Self-induced medical abortion in an adolescent

An 18-yr-old female presented to her local pediatric clinic with a 4-day history of vaginal bleeding and cramping. She reported sexual activity with last coitus two weeks prior and intermittent condom usage. Examination revealed blood in the vaginal vault and a 4- to 5-cm uterus, slightly tender to palpation. Urine human chorionic gonadotropin (hCG) was positive. She reported having taken "four little white pills" from a friend, prior to onset of bleeding, "so that she would not be pregnant." Further questioning revealed that the pills were misoprostol. An ultrasound demonstrated no intrauterine or tubal pregnancy. The patient was followed; her bleeding resolved over two weeks and her ss-hCG levels declined steadily.

There are some studies in the adult literature that address medical self-induction of abortion, and sporadic reports on the Internet and in the lay press. No pediatric literature has been published on this topic in the United States. It is important for clinicians to be aware that such an option exists for pregnant young women when evaluating an adolescent who presents with vaginal bleeding and cramping.