A 28-year-old woman who took abortion pills at around 16 weeks of pregnancy arrived at a hospital with severe abdominal pain and haemodynamic instability. Doctors found that her uterus had ruptured. Despite an emergency hysterectomy and blood transfusion, she died from haemorrhagic shock.
In another case, a teenage student who had taken abortion pills reached the hospital after developing high-grade fever, foul-smelling vaginal discharge and altered sensorium. She was found to have septic shock following an incomplete abortion. Despite antibiotics, intensive care and resuscitation, she developed multi-organ failure and died.
These two unfortunate deaths are among the starkest findings of a study from gynaecologists from Gujarat that has highlighted the potentially fatal consequences of taking medical abortion pills without medical supervision.
The study, based on 76 women who presented with complications after self-administering abortion pills, found that more than seven in 10 had an incomplete abortion, while others developed shock, sepsis, ruptured ectopic pregnancy or uterine rupture.
The researchers of the findings, published in the Indian Journal of Medical Research, made it, however, clear that the study did not mean that abortion pills themselves are unsafe. Medical abortion is an established and generally safe method of terminating an early pregnancy when the correct medicines are used at the appropriate gestational age and women have access to medical advice and emergency care when required.
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What the study titled, ‘Adverse events following self-administered abortion pills: A retrospective observational study' exposes the danger of using the pills blindly — without confirming the pregnancy, determining how far it has progressed or identifying conditions such as ectopic pregnancy.
Authors Dr Anuja Sachapara, Dr Shruti A. Naria, Dr Isha Minjarola, Dr Sweta Shrivastava and Dr Tithi Patel from the Department of Obstetrics and Gynaecology, Sumandeep Vidyapeeth Deemed to be University, Vadodara, Gujarat, after reviewing hospital records of women who had taken abortion pills without a prescription and subsequently required medical care, found that more than 70% had incomplete abortion.
Lead author Dr Sachapara said, of the 76 women studied, 54 (71.1%) had an incomplete abortion, making it by far the most common complication. Ten women had incomplete abortions accompanied by shock, while eight developed sepsis.
Bleeding was the most common complaint, reported by 36 women, while 22 presented with abdominal pain.
Three women had ruptured ectopic pregnancies — a particularly dangerous complication in which the pregnancy develops outside the uterus and can rupture, causing potentially fatal internal bleeding. One woman suffered uterine rupture, she added.
The complications were serious enough to require major interventions. Dilatation and evacuation was performed in 42 women, while 12 received another dose of misoprostol. Ten required blood transfusions, and three underwent laparotomy with blood transfusion. One woman required a hysterectomy.
Five women, or 6.6% of the study group, needed intensive care, while nearly one in four stayed in hospital for more than three days, said the study.
One of the biggest concerns was the gestational age at which the women took the pills, noted the study, adding that nearly two-thirds — 46 of the 76 women — took them between seven and 12 weeks of pregnancy. More worrying, eight women consumed the pills between 13 and 20 weeks, well beyond the gestational limit specified for the regimen examined in the study.
Only 20 women had undergone an ultrasound before taking the medication, while another 22 had taken the pills merely because they had missed their periods, without objectively confirming the pregnancy.
Warning that medical abortion is not simply a matter of taking two medicines, Dr Shrivastava explained that before treatment, the gestational age and clinical circumstances need to be considered. An ectopic pregnancy, for instance, requires different treatment and can become life-threatening if diagnosis is delayed, she noted.
The study comes amid widespread availability of mifepristone and misoprostol, medicines that have made early medical abortion more accessible and less invasive than surgical procedures.
When used appropriately, these medicines can allow abortion to be managed outside a hospital in suitable cases. But self-managed abortion and unsupervised use are not necessarily the same thing, said the doctors.
The distinction is important, cautioned the authors, because portraying all self-managed medical abortion as dangerous could discourage women from accessing a safe and legal healthcare option. At the same time, treating abortion pills as ordinary over-the-counter medicines that can be taken without assessment can expose women to avoidable risks.
The two maternal deaths make the findings particularly serious. But researchers caution against interpreting the figure as evidence that 2.6% of women taking abortion pills are at risk of dying.
The study included only women who developed complications and reached a tertiary hospital. Thousands of women who may have taken abortion pills without complications would not have appeared in these hospital records, said the doctors.
Therefore, the study cannot establish how frequently complications occur among all women using abortion pills in the community, nor can it establish a causal relationship between self-medication and each individual complication.
The researchers pointed to the availability of abortion pills from pharmacies without a valid prescription as an important concern, despite existing legal provisions.
The study also found gaps in follow-up, as 45 women accepted some form of post-abortion contraception, and 31 did not, with reasons for refusal not consistently recorded.
The authors have called for stronger enforcement of pharmacy regulations, wider access to authorised abortion services and better public-health messaging about the risks of inappropriate pill use. “Self-management can be safe when women have accurate information, quality-assured medicines and access to appropriate healthcare if complications occur,” said the study.
