More About Medical Abortion

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And to be clear, most people are self-managing early in pregnancy safely, effectively, privately, we never hear about it, but if things have progressed to to a later stage in pregnancy, and the attempt to self-manage an abortion, and there’s a medical complication, well, then they end up maybe having to seek emergency medical care, and then.

Some women prefer the use of medicines to terminate a pregnancy because:

• It may be used in early pregnancy.
• It may be used at home.
• It feels more natural, like a miscarriage.
• It is less invasive than an in-clinic abortion.

Medicines can be used to end an early pregnancy. In many cases, the first day of your last period has to be less than 9 weeks ago. If you are over 9 weeks pregnant, you can have an in-clinic abortion. Some clinics will go beyond 9 weeks for a medicine abortion.

Be very certain that you want to end your pregnancy. It is not safe to stop the medicines once you have started taking them. Doing so creates a very high risk for severe birth defects.

Who Should Not Have a Medical Abortion

You should NOT have a medicine abortion if you:

• Are over 9 weeks pregnant (time since the start of your last period).
• Have a blood clotting disorder or adrenal failure.
• Have an IUD. It must be removed first.
• Are allergic to the medicines that are used to end pregnancy.
• Take any medicines that should not be used with a medical abortion.
• Do not have access to a doctor or an emergency room.

Getting Ready for a Medical Abortion

The health care provider will:

• Do a physical exam and ultrasound
• Go over your medical history
• Do blood and urine tests
• Explain how the abortion medicines work
• Have you sign forms

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What Happens During a Medical Abortion

You may take the following medicines for the abortion:

• Mifepristone - this is called the abortion pill or RU-486
• Misoprostol
• You will also take antibiotics to prevent infection

You will take mifepristone in the provider's office or clinic. This stops the hormone progesterone from working. The lining of the uterus breaks down so the pregnancy cannot continue.

The provider will tell you when and how to take the misoprostol. It will be about 6 to 72 hours after taking mifepristone. Misoprostol causes the uterus to contract and empty.

After taking the second medicine, you will feel a lot of pain and cramping. You will have heavy bleeding and see blood clots and tissue come out of your vagina. This most often takes 3 to 5 hours. The amount will be more than you have with your period. This means the medicines are working.

You may also have nausea, and you may vomit, have a fever, chills, diarrhea, and a headache.

You can take pain relievers such as ibuprofen (Motrin, Advil) or acetaminophen (Tylenol) to help with the pain. Microsoft office for os x. Do not take aspirin. Expect to have light bleeding for up to 4 weeks after a medical abortion. You will need to have pads to wear. Plan to take it easy for a few weeks.

You should avoid vaginal intercourse for about a week after a medical abortion. You can get pregnant soon after an abortion, so talk with your health care provider about what birth control to use. Make sure you are using an effective contraception before you resume sexual activity. You should get your regular period in about 4 to 8 weeks.

Follow up with Your Health Care Provider

Make a follow-up appointment with your provider. You need to be checked to make sure the abortion was complete and that you are not having any problems. In case it did not work, you will need to have an in-clinic abortion.

Risks to Ending Pregnancy with Medicine

Most women have a medical abortion safely. There are a few risks, but most can be treated easily:

• An incomplete abortion is when part of the pregnancy does not come out. You will need to have an in-clinic abortion to complete the abortion.
• Heavy bleeding
• Infection
• Blood clots in your uterus

Medical abortions are typically very safe. In most cases, it does not affect your ability to have children unless you have a serious complication.

When to Call the Doctor

Serious problems must be treated right away for your safety. Call your provider if you have:

• Heavy bleeding - you are soaking through 2 pads every hour for 2 hours
• Blood clots for 2 hours or more, or if the clots are larger than a lemon
• Signs that you are still pregnant

You should also call your doctor if you have signs of infection:

• Bad pain in your stomach or back
• A fever over 100.4°F (38°C) or any fever for 24 hours
• Vomiting or diarrhea for more than 24 hours after taking the pills
• Bad smelling vaginal discharge

Lesnewski R, Prine L. Pregnancy termination: medication abortion. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 114.

