Since the 1980s, abortion using medications taken by mouth - or'medical abortion' - has been available in a number of countries. Inmany places, the drug misoprostol is added to the treatment regimen tohelp terminate the pregnancy more safely. Experts in reproductivehealth say medical abortions using only misoprostol are common in manycountries where abortions are not permitted because the drug has other,legal uses, especially to treat stomach ulcers. But they say it isimpossible to know exactly how many abortions the drug is used in,because of the difficulty in collecting data in countries whereabortion is illegal. More from Rose Hoban.
 
Misoprostol has someunpleasant side effects, including nausea and vomiting. So, to reduceside effects, some medical practitioners have found that if a womanplaces the medication directly into her vagina, where it's absorbedinto the bloodstream, these side effects can be reduced.

Butresearch from the University of Michigan suggests that this practicemay have a deadly side effect. Several women who administeredmisoprostol vaginally died of infections from an unusual bacterium.Infectious disease specialist David Aronoff became interested when heheard about their deaths. He had been studying a compound calledprostaglandin E2 or PGE2 in his lab.
 
"Misoprostol is asynthetic version of this compound," Arohoff explains. "And we hadfound some time ago [that] prostaglandin E2 actually is somewhat of asuppressor of normal immune responses, particularly when its productionis exaggerated, or enhanced."
 
Aronoff wondered if the problemwith 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 inanimals that had uterine infections.
 
Aronoff found that giving the rats misoprostol by mouth had no adverse effects on the uterine infection.
 
"Butwhen we gave the misoprostol directly into the reproductive tract, intothe uterus, at the time of infection, that the infection was much moresevere," Aronoff says. "Then we later went on to show that misoprostolcould inhibit some of the immune defense functions of cells that arenormally very important in protecting the uterus from infection."
 
Aronoffsays researchers need to do more work to find the best ways of usingmisoprostol to reduce unpleasant side effects. He says it's still tooearly to use his research to change global reproductive health policy,but adds, "perhaps this will provide an impetus to enhance surveillanceof infectious complications of medication abortion on a global basis."
 
Aronoffsays taking misoprostol by mouth has few complications. Some doctorssuggest that letting the pill dissolve under the tongue rather thanswallowing it seems to reduce the side effects. Aronoff notes thatabortions using misoprostol are a safe alternative to many unsafepractices used around the world that result in tens of thousands ofwomen dying each year.
 
Aronoff's paper is published in The Journal of Immunology.