‘ABORTION REVERSAL’ WARNING.
Three women sent to ER after complications
The first true test of so-called “abortion reversal” — a highly controversial practice that’s been used in Canada — has been abruptly halted after three women had to be rushed to hospital for severe haemorrhaging.
Doctors are warning women who start, but then stop a medical abortion may be risking serious blood loss.
Researchers had planned to enrol 40 women in the first double-blind, placebo-controlled, randomized trial of whether the effects of the “abortion pill” can be reversed. They stopped after 12 women over safety concerns.
The study comes as numerous American states introduce abortion “reversal” laws compelling doctors, on pain of civil or criminal penalties, to inform women that it may be possible to undo a medication-induced abortion once started, a claim that leading medical groups have argued is “patently false” and unsupported by science.
A medical (and not surgical) abortion involves taking two pills in sequence: mifepristone and misoprostol.
Taken first, mifepristone blocks the hormone progesterone, which normally prepares the lining of the uterus for pregnancy. Misoprostol, taken 24 to 48 hours later, causes the uterus to contract, expelling the pregnancy.
An abortion “reversal” protocol promoted by prolife groups involves giving women who have taken the first pill only, and not the second, high doses of progesterone to stop the process, the theory being that flooding the body with progesterone blunts the effects of mifepristone, making the woman less likely to lose the pregnancy.
However, in what is being described as the first study to attempt to rigorously test abortion “reversal,” researchers at the University of California, Davis Medical Center had to cut the trial short when three women developed such “brisk” and heavy bleeding they had to be rushed by ambulance to an emergency room.
One of the women had been given progesterone, the other two placebos.
“We halted enrolment after the third hemorrhage,” the team reports in the journal Obstetrics & Gynecology.
Given the trial was abruptly terminated after only a handful of women were enrolled, the researchers can’t say with any certainty how effective, or even safe, progesterone is in stopping a medical abortion.
“However, we can make a few global and important conclusions from this very small, randomized trial,” they wrote.
First, the women who received high-dose progesterone didn’t experience side effects that were noticeably different from women in the placebo group, although some did report more vomiting and tiredness.
However, women should be warned that taking mifepristone only, without taking the second pill, “could result in severe hemorrhage, even with progesterone treatment,” the researchers said.
One woman in the placebo group developed such heavy bleeding she needed a blood transfusion.
Until more research is done, abortion “reversal” using progesterone should be considered a purely experimental treatment “and should be offered only in institutional review board-approved clinical trials to ensure proper oversight,” they added.
“Laws should not mandate counselling or provision of any treatment that claims to reverse abortion when both its efficacy and safety are unclear,” lead author Dr. Mitchell Creinin, director of Family Planning at UC Davis Health said in a statement.
About 820,000 abortions occur each year in the U.S; almost 40 per cent are medical abortions.
While some women change their minds about ending their pregnancies, “the best estimate is that fewer than 0.005% of patients who use mifepristone chose to continue their pregnancy” by not taking the second pill, the researchers wrote.
Of the 12 women in the study, four of five women in the progesterone group, and two of five in the placebo arm, had continuing pregnancies. (The study enrolled women planning a surgical abortion who were willing to delay the procedure for two weeks. Women who had a continuing pregnancy had a surgical abortion as scheduled.)
“Medical abortion cannot be ‘reversed,’ which would imply putting the pregnancy back in the uterus,” Creinin and co-author Melissa J. Chen wrote in a related commentary published in the Journal Contraception.
“Unfortunately, in the absence of rigorous evaluations, some lawmakers are using case reports as medical gospel and passing laws stipulating mifepristone antagonization as fact,” they wrote.
Pro-life proponents claim more than 900 babies have been born after a successful medical abortion “reversal,” including babies in Canada.