Complication of over-the-counter use of medical abortion pills including ectopic pregnancy: a prospective observational study from a tertiary care centre

Background: Over-the-counter (OTC) availability of medical abortion pills has led to widespread unsupervised self-administration, increasing clinical complications and the risk of missed ectopic pregnancy. Methods: A prospective observational study was conducted on 50 women presenting with a history of self-administered abortion pills between October 2025 and March 2026 at a tertiary care centre in northern India. Clinical presentations, diagnostic findings, and therapeutic management were systematically analyzed using IBM SPSS Statistics software. Results: Bleeding per vaginum was the most common presentation (84%). Major complications included incomplete abortion (68%), severe anemia requiring blood transfusion, and ruptured ectopic pregnancy (8%). All ectopic pregnancies identified were ruptured at presentation and required emergency exploratory laparotomy, with intraoperative hemoperitoneum ranging from 400 to 800 ml. Conclusions: OTC use of abortion pills is associated with significant morbidity, including life-threatening ruptured ectopic pregnancy. Proper medical evaluation prior to abortifacient use is indispensable. Stricter enforcement of drug distribution regulations and enhanced public awareness regarding safe abortion practices are urgently needed.