A woman at 7 weeks gestation requests medical abortion with mifepristone and misoprostol. Which of the following conditions is a CONTRAINDICATION to giving mifepristone?
- A Chronic adrenal insufficiency on replacement glucocorticoids ✓
- B Mild intermittent asthma using salbutamol inhalers
- C Previous uncomplicated lower segment cesarean section
- D Treated pulmonary tuberculosis on completion of therapy
Correct answer: A. Chronic adrenal insufficiency on replacement glucocorticoids
Explanation
Mifepristone antagonizes glucocorticoid receptors, so patients with chronic adrenal insufficiency or those on long-term systemic corticosteroids cannot mount a stress response and mifepristone is contraindicated. Mild asthma, a healed previous cesarean section and completed tuberculosis therapy do not preclude medical abortion. Uncontrolled hypertension, severe uncontrolled asthma on steroids and coagulopathy or anticoagulant use are other recognized contraindications.
Reference: Williams Obstetrics, 26th ed.
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