R. Wayne Whitted MD, MPH

Paul A. Pietro MD

Marina Santana MMS, PA

8740 North Kendall Dr.

Suite 101

Miami, Florida 33176-2212

Phone: 305-596-3744

Fax: 305-596-3676

www.floridaamigos.com

The Association of Minimally

Invasive Gynecologic Surgeons

...dedicated to healthy lifestyles and safe, state-of-the-art

surgery for women of all ages.

Non-Surgical Termination of

Pregnancy

How Does It Work?

Mifepristone blocks the hormone progesterone needed to

maintain the pregnancy. Because this hormone is

blocked, the uterine lining begins to shed, the cervix be-

gins to soften and bleeding may occur. When the miso-

prostol is later inserted into the vagina, the uterus con-

tracts and the pregnancy is usually expelled within 6-8

hours.

Because the woman decides when to take the second

medication within the time frame of 24-72 hours after the

first medication, she has some control over when she

experiences the miscarriage and its side effects. Some

women choose this approach because of the privacy it

offers. Some women feel empowered by taking an active

role in the process.

The Association is dedicated to safe, state-of-the-

art, innovative surgeries and healthy lifestyles for

women of all ages. In a nurturing environment,

the physicians and staff strive to promote a part-

nership in your healthcare and make every effort

to bridge the sterile science of diseases with your

emotional, physical, and spiritual needs. Every-

one is confronted with difficult healthcare deci-

sions at one time or another. You’ll want your

physician and staff to have the knowledge, experi-

ence, and sensitivity to guide you safely through

the decision-making process.

The Association of Minimally Invasive Gyneco-

logic Surgeons provides comprehensive gyneco-

logic office and surgical healthcare. The physi-

cians are certified in laparoscopy and hys-

teroscopy and are experts in advanced gyneco-

logic surgery. Doctors Whitted and Pietro are na-

tional speakers, trainers, and researchers in ad-

vanced surgical techniques. In addition, Doctors

Pietro and Whitted are Certified Menopause Clini-

cians who educate, train, and research the sci-

ence of menopause. Finally, they are certified in

advanced colposcopy.

Doctors Whitted and Pietro offer expert education

and care in the following areas:

If you need surgery, The Doctors in the Associa-

tion perform most gynecologic surgeries with mini-

mally invasive techniques to reduce hospitaliza-

tion, recovery, scarring, discomfort and absence

from work in most cases.

Abnormal Paps (HPV) Loss of Urine

Abnormal Menstrual Cycles Menopause

Bladder Prolapse Ovarian cysts

Chronic Pelvic Pain Osteoporosis

Endometriosis Rectocele

Ectopic Pregnancy Uterine Prolapse

Family Planning/contraception Vaginal Prolapse

Fibroids (Leiomyoma) Well-Woman visit

***Evaluation and Diagnosis of Gynecologic Cancers

What is the Abortion Pill?

Non-Surgical Termination of Pregnancy a form of early

abortion caused by the combination of two medications,

mifepristone and misoprostol. Also known as RU486,

mifepristone has been used safely in Europe for many

years. It is an early abortion option for women who are 8

weeks pregnant or less. During your first appointment

you receive the mifepristone pills to take orally. Then 24

to 72 hours later, in the privacy of your own home, you

insert 4 small tablets of misoprostol into your vagina,

which causes cramping and bleeding resulting in a miscar-

riage. When used in combination, mifepristone and miso-

prostol are 95-97% effective within two weeks. Mifepris-

tone and misoprostol are FDA approved.

How is this done?

At your first appointment, an ultrasound is performed to

confirm you are less than 8 weeks pregnant. You then

speak with your doctor who explains how mifepristone

and misoprostol work and makes sure you get your ques-

tions answered. Your health history is carefully reviewed

and if you meet the criteria, the doctor will give you the

mifepristone to take orally. You are also given 4 tablets of

misoprostol (800 micrograms). At your first visit you will

take the mifepristone (600 mg) orally. Between 24-72

hours later insert the 4 tablets of misoprostol deep into

the vagina.

What to Expect?

Upon taking mifepristone at the clinic you may begin to

bleed. As each woman’s body is different, bleeding varies

from woman to woman. Some may experience light

bleeding much like spotting towards the end of a men-

strual period. Others have heavier bleeding like their

regular menstrual period, or like a heavy period. Some

women do not experience any bleeding until taking the

misoprostol.

Upon inserting the misoprostol tablets into your vagina,

cramping, bleeding, and clotting may begin as soon as 20

minutes. Within the next 6-8 hours, most women will

miscarry. Cramping may come in waves with increasing

and decreasing intensity. You can expect bleeding heavier

than a menstrual period with large clots. During this time,

you will pass the embryo although you may not see it

since it is very small. The amount of bleeding when using

this approach is greater than with surgical termination of

pregnancy.

Aftercare

A follow-up exam is scheduled for 2 weeks later to make

sure the process is complete. If you have not yet miscar-

ried, we will perform a surgical abortion. A very small

percentage (5%) of women do not pass the pregnancy

tissue and need a suction procedure to complete the proc-

ess.

Side Effects

Most of the side effects when using this protocol are

caused by the second medication, misoprostol. Side-

effects may include heavy bleeding, headache, nausea,

vomiting, diarrhea, and heavy cramping.

Risks

Vaginal bleeding during the induced miscarriage could be

extremely heavy. In rare situations it could require a surgi-

cal abortion and very rarely, a blood transfusion. You will

be given our 24-hour call service to call if you have any

problems. We are on call at all times to answer your medi-

cal questions and concerns.

If pregnancy is continued after taking these

medications, there is a high risk of fetal de-

formities.

Criteria

This protocol may be an option for you if you:

• Are less than 8 weeks since the first day of you last

menstrual period.

• Are willing and able to give informed consent

• Have the support you need such as access to reliable

transportation and ability to communicate by tele-

phone

• Live no more than 2 hours away from emergency

medical care (a hospital)

• Are able to come back to the office for 2 follow-up

appointments.

• Agree to have a surgical abortion if the Misoprostol

does not induce termination.

• Are willing to insert medications into your vagina

Your Health

Due to the risk of serious health problems, mifepristone

and misoprostol may not be recommended if you:

• Have had blood clotting problems or are taking anti-

coagulants

...

dedicated to healthy lifestyles and safe, state-of-the-art, innovative surgery for women of all ages

• Have severe anemia

• Have adrenal failure

• Are taking long-term systemic corticosteroids

• May have an ectopic pregnancy

• Have a mass in the tubes or ovaries

• Have inherited porphyria

• Have an allergy to mifepristone, misoprostol or

other prostaglandin medicine

• Have severe diarrhea

Future Fertility

According to studies of the FDA (Food and drug Ad-

ministration) and the National Abortion Federation,

there are no known long term risks associated with

using mifepristone and misoprostol. Therefore,

women may pursue another pregnancy whenever they

feel the time is right after using

Other Options for Early Abortion

If you are at least 6 weeks by ultrasound, you can

choose to have a surgical abortion, in which the cervix

is dilated and suction aspiration is used to remove the

tine pregnancy.

Another option may be a chemical or medical abortion

using Methotrexate. Ask at the clinic about your par-

ticular circumstances.

Confusion

This treatment protocol should not be confused with

Emergency Contraception Pills. They are completely

different medications taken for different purposes.

Emergency Contraception (“morning after pill”) is

used to prevent pregnancy after unprotected sex when

taken within 72 hours of the event. Emergency contra-

ception does not cause abortion and it will not harm an

existing pregnancy.

Association of Minimally

Invasive Gynecologic Surgeons