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
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
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
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
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
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-
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.
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-
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-
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
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-
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.
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