Nelson-Piercy C, Mullins EWS, Regan L. Women's health. In: Kumar P, Clark M, eds. Kumar and Clarke's Clinical Medicine. 9th ed. Philadelphia, PA: Elsevier; 2017:chap 29.

Oppegaard KS, Qvigstad E, Fiala C, Heikinheimo O, Benson L, Gemzell-Danielsson K. Clinical follow-up compared with self-assessment of outcome after medical abortion: a multicentre, non-inferiority, randomised, controlled trial. Lancet. 2015;385(9969):698-704. PMID: 25468164 www.ncbi.nlm.nih.gov/pubmed/25468164.

Rivlin K, Westhoff C. Family planning. In: Lobo RA, Gershenson DM, Lentz GM, Valea FA, eds. Comprehensive Gynecology. 7th ed. Philadelphia, PA: Elsevier; 2017:chap 13.

Updated by: John D. Jacobson, MD, Professor of Obstetrics and Gynecology, Loma Linda University School of Medicine, Loma Linda Center for Fertility, Loma Linda, CA. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

If a painful lump has developed on the side of your foot that just won't budge, you might have a bunion. More than 15 million people in the UK suffer with bunions and they are a common foot problem. Painful bunions can interfere with walking and exercising.

To put your toes at ease, Consultant Orthopaedic Surgeon Dr Andrea Bianchi and Orthopaedic Surgeon David Gordon, reveal bunion common causes, symptoms and the best bunion treatment options, ranging from shoe stretchers to keyhole surgery:

What are bunions?

Bunions are bony bumps that are usually prominent on the inside of the foot by the big toe joint. 'A bunion, medically known as hallux valgus, is a deformity of the foot that forms around the base of the big toe,' says Dr Bianchi.

They develop due to repeated pressure on the big toe joint. Eventually, the structure of the bone changes, resulting in a bunion. 'Bunions are very easy to spot,' says Dr Bianchi. 'You’ll know that you are suffering from them when you see a bulging lump on the side of your foot and your big toe leans against your second toe.'

Bunions causes

The three main causes of bunions are genetics, pregnancy and footwear, though certain conditions – like arthritis – are also associated with them. If members of your family suffer from bunions, you have a much higher chance of developing them, says Dr Bianchi.

While anyone can get a bunion, they are more common in women. Women may develop bunions during pregnancy due to changes in hormones, which effectively loosen the ligaments and flatten the feet. Women are also more likely to wear tight, narrow shoes that force the toes together.

'Tight-fitting shoes can cause bunions, as they put more pressure on the toes,' Dr Bianchi adds. 'If you are genetically predisposed to bunions, wearing shoes like this can cause bunions to form at a much more rapid rate. High heels do not cause bunions, but they can exacerbate the problem, as they force your body weight to the front of your foot.'

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Bunion symptoms

At first, the bunion bump will be painless. However, over time it can cause the toes to crowd closer together, which can bring about further issues, such as:

• Your big toe turning towards your second toe
• Pain and tenderness on the side of your big toe
• Redness, swelling and inflammation on the side of your big toe
• Hardened, thick skin on the bottom of the foot
• A callus or corn on the big toe or second toe
• Stiffness and restricted motion in the big toe

For many patients, the pain can be particularly bad after wearing tight-fitting shoes such as high heels, says Dr Bianchi. 'For lots of people, suffering from bunions means that they can no longer wear the fashionable they want to,' he explains. 'Some people suffering from arthritis may also experience restricted movement of their big toe.'

When to see a doctor about bunions

Many people with bunions don't experience any problems at all. 'Bunions often don’t require any kind of medical treatment,' says Dr Bianchi, 'but if the pain is having an impact on your quality of your life, then treatment might be the right option for you.'

If your experience any of the following, book a consultation with a specialist:

• Continuous pain that is stopping you doing normal activities.
• Decreased movement of your big toe.
• Difficulty finding shoes that fit properly.
• Worsening symptoms.
• Pain has not improved after trying home treatments for a few weeks.
• You have diabetes (foot problems can be more serious if you have diabetes).

