Since the 1980s, abortion using medications taken by mouth – or
'medical abortion' – has been available in a number of countries. In
many places, the drug misoprostol is added to the treatment regimen to
help terminate the pregnancy more safely. Experts in reproductive
health say medical abortions using only misoprostol are common in many
countries where abortions are not permitted because the drug has other,
legal uses, especially to treat stomach ulcers. But they say it is
impossible to know exactly how many abortions the drug is used in,
because of the difficulty in collecting data in countries where
abortion is illegal. More from Rose Hoban.
Misoprostol has some
unpleasant side effects, including nausea and vomiting. So, to reduce
side effects, some medical practitioners have found that if a woman
places the medication directly into her vagina, where it's absorbed
into the bloodstream, these side effects can be reduced.
But
research from the University of Michigan suggests that this practice
may have a deadly side effect. Several women who administered
misoprostol vaginally died of infections from an unusual bacterium.
Infectious disease specialist David Aronoff became interested when he
heard about their deaths. He had been studying a compound called
prostaglandin E2 or PGE2 in his lab.
"Misoprostol is a
synthetic version of this compound," Arohoff explains. "And we had
found some time ago [that] prostaglandin E2 actually is somewhat of a
suppressor of normal immune responses, particularly when its production
is exaggerated, or enhanced."
Aronoff wondered if the problem
with misoprostol wasn't the drug itself, but how the women used it. So,
he tested it on rats to see if the drug enhanced bacterial growth in
animals that had uterine infections.
Aronoff found that giving the rats misoprostol by mouth had no adverse effects on the uterine infection.
"But
when we gave the misoprostol directly into the reproductive tract, into
the uterus, at the time of infection, that the infection was much more
severe," Aronoff says. "Then we later went on to show that misoprostol
could inhibit some of the immune defense functions of cells that are
normally very important in protecting the uterus from infection."
Aronoff
says researchers need to do more work to find the best ways of using
misoprostol to reduce unpleasant side effects. He says it's still too
early to use his research to change global reproductive health policy,
but adds, "perhaps this will provide an impetus to enhance surveillance
of infectious complications of medication abortion on a global basis."
Aronoff
says taking misoprostol by mouth has few complications. Some doctors
suggest that letting the pill dissolve under the tongue rather than
swallowing it seems to reduce the side effects. Aronoff notes that
abortions using misoprostol are a safe alternative to many unsafe
practices used around the world that result in tens of thousands of
women dying each year.
Aronoff's paper is published in The Journal of Immunology.
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