Medical Abortion and Ectopic Pregnancy: Essential Facts and Risks

First-trimester abortions can have several causes. It is also possible to differentiate them into types of abortions, according to the development of the embryo and/or its place of implantation. In addition, any pregnancy loss before the 20th week is considered a miscarriage.

Types of Miscarriage and Pregnancy Loss

Some of the possible types of miscarriages are the following:

• Biochemical pregnancy: this is when the pregnancy test is positive, but after a few days the amount of beta hCG begins to decrease.
• Anembryonic pregnancy: an embryonic sac is observed, but without an embryo inside.
• Molar pregnancy: it is not an anembryonic pregnancy.
• Ectopic pregnancy: if the embryo implants outside the uterus.

Medical Abortion and Abortion Pills

Medical abortion is when a pregnant person takes medication to end a pregnancy. It differs from a surgical abortion, in which tissue from the pregnancy is removed from the uterus during a surgical procedure. Another term for medical abortion is Plan C. Medication to terminate a pregnancy typically involves two drugs: mifepristone (Mifeprex, RU-486, “the abortion pill”) and misoprostol (Cytotec).

Mifepristone stops progesterone, a hormone needed to sustain pregnancy. Misoprostol tells the uterus to contract to empty its contents. Cervical dilation (opening) also happens at this time, allowing for the tissue to be expelled from the uterus. The drugs are taken 24 to 48 hours apart.

Timing and Eligibility

A medication abortion can be done up to 11 weeks from the first day of your last menstrual period, according to Planned Parenthood, though some insurers will cover the cost only up to seven weeks. The U.S. Food and Drug Administration (FDA) approves the use of abortion pills for up to 10 weeks. Many physicians will recommend medical abortion no later than 10 weeks in the outpatient setting; later it may be done in a supervised hospital setting so health practitioners can monitor the pregnant person’s status.

Effectiveness of Medical Abortion

According to Planned Parenthood, the effectiveness of a medical abortion varies depending on how far along the pregnancy is:

• 8 weeks pregnant or less: it is effective in 94–98 out of 100 people.
• 8–9 weeks pregnant: it is effective in 94–96 out of 100 people.
• 9–10 weeks pregnant: it is effective in about 91–93 out of 100 people. (If an extra dose of medicine is taken, as directed by a medical professional, it is effective in 99 out of 100 people).
• 10–11 weeks pregnant: it is effective in about 87 out of 100 people; with extra medication, it is effective in about 98 out of 100 people.

Understanding Ectopic Pregnancy

An ectopic pregnancy, as its name suggests, is a pregnancy that is out of place. While normal pregnancies grow in the uterus, an ectopic pregnancy is located outside of it, usually in a fallopian tube (which is where egg and sperm meet). In some rare cases, the fertilized egg can also attach itself to other parts of a woman’s body, namely, her belly, her ovary, her cervix (which is the opening of the uterus), or to a scar from a previous C-section. Even more rarely, a pregnancy can be both normal and ectopic, meaning that one embryo will be located in the uterus and another one outside of it. It’s called a “heterotopic” pregnancy and can be trickier to diagnose.

An ultrasound is essential to check whether a pregnancy is located in the uterus. Since ectopic pregnancies are usually nonviable and can become life-threatening if left untreated, it’s important to get medical care. Ectopic pregnancies represent 1 to 2% of all pregnancies, but certain factors can make a woman more at risk for having one.

Risk Factors

According to ACOG, about half of ectopic pregnancies don’t have a clear cause. However, the following factors can make a woman more likely to have an ectopic pregnancy:

Medical Conditions

• Anatomical abnormalities of the fallopian tubes: if the tubes are misshapen, the fertilized egg will have a harder time traveling through them to reach the uterus.
• Previous infections and PID: Sexually Transmitted Infections can cause inflammation and scarring in the reproductive tract.
• Endometriosis: a chronic disorder in which a similar type of cells to those lining the uterus grow in other organs such as the ovaries or the fallopian tubes.
• Tubal, abdominal, or pelvic surgeries: such as surgical treatment of a previous ectopic pregnancy or the removal of the appendix.

Medical History

• Smoking: a woman who smokes is 4 to 20 times more likely to have an ectopic pregnancy.
• IUD and tubal ligations: if a woman were to get pregnant while having an IUD inserted or after getting her tubes tied, then the pregnancy is more likely to be ectopic.
• History of ectopic pregnancies: a woman who had an ectopic pregnancy once is 17 times more at risk of having another.
• Fertility treatment: treatments such as IVF can increase not only the risk of a typical ectopic pregnancy but also the risk of heterotopic pregnancies.
• Multiple abortions: some studies have shown that having more than one abortion can also increase the risk of ectopic pregnancy in the future.

Several steps are usually necessary to get a proper diagnosis of an ectopic pregnancy. Even if you plan to have an abortion, we recommend that you get these evaluations. Skipping them could put your health at risk.