U.S. Abortion pill legal challenge threatens miscarriage care

Less than a year after losing her daughter Emilia at five days old, Gillian Phillips suffered a miscarriage.

It was Halloween weekend 2016, and her doctor said she could wait to heal on her own, have surgery, or take medication. She chose her medicine, gave her nine weeks pregnant remains at her home, and buried them in a memorial garden near her ashes in Emilia.

Phillips, a 41-year-old single mother of three from Northbrookfield, Massachusetts, said: “You just want it to end. And the drug works pretty quickly.

But the future of this popular abortion treatment is in jeopardy. Mifepristone in tablets has been targeted because it is used for abortion.

Last month, a federal judge in Texas ruled to block the approval of mifepristone by the Food and Drug Administration. Did. A long way to go will follow the debate in the Court of Appeals on May 17th.

Physicians and patients fear that mifepristone may be withdrawn from the market when the legal dispute is over. I hesitate to prescribe it.

One million women in the United States suffer miscarriages each year, which occurs in at least 15% of known pregnancies. Mifepristone was approved for early miscarriage in 2000, but is often used “off-label” to treat early miscarriage and to hasten delivery after fetal death in late pregnancy. These uses are so common that U.S. senators have asked the manufacturer, Danko, to petition the FDA to add abortion to the label of its drug, Mifeplex.

Denise Haar, an attorney for the group, which has filed a lawsuit in Texas on behalf of doctors and medical organizations that oppose abortion, said it has no objections to drug use beyond abortion. experts say that once removed from the market for approved use, it is not available for miscarriage.

Dr. Christine Brandy said the “gold standard in miscarriage management”, a two-drug combination of mifepristone and misoprostol, helps empty the uterus and reduce the chance of infection.

Brandi, an OB-GYN in Newark, New Jersey, said: “It will be a big problem if that medicine can no longer be used.”

get over the pain

Brandy said medication speeds up the miscarriage process when a woman is already suffering physically and mentally.

Most patients pass through pregnancy tissue spontaneously within two weeks of diagnosis, but it can take several weeks, according to the American College of Obstetricians and Gynecologists. When a woman takes the drug, the tissue generally clears her within 48 hours. Studies show that the drug is about 80% to 90% effective.

Brandi administers mifepristone to a patient in her office. It blocks the hormone progesterone and prepares the uterus to respond to the contractile-inducing effects of misoprostol, which is taken at home later.

Phillips, a social worker, said the drug had made the horrible situation a little more bearable.

On her second ultrasound, doctors found no fetal heart activity. Ms. Phillips considered undergoing “dilation and curettage” surgery, but she didn’t like the need for general anesthesia and was unable to take her remains home. Medication seemed like a better option.

She was put on mifepristone and eventually needed two doses of misoprostol. “But the miscarriage itself was less significant than my worst period,” she said. “And I was home with my family.”

Today she finds solace in the Memorial Gardens. There, small angel figurines are lined up near the tree in the front yard.

Myriad Norris, 25, of Lexington, Kentucky, said she was glad mifepristone was available even though she no longer needed it when she miscarried in late March.

About 12 hours after finding out she was pregnant, Norris began having convulsions and then bleeding. Worried she might develop an infection, she asked her doctor about mifepristone. She was just past her fifth week of pregnancy, and her tissue disappeared on its own.

Soon, news broke of a Texas judge’s ruling. Norris, a stay-at-home mom who works with the Kentucky for Reproductive Freedom group, said it brought “another layer of grief.”

“Chilling Effects” and Backup Plans

Mifepristone has long been subject to special restrictions, but experts say it is just as safe as the over-the-counter pain reliever ibuprofen. Requests to be dispensed.

Doctors say the current legal situation has made access even more difficult.

“It produces some kind of chilling effect,” and even though it’s still approved and available, doctors are “too worried about the aftermath to give it.” said Brandy.

Dr. Sarah Prager, an OB-GYN at the University of Washington School of Medicine, said her health system does not restrict mifepristone, but others in her state do.

“Facilities that don’t want to have anything to do with abortion have chosen not to carry mifepristone on site,” she said. This includes Catholic institutions that are

Doctors are waiting to find out about Mifepristone’s fate, so they have a back-up plan for miscarriage treatment.

One is to use misoprostol alone to manage the miscarriage. Although safe, studies show that it’s not very effective at helping the expulsion of pregnancy tissue, and if it remains in the uterus it can lead to dangerous infections. A 2018 study published in the New England Journal of Medicine. Abortion patients who received only misoprostol had a treatment success rate of 67%, while those who received the two drugs had an 84% success rate.

This means patients on misoprostol alone are likely to require follow-up surgery or additional doses. I’m here.

“I feel like we’re just punishing people for not being able to give them the evidence-based, least-impact regimen,” she said.

Phillips said the patient deserved every option she had.

“You already feel completely traumatized and devastated” during the miscarriage, Phillips said. ”.


Associated Press reporter Heather Hollingsworth contributed to this report from the Kansas Mission.


The Associated Press’ Health Sciences Division is supported by the Scientific and Educational Media Group at the Howard Hughes Medical Institute. AP is solely responsible for all content.

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