Analysis of Complications and Management After Self-Administration of Medical Termination of Pregnancy Pills

Abstract

Background Medical abortion up to seven weeks of pregnancy by using a combination of mifepristone and misoprostol with careful follow-up is approved by WHO guidelines. But due to the counter sale of medical termination of pregnancy (MTP) pills, in our country, pregnant women have easy access to use them landing upon serious complications. The present study aims to assess the outcome of self-medicated MTP pills in pregnant women. Method This prospective observational study includes pregnant women who presented to our hospital for medical assistance due to complications after using the counter of MTP pills without medical consultation. Findings of ultra-sonographic and physical examination were noted along with analysis of subsequent management. Results The major complaint at presentation was excessive bleeding (78%). Out of 100 patients, 66% of cases were diagnosed as incomplete abortion, 6% as missed abortion, and 6% as unaffected pregnancy. Ectopic pregnancy was detected in 12% of cases. Sixty patients of incomplete abortion were managed with suction and evacuation and six were supplemented with misoprostol. All patients with ectopic pregnancies were managed surgically. Conclusion The majority of the pregnant women who took MTP pills presented with serious complications in the form of bleeding, incomplete/missed abortion, and ectopic pregnancy. Restriction of the over-the-counter dispensation of abortion pills needs to be strictly implemented and knowledge of women regarding the unfavourable outcome of MTP pill intake without proper consultation needs to be improved.

Medical abortion in India – An imperative need for task sharing

“…More recently Rath et al . [ 30 ] in 2021, from Oddissa, reported similar spectrum of complications subsequent to unsupervised use of medical abortion drugs. Hence, this study observation remains relevant even in the current scenario.…”

Occurrence and Determinants of Psychological Distress among Women Undergoing Abortion/Medical Termination of Pregnancy

“…3 No estimate can be accurate on this specific number due to the high prevalence of over-the-counter MTP pills and their attendant complications. 4,5 Though the association between abortion and mental health disorders is not entirely new, the importance attached to this entity is not high. 6 In a broad scoping review analyzing many matters relating to miscarriage, Quenby et al estimate that there may be 44 pregnancy losses every minute and have highlighted the significant burden of the psychological consequences of early pregnancy loss.…”

Determinants of Unsupervised Medical Termination of Pregnancy Pill Usage Among Women: A Cross-Sectional Study From North India

“…While unsupervised intake offers women more autonomy and privacy, it also raises serious concerns about the procedure's safety and effectiveness. In such cases, the lack of medical supervision may result in life-threatening complications such as severe bleeding, infection, and sepsis caused by incomplete abortions, failed abortions, and ruptured ectopic pregnancies [ 3 , 4 ].…”

“…This crisis is especially acute in the context of India. Annually, approximately 6.4 million abortions are performed in the country, with 56% of them classified as unsafe, accounting for 8%-20% of all maternal fatalities [ 3 ]. As concerning as these figures are, they only scratch the surface of the issue.…”