of law of India, abortion pills can only be prescribed by
pregnancy up to 49 days gestation period. In December registered medical practitioner.4 But self-administration
2008, Mifepristone + Misoprostol (1 tab of mifepristone of abortion pills is rampant throughout the country due to
200mg and 4 tab of misoprostol 200 mcg each) over the counter availability of these drugs and
Combipack was approved by the Central Drugs Standard complications are not uncommon due to this practice.
Control Organization, Directorate General of Health The society perceives unsupervised medical abortion as a

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 Munshi KS et al. Int J Reprod Contracept Obstet Gynecol. 2018 Jan;7(1):205-209

very safe method of termination and women use this as a History of previous one or more caesarean delivery was
method of spacing. Hence, this study was carried out to present in 10 (25%) of patients. All patients were
analyse the complications following self-medication of married.
abortion pills and to suggest measures to prevent such
practice. As shown in Table 2, as per history received from
patients, 25 (62.5%) had consumed the tablets upto 9
METHODS weeks of pregnancy, 13 (32.5%) had consumed between
9-12 weeks and 2 (5%) had consumed beyond 12 weeks
This was a retrospective observational study conducted at of gestation.
our hospital from March 2017 to July 2017 after due
permission from authority. Data was collected from 40 Table 2: Gestation weeks (N=40).
patients who had come after self-medication (purchased
the drug by self or by family members without medical Gestation weeks No. %
guidance or supervision) for medical method of Up to 9 weeks 25 62.5
termination of pregnancy. After taking detailed history 9-12 weeks 13 32.5
and clinical examination, all patients were admitted and >12 weeks 02 05
treated after routine investigations and sonography. Data
was collected from all patients regarding their age, As shown in Table 3, majority of women, 30 (75%) had
marital status, education, obstetric history, duration of consumed the abortion pills 1-10 days before coming to
intake of abortion pills and visit to hospital, chief the hospital. There were 8 (20%) of patients who had
complain and sign-symptoms on arrival at hospital, consumed abortion pills before three weeks or more.
investigations and ultrasonography at time of admission,
treatment given, management of complications, need for Table 3: Duration of consumption of abortion pills
blood/blood product transfusion and duration of hospital before admission to hospital (N = 40).
stay. Analysis of data was done with help of appropriate
statistical tool. No. of days since consumption
No. %
of pills to hospital visit
RESULTS 1-10 days 30 75%
11-20 days 2 5%
Despite MTP law, patient/her relative had procured the 21-30 days 4 10%
MTP pills without prescription and had consumed >1 month 4 10%
without medical supervision and appropriate protocol.
Total of 40 patients were studied. Data obtained was as As shown in Table 4, 14 (35%) of patients had come with
follows. complain of excessive bleeding per vagina and 13
(32.5%) of patients had complain of bleeding per vagina
Table 1: Demographic data (N = 40). associated with abdominal pain. Irregular bleeding per
vaginum was present in 10 (25%). Giddiness and fainting
Age (years) No. % was chief complain in 2 (5%) of patients and in 1 (2.5%)
<19 3 7.5 of patients, product of conception was not expelled.
20-25 13 32.5
26-30 17 42.5 Table 4: Complaints on arrival at hospital (N = 40).
31-35 7 17.5
Education Complaints on arrival No. %
Nil 22 55 Excessive bleeding per vagina 14 35
Primary 9 22.5 Bleeding with abdominal pain 13 32.5
Secondary 4 10 Irregular bleeding per Vagina 10 25
Higher secondary 3 7.5 Giddiness and fainting 02 5
College 2 5 Product of conception not expelled 01 2.5
No. of children
1 4 10 As shown in Table 5, diagnosis of incomplete abortion
2 16 40 was made in 32 (80%) of patients. After per vaginal
3 or more 20 50 insertion of tablet Misoprostol, complete abortion
occurred in 4 (12.5%). Instrumental evacuation was
As shown in Table 1, majority of patients 17 (42.5%) required in 28 (87.5%) patients. Complete abortion had
were in age group of 26-30 years. In the age group of 20- occurred in 5 (12.5%) of patients, who were given
30 years, there were 30 (75%) patients. Uneducated antibiotics and analgesics. In 1 (2.5%) patient, there was
patients were 22 (55%), whereas primary education was live intra uterine pregnancy and as patient was willing for
present in 9 (22.5%) patients. Half of the patients, 20 its termination, dilatation and evacuation was performed
(50%) were having three or more than three children. after intravaginal insertion of tablet misoprostol.