Bunions treatment options

While you can't prevent bunions completely, there are a few things you can do to minimise the discomfort they cause and avoid aggravating them further. In most cases, bunion symptoms can be relieved with simple treatments to relieve pressure on the big toe, such as the following:

• Change your footwear

Wearing wide shoes with padded soles can help alleviate the pain associated with bunions. Opt for a soft, wide shoe without a heel, says Gordon, making sure they don't compress the toes. Avoid high heels and tight shoes.

• Try shoe stretchers

Some shoes can be modified and reshaped using a shoe stretcher. This stretches out the areas that put pressure on your toes and increases the width to accommodate the bunion, says Gordon. Buying over-the-counter arch supports to wear in your shoes may also be helpful.

• Take painkillers

Taking over-the-counter pain relievers paracetamol can help you manage the pain of bunions. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can also alleviate swelling. However, speak to your doctor before taking any painkillers on a longer-term basis (more than 10 days).

• Apply ice or heat

When the bunion is irritated and painful, try applying heat – for example, soaking in a warm bath or applying a hot water bottle – or ice packs to the area for 20 minutes, several times a day.

• Use bunion correctors

This includes bunion splints, bunion sleeves, bunion pads, and toe spacers. While they won't cure bunions, they can help ease some of the discomfort and pain associated with them.

• Cortisone injections

Steriod injections can relieve pain temporarily by reducing inflammation at the site of the bunion, but they can cause tissue damage when used often and at high doses.

Bunion correctors

The easiest way to ease the pain caused by bunions is by using bunion correctors. These include bunion sleeves, bunion splints, bunion pads, and toe spacers:

➡️ Bunion sleeves

These bunion correctors are elastic compression socks that cover the entire big toe joint. Designed to be worn with shoes and socks, they cushion the area and protect it from the friction of the shoe.

➡️ Bunion pads

Bunion pads help to cushion the painful area around the bunion. Often made from silicon rubber with gel inside, they protect the area from rubbing. Make sure you test the pads for a short period of time. If you find they increase the pressure on the bump, stop using them.

➡️ Bunion splints

A bunion corrector splint wraps around your foot with hinges and velcro straps. It's designed to gently stretch the toe back into a natural position while you wear it, and can be especially useful post-surgery, while tendons, ligaments and bones are healing. However, a bunion corrector splint cannot heal or correct a bunion. It can only provide pain relief.

➡️ Toe spacers

These are silicone devices that can be placed between the big toe and the index toe to prevent them from rubbing together. Some toe spacers can be worn inside shoes, while others are designed to be used barefoot at home.

Bunion surgery, explained

If other options fail to resolve your symptoms and your bunions are very painful or affecting your quality of life, your doctor may refer you to a surgeon. Surgery is the only way to get rid of bunions.

'In the past, surgery involved a general anaesthetic, invasive and painful surgery and recovery can be up to six weeks,' says Dr Bianchi. 'Many people are told to avoid exercise for up to six months. For active people who are living busy lives, this type of surgery has not been an option.'

Today, minimally-invasive keyhole surgery is more commonplace. 'The treatment requires only a local anaesthetic and removes the bunion quickly without the use of screws or plates,' explains Dr Bianchi. 'Patients can walk without crutches immediately after the procedure and are able to return to everyday activities almost straight away.'

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What happens in keyhole bunion surgery?

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Keyhole surgery is one of several options for bunion surgery. Gta san andreas ios. It ensures patients have a much faster recovery time and it provides the ability to restore the foot back to a normal shape.

'During the 20-30-minute procedure, 2 to 3-millimetre incisions are made in the skin and then small surgical burrs are used to correct the deformity and modify the bones of the foot,' Dr Bianchi explains.

'A series of small and precise fractures are made in the foot which do not require screws or pins to force the bone into place,' he says. 'Once the bones have been realigned, they are then left to heel naturally and according to the patients load-bearing needs.'

Your surgeon will decide which surgery is most appropriate for your individual situation. For advice about bunion surgery or any other foot complaint, speak to your GP.

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Last updated: 04-01-2021