André Seidenberg, Dr.med. LEGAL ABORTION BY MEDICATION Emergency call: +41 44 266 58 03 Abortion by medicaments is an outpatient treatment. You may stay at home or in our medical practice. Up to 7 weeks after the beginning of the last menstrual bleeding, abortion induced by the following two medicaments is the methode of choice: Mifegyn® (Mifepriston or RU486) blocks the pregnancy maintaining hormonal effect of the gestagens produced by the pregnant body. Mifegyn® interrupts the development of the fetus and loosens the connection to the uterus. Cytotec® (Misoprostol) is a prostaglandin which stimulates the contraction of the uterus and the extrusion of the fetus and the mucous tissue and blood.
The abortion by medicaments is more often not successful after the 9th week of the pregnancy. Officially and reimburseably by the health insurance, the method is allowed in Switzerland until the 49th day of the pregnancy. Up to 63 days, the success rate of the combined medication with Mifegyn® and Cytotec® reaches 95 to 98 %. Medical induced abortions of longer gestational age than 9 weeks were slightly less often successful and pain and cramps (due to Cytotec®) are increased. Above the 12th week of the pregnancy the medication method is markedly less effective and side effects are even more severe. Abortion by medication remains a method with small risks. More often and longer you need to stay in medical supervision. For the abortion of a pregnancy we use two different methods: With the careful and most thorough suction method the outpatient surgical operation can safely be performed usually before the end of the twelfth week of the pregnancy. Side effects: Usually both medicaments are well tolerated. Occasionally we observe cramps, nausea, vomiting and diarrhea caused by Cytotec®. We will give you the needed medicaments. Headache and allergic reactions are known as seldom side effects. Complications are rare and not to be expected. Heavy bleeding very rarely could force a surgical suction procedure. In less than 2-4% of the cases remaining products of the pregnancy must be removed by the surgical suction method. Most rarely the pregnancy continues although the medicaments have been taken regularly. In this case the fetus could be damaged by the medication and therefore we strongly recommend the surgical termination oft the pregnancy. There is no doubt of your fertility for you are pregnant. Your fertility is not impaired through an abortion. Contraindication: Obstacles for the medication procedure are severe and uncontrollable asthma, severe disturbances of the adrenal glands, severe cardiac or cardiovascular diseases, severe uncontrollable hyperte nsion, severe arrhythmias and allergic reaction against the prescribed medicaments. For heavy smokers older than 35 years the medication method is theoretically connected with elevated risks. But smoking is even more hazardous to your health during an ongoing pregnancy. Before start: Blood and urine samples are investigated e.g. to exclude inflammations and anemia and to confirm an actual pregnancy. Additional to an ordinary gynecological examination we look through a vaginal ultrasound to measure the fetal size and determine the location of the fetus and the duration of the pregnancy. We talk over risks, procedure and alternatives. You sign this informed consent sheet. For legal reasons, we need your formal request for an abortion and you have to declare to be in a state of distress. We will hand out a list of charge free advice bureaus. You take your time for your own personal decision. Start: If and as soon as your decision is clear, the procedure can begin. Now you take the Mifegyn® 200 mg tablet. This must be done in our office. Sometimes bleeding begins already before the second medication. Two days later (36 to 48 hours later) you take 2 or 4 tablets of the prostaglandine-analogue Cytotec®. Please insert all Cytotec® deeply into your vagina. Most women extrude within the next 3 to 4 hours a small sponge like fetal vesicle together with some blood. If this is not yet the case you need another 2 tablets of Cytotec®. This abortion can be accompanied with cramps. Even when bleeding starts later or the extrusion of the fetal vesicle is not recognized, most often the extrusion is finally completed during the following days. Cytotec® can cause unpleasant cramps. If wanted, you can stay in our rooms for the first hours. Whether you stay at home or with us, a sympathetic companion can be of help. Minimally we keep contact by phone. Control: Bleeding is not a sufficient proof for the completion of the extrusion. After three weeks we confirm the abortion by ultrasound. In doubtful cases we need to trace blood levels of the human chorionic gonadotropine hormone to prove the disappearance of the pregnancy. After all experiences we are prudently patient: A surgical suction is most seldom necessary.
It’s usually well possible to work already a day after the abortion. If you wish a certificate of inability to work for 2-3 days, please do not hesitate to ask us. Do not let in anything into your vagina the first three weeks after the treatment. The entrance of the uterus may still be open and it could cause an infection: Do not use Tampons, only sanitary towels are allowed. Do not take a full bath. No vaginal douche and no swimming, only outside washing or shower are allowed. Make love only without penetration. Perhaps you need time to feel a bodily desire for love. Further medication: Mefenamin® reliefs pain in your belly. A rubber bottle full of warm water will often do. Against nausea or vomiting
you received Motilium®. Please bring it with you in case you stay with us after taking Cytotec®.
Antibiotics: As a precaution you receive Flagyl® 1 g rectally and Azithromycine® (4 Tbs. of 250mg). Oral contraceptives should be started at the first three days after the Cytotec®.
A most clear decision is important for you. Once the treatment has been started the completion of the abortion is inevitable, for the medicaments could have damaged a continuously growing fetus. Do not let yourself be annoyed or be influenced by people who will not help you and who cannot take your responsibility. In case you decide to carry on with the pregnancy, please talk to us. We will hand out your medical report with our findings (ultrasound). We stay with you in any case.
An affectionate companion is oftentimes a help. During the consultation and examination she or he has to wait outside in the waiting room. One can eat light meals before taking Cytotec®. Please only take the medication we prescribed or explicitly admitted to use. The driving ability can be impaired.
Please bring, if available, your Blood-group Card with you. In case you have a Rhesus-negative blood-group, or that we do not have your Blood-group card with us, we shall inject the Rhesus-antibody for precautionary measures. The Rhesus-antibody injection costs CHF 140.- (≈ € 120.-) additionally.
Abortion, according to the federal insurance-court, is a performance of duty of medical insurance. We need a membership card of insurance. Otherwise we have to request payment of CHF 600.- (≈ € 480.-) on account. You will receive a bill after the treatment is completed. The biggest part of the whole amount will be reimbursed by the medical insurance; you should just send in a reimbursement voucher of our invoice.
The medical-profession secrecy obliges us to be totally discrete. Of course, without your explicit wish, we do not give any information further, not even to the nearest relatives.
We recommend an annual gynecological examination with a smear-test (Papanicolou). You have been informed about your options of birth control. If you want to have a hormonal birth control with a pill, you should start to take the first daily pill lately at the first three days after the second medicaments (Cytotec®). If you wish to insert an IUD (Mirena®) it can be done safely after one week or with the onset of the next menstrual bleeding. For safe protection against sexually transmittable diseases we recommend to use condoms (rubbers). In the case of bad luck and again undesired being pregnant do not hesitate to call. Do not be ashamed. Phone +41 44 266 58 00: Please call us from 8 a.m. to 1 p.m. and from 3 to 6 p.m. Saturdays we are on the phone from 9 to 11 a.m. In case of emergency please dial +41 44 266 58 03; we will recall if you leave a message. Another number for emergency calls is +41 44 421 21 00.
I am undesired pregnant and in a state of distress. Therefore I request for an abortion according to the law. My doctor informed and advised me extensively and personally about an abortion. We talked over risks, procedure and alternatives. I received a copy of this informed sheet and the 'Leitfaden der Gesundheitsdirektion des Kantons Zürich' which contains a list of charge free advisory boards. I agree with the scientific use of my anonymised data. I will have a gynecological control check after three weeks. Foreign courts would be excluded.
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