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 Munshi KS et al. Int J Reprod Contracept Obstet Gynecol. 2018 Jan;7(1):205-209

Laparotomy for ruptured ectopic pregnancy was Counselling, careful history taking, and clinical
performed in 1 (2.5%) patient and salpingectomy was examination is must. Pregnancy confirmation for its
done. A patient who had history of previous two gestational age and location is also very important and
caesarean section came in shock due to rupture uterus for where available, urine test for pregnancy and an USG
which hysterectomy was performed. In the present study, examination for confirmation of intra uterine pregnancy
6 (15%) patients were severally anaemic and 16 (40%) along with the exact gestational age should be done in all
were having moderate anaemia. Transfusion of blood was cases. Laboratory tests such as hemoglobin level, blood
required in 9 (22.5%) of patients. group and rhesus (Rh) typing, and screening for hepatitis,
human immunodeficiency virus (HIV), and sexually
Table 5: Diagnosis and management (N=40). transmissible Infections (STIs), may be offered on the
basis of individual risk factors or available resources.
Diagnosis No. % Management Patient selection is very important and contraindications
After intravaginal for use of medical abortion must be ruled out. After
insertion of tablet taking formal consent, the recommended protocol is oral
Misoprostol 200 mg of Mifepristone on first day. After 36-48 hours
Incomplete abortion 32 80
4 - complete abortion 800 micrograms of vaginal Misoprostol or 400
28-instrumental micrograms of oral Misoprostol is given. The tablets are
evacuation to be taken under medical supervision. The patient is
Complete abortion 05 12.5 Antibiotics asked to report immediately if excessive bleeding, pain,
Tab Misoprostol fainting or any problem occurs. Average blood loss in
Live intrauterine followed by medical abortion may be more than that in surgical
01 2.5 abortion.
pregnancy instrumental
evacuation
Rupture ectopic On third visit at 15th day, clinical history and pelvic
01 2.5 Laparotomy examination should be done to ensure that there are no
pregnancy
Rupture uterus 01 2.5 Hysterectomy complications and abortion is complete. USG is required
if history and examination do not confirm expulsion of
DISCUSSION products of conception. If woman is still having irregular
bleeding, surgical curettage may be required.
In India MTP Act was passed in 1971 to prevent unsafe
and illegal abortion with the aim of reducing the number Majority of patients, 25 (62.5%) had consumed the
of maternal morbidity and mortality due to unsafe tablets up to 9 weeks of pregnancy which is prescribed
abortion.4 Any procedure which is performed outside the limit as per recommendation. But 13 (32.5%) had
bounds of law tends to be unsafe. Due to easy availability consumed between 9-12 weeks and 2 (5%) had consumed
of MTP pills over the counter, 40 patients came to our beyond 12 weeks of gestation. Patient needs to be
hospital with self-medication of MTP pills in spite of counselled about the fact that this method is possible for
clear guidelines that these pills have to be taken only intrauterine pregnancies of less than 9 weeks. It does not
under medical supervision and can be prescribed only by terminate ectopic pregnancy.2 In a study by Sarojini et al,
a person authorized under the MTP Act. 64.4% of patients had consumed the pills beyond the
recommended period of gestation.5
Three patients (7.5%) were less than 19 years of age who
already had one child and had not used any method of In 14 (35%) of patients’ chief complain on admission was
contraception for spacing. So, these patients took this pill excessive bleeding per vagina and 13 (32.5%) of patients
to get rid of unwanted pregnancy. In a study by Sarojini had complain of bleeding per vagina associated with
et al 3.8% patients were less than 19 years of age.5 In abdominal pain. In a study by Sarojini et al, 69.3%
present study, majority of patients were in age group of patients reported with bleeding per vaginum and 11.5%
26-30 years which is comparable to the study by Sarojini had reported with pain in abdomen.5 In the present study,
et al where majority of women, 37.5% were in same age irregular bleeding per vaginum was present in 10 (25%)
group. In present study, 50% of patients were and giddiness with fainting was chief complain in 2(5%)
multigravida. In a study by Sarojini et al, majority of of patients. In a study by Sarojini et al, 2.9% of patients
patients were multigravida.5 were admitted with shock.

