If a medication abortion is unsuccessful and the pregnancy continues, the fetus can continue to develop. However, taking misoprostol (the second pill) during pregnancy carries specific medical risks that you should discuss with a healthcare provider.
1. Fetal Development and Survival
While medication abortion is highly effective, it does not work in 100% of cases.
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Ongoing Pregnancy: If the pills do not work, the pregnancy may continue to grow. In these cases, the fetus can be born alive, but it has been exposed to powerful medications designed to cause uterine contractions.
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Effectiveness: When used correctly, the medication abortion process is successful about 95–98% of the time. If only misoprostol is used (without mifepristone), the success rate is lower, which increases the chance of an ongoing pregnancy.
2. Medical Risks of Misoprostol Exposure
If a pregnancy continues after exposure to misoprostol, there is a small but increased risk of certain congenital anomalies (birth defects). This is because the drug causes the uterus to contract, which can temporarily disrupt the blood supply to the developing embryo.
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Möbius Syndrome: This is the most commonly cited risk. It is a rare neurological condition that primarily affects the muscles that control facial expression and eye movement.
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Limb Defects: Exposure can sometimes lead to abnormalities in the fingers, toes, or limbs (such as clubfoot).
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Statistical Risk: While the risk is real, it remains statistically low. Research indicates that the risk of a major malformation following misoprostol exposure is less than 10 in 1,000 births (less than 1%). For comparison, the “natural” risk of birth defects in the general population is about 2–3%.
3. What to Do if the Pills Fail
If you have taken the medication and believe you are still pregnant (for example, if you had very little bleeding or your pregnancy symptoms have not gone away), it is important to seek medical care immediately.
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Verification: A provider can use an ultrasound to determine if the pregnancy is still viable or if there is “retained tissue” that needs to be cleared.
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Decision Making: If the pregnancy is ongoing, you will need to decide whether to continue the pregnancy or proceed with a procedural abortion to ensure the termination is complete.
Support at Serenity Choice Health
At Serenity Choice Health, we provide a safe and private experience that includes a high level of follow-up care.
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24/7 Clinical Line: Our medical team is available to help you monitor your symptoms and determine if the medication has worked.
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In-Clinic Support: If a medication abortion is incomplete, we offer in-clinic abortion services to safely resolve the situation.
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No-Cost Care: We offer free abortion pill services for those who qualify, so you can get the follow-up care you need without worrying about the cost.
Are you concerned that the medication didn’t work for you, or are you looking for information on what happens if you change your mind after taking the first pill? Book an appointment with our clinical team today for a confidential medical evaluation.
Dr. James Carter is a board-certified physician and lead clinician at Serenity Choice Health, specializing in reproductive health access and medication abortion protocols. With over 20+ years of experience, he combines clinical expertise with patient-centered care to ensure safe, compassionate, and confidential reproductive healthcare.
