Contraindications and precautions in medical abortion

Contraindications to medical abortion in general practice include:

  • travel time to hospital emergency services is longer than 2 hours; a small percentage of users experience a haemorrhage or other severe complications in the 14 days following administration of mifepristone
  • confirmed or suspected ectopic pregnancy
  • intrauterine contraceptive device (IUD) currently in place; mifepristone and misoprostol cause strong uterine contractions, which can cause uterine injury if an IUD is in place. Other risk factors for uterine rupture (including previous caesarean section and other uterine surgery) are not contraindications to medical abortion
  • uncertainty about gestational age
  • suspected or known haemorrhagic disorders or treatment with anticoagulants
  • inherited porphyria; there is a theoretical risk of precipitating or exacerbating attacks of porphyria, but no data are available
  • hypersensitivity to mifepristone, misoprostol or any prostaglandin
  • long-term use of an oral corticosteroid (eg in chronic adrenal insufficiency, rheumatoid arthritis or difficult-to-control asthma). Mifepristone has antiglucocorticoid effects; its use in individuals taking regular oral corticosteroids is contraindicated without specialist advice. If medical abortion is considered (eg due to competing risks from surgical abortion), seek advice from a specialist regarding the safety of offering medical abortion and the potential need to change corticosteroid dosages.

Precautions for medical abortion in general practice include:

  • difficult-to-control asthma—even if not taking long-term oral corticosteroids, seek advice from a specialist or experienced provider of medical abortion about the safety of medical abortion
  • well-controlled asthma—if asthma is stable (and long-term oral corticosteroids are not being taken) ensure the individual has an asthma action plan and access to medical services. Long-term inhaled corticosteroid doses may need to be increased for 3 to 4 days after medical abortion because mifepristone has antiglucocorticoid effects
  • severe anaemia—seek advice from a specialist or experienced provider of medical abortion about the safety of medical abortion
  • epilepsy—seizures have been reported with misoprostol use, but none with medical abortion; caution may be required if there is a history of seizures induced by pain or vomiting
  • history of ischaemic heart disease or severe hepatic, kidney or respiratory disease—consult an experienced provider of medical abortion
  • diabetes requiring insulin—nausea and vomiting after taking mifepristone and misoprostol may affect poorly controlled diabetes; additional blood glucose monitoring and nausea prevention may be required.

Breastfeeding is not a contraindication to the use of mifepristone and misoprostol.