As per the guidelines for medical abortion in India, Diagnosis of incomplete abortion was made in 32 (80%)
medical abortion is offered only to those patients, who of patients. Out of these, instrumental evacuation was
are ready for minimum three follow-up visits, can required in 28 (87.5%) patients. In a study by Sarojini et
understand the instructions, ready for surgical procedure al, instrumental evacuation was required in 90.4%. When
if failure or excessive bleeding occurs, good family drug is given under medical supervision, 1-2% women
support and easy access to appropriate healthcare may need surgical evacuation for heavy bleeding and 2-
facility.6 3% may need surgical evacuation due to incomplete
abortion.5,2

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 Munshi KS et al. Int J Reprod Contracept Obstet Gynecol. 2018 Jan;7(1):205-209

In 1 (2.5%) patient, there was live intra uterine pregnancy show the vital role-played by self-sourced medical
and as patient was willing for its termination, dilatation abortion in providing an option with high
and evacuation was performed after intravaginal insertion effectiveness rates and few reported adverse
of tablet misoprostol. In a study by Sarojini et al, live outcomes. These findings suggest that self-sourced
intrauterine gestation was present in 1.9% of patients. As medical abortion using online telemedicine "can be
per guidelines, 1% may fail to abort. In such a case since highly effective"
there is a possibility of congenital malformation in the
fetus a surgical MTP by suction evacuation is Present study highlights complications following self-
advisable.2,5 medication of abortion pills that were taken without
proper screening, monitoring and protocol. In present
Laparotomy for ruptured ectopic pregnancy was study, illiterate patients were 55% and only 5% of patient
performed in 1(2.5%) patient and salpingectomy was had studied up to college level. Level of education has
done. In a study by Sarojini et al, ruptured ectopic great impact on women’s health for health seeking
pregnancy was present in 1.9%.5 behavior. Intense awareness generation through a mass
media approach, stressing on female literacy, improving
One patient who had history of previous two cesarean the overall socioeconomic conditions, along with
section came in shock due to rupture uterus for which counseling on the benefits of timely and appropriate
hysterectomy was performed. This patient had consumed healthcare-seeking behaviors, both in preventive and
the pills in second trimester. The chance of scar rupture curative aspects, may lead to the desired health outcomes
in post caesarean pregnancy following first trimester and favorable health indicators.10
medical abortion is non-existent but the risk of rupture is
0.28% in II trimester abortions.7 In a study by Sarojini et Health education and awareness regarding life-
al, rupture uterus was present in 1.9% of patients.5 threatening consequences after self-medication of
abortion pills can help to prevent maternal morbidity and
In the present study, 6 (15%) patients were severely mortality.
anaemic and 16 (40%) were having moderate anaemia.
Transfusion of blood was required in 9 (22.5%) of CONCLUSION
patients. More than two units of blood were required in 4
patients where as in 5 patients, two units of blood were Medical abortion is effective and safe when carried out
given. In a study by Sarojini et al, blood transfusions under medical supervision. Unsupervised use of medical
were required in 75% of patients, out of these, 52% were abortion pills was associated with many complications
given one unit and 23% were given more than one unit.5 like higher chances of incomplete abortion, hemorrhage,
Complications like excessive bleeding per vaginum, ectopic pregnancy and rupture uterus necessitating blood
rupture ectopic and rupture uterus can be life threatening transfusion. So, over the counter sale of medical abortion
in already anaemic patient. When drugs are given under pill should be restricted. Health education and awareness
medical suoervision, only 1-2 per thousand may need regarding life-threatening consequences after self-
blood transfusion due to heavy bleeding.2 In a study by medication of abortion pills can help to prevent maternal
Deshpande et al, no woman required blood transfusion morbidity and mortality.
when drugs were given under medical supervision.8
Funding: No funding sources
Findings from a population-based study of using online Conflict of interest: None declared
telemedicine suggest that Ethical approval: The study was approved by the
Institutional Ethics Committee
• Women’s self-reports of outcomes and complications
of medical abortion and provides the best evidence to REFERENCES
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Comparative study of medical abortion by

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