Abortifacients

Key Points

• Abortifacients promote uterine evacuation by inducing strong uterine contractions and trophoblast expulsion.
• Core agents in this section are mifepristone (used with misoprostol) and carboprost.
• Standard early medication-abortion pathway: mifepristone 200 mg PO (day 1), then misoprostol 800 mcg buccal (day 2 or 3) with at least a 24-hour interval.
• Mifepristone access is restricted through the Mifepristone REMS Program.
• Serious infection or hemorrhage can occur rarely; emergency-return teaching is mandatory.

Drug Class Overview

Abortifacients are medications used to evacuate the uterus through potent uterine contractions. Clinical uses include medication termination pathways and selected uterine-evacuation contexts after fetal demise, with protocol and gestational-age limits determined by institutional and legal frameworks.

These medications are high-risk in nursing practice because complications can escalate rapidly if bleeding, infection, or incomplete evacuation is not recognized early.

Core Agents and Typical Dosing

Drug	Typical Route/Dose	Primary Use
Carboprost (Hemabate)	Initial 250 mcg deep IM; may repeat 250 mcg every 1.5-3.5 hours based on uterine response	Uterine evacuation/contractile support in selected abortion or hemorrhage contexts
Mifepristone + misoprostol	Day 1: mifepristone 200 mg PO; Day 2 or 3: misoprostol 800 mcg buccal; minimum 24-hour interval	Medical termination of intrauterine pregnancy through early gestational windows

Contraindications and Cautions

Major contraindications for mifepristone pathways:

• Confirmed or suspected ectopic pregnancy
• Chronic adrenal failure
• Concurrent long-term corticosteroid therapy
• Hemorrhagic disorders or concurrent anticoagulant therapy
• Current IUD in place (remove before medication pathway)
• Hypersensitivity to mifepristone, misoprostol, or prostaglandins

Additional class cautions/contraindication contexts:

• Active pelvic inflammatory disease
• Acute cardiac, renal, hepatic, or pulmonary disease
• Lactation when safe alternative infant-feeding plan is not available
• History of asthma, hypertension, adrenal disease, vaginitis, or uterine scarring (enhanced caution and monitoring)

Adverse Effects

• Expected/commonly reported: abdominal cramping, heavy bleeding, headache, nausea, vomiting, diarrhea, backache, diaphoresis
• Serious: severe hemorrhage, serious infection/sepsis, uterine perforation, uterine rupture

FDA Black Box Warning - Mifepristone

Mifepristone can increase the risk of severe infection and fatal sepsis. Any delayed systemic illness after misoprostol requires immediate emergency assessment.

Nursing Assessment and Monitoring

Before administration:

• Confirm intrauterine pregnancy and gestational-age eligibility per protocol
• Complete medication/allergy history and contraindication screening
• Assess baseline hemodynamic status and bleeding risk
• Confirm informed-consent readiness and follow-up reliability

After administration:

• Monitor bleeding amount, pain trajectory, and vital signs
• Escalate for heavy bleeding, fever, syncope, severe persistent pain, or worsening systemic symptoms
• Coordinate follow-up confirmation of complete uterine evacuation

Mifepristone REMS Requirements

• Mifepristone is dispensed only through the restricted REMS program
• Client must sign a patient agreement form
• Medication is provided by or under certified prescribers and certified pharmacies

Patient Education

• Explain expected cramping and bleeding patterns versus emergency findings
• Instruct strict timing adherence for misoprostol after mifepristone
• Reinforce emergency return for fever, severe abdominal pain, prolonged heavy bleeding, syncope, or delayed malaise/nausea/vomiting/diarrhea more than 24 hours after misoprostol
• Advise against self-adjusting dose or schedule
• Review legal and institutional follow-up requirements in the care setting

Related Concepts

• induced-abortion-care - Nursing framework for medication and procedural abortion pathways
• misoprostol - Prostaglandin component of medication-abortion protocols
• uterotonics - Uterine contraction medications used in labor and postpartum contexts
• postpartum-hemorrhage - Overlapping uterine-contraction pharmacology and hemorrhage surveillance priorities
• therapeutic-communication - Nonjudgmental, patient-centered communication during reproductive decision-making

Self-Check

1. Which contraindications must be screened before a mifepristone-misoprostol regimen is started?
2. What teaching point about delayed systemic symptoms after misoprostol requires emergency-level escalation?
3. Why is REMS verification part of the nurse safety workflow for mifepristone?