Abortion

Definition

An abortion is a procedure, either surgical or medical, to end a pregnancy by removing the fetus and placenta from the uterus.

Description

A surgical abortion that is performed between 6 and 12 weeks into a pregnancy may be done while the woman is awake. She may be given the option of being sedated by medication through an IV, or having her cervix numbed with an injection of anesthesia.

A surgical abortion for a pregnancy over 12 weeks is usually done while the woman is sedated, although it can also be performed while the woman is awake. The cervical canal is opened (dilated) and a hollow tube is inserted into the uterus.

For abortions later than 12 weeks, the woman may need to come for an appointment the day before her procedure to begin the process of opening the cervix. In this procedure, small sticks called laminaria are placed in the cervix to begin dilation.

A vacuum (suction) machine is used to remove the tissues (fetus and placenta) from the uterus. Medicines such as oxytocin are sometimes given to cause the uterine muscles to contract and reduce bleeding.

An abortion can be performed non-surgically for a pregnancy less than 7 weeks from the first day of the woman's last menstrual period using a combination of medications. The current regimen approved by the FDA includes administration of one dose of Mifepristone (RU486), an antiprogestin, followed two days later by one dose of Misoprostol, a prostaglandin analogue.

These medications may be given in the doctor's office, after a thorough history and physical is performed. Women who undergo medical abortions experience cramping and bleeding, and pass the pregnancy as though they were having a miscarriage.

Indications

There are several reasons an abortion might be considered:

• The woman may not wish to be pregnant (elective termination)
• The woman's health is endangered by pregnancy (therapeutic abortion)
• There is an abnormality in the developing fetus (birth defect, genetic abnormality)

The decision to end a pregnancy is intensely personal. Most health care providers recommend careful counseling before making such a decision.

Because abortion is a controversial issue in the U.S., a woman who chooses to end a pregnancy may feel she cannot share her decision with others. Therefore, it is important for her to examine her support system and identify those people who may be capable of helping her through what may be a difficult time.

It is also important to choose a reputable provider or clinic that advocates choice for women. In many communities, crisis pregnancy centers offer counseling that is designed to dissuade women from choosing abortion. Women who are trying to make this difficult decision should avoid crisis pregnancy centers, and instead find a safe environment in which they can obtain adequate counseling regarding all options for pregnancy resolution.

If a woman chooses to have an abortion, she should find a safe place to have the procedure performed, and obtain the support and follow-up care that may be necessary after the abortion.

Risks

The risks for any anesthesia are:

• Reactions to medications
• Problems breathing

The risks for any surgery are:

• Bleeding
• Infection

Additional risks of surgical abortion include:

• Excessive bleeding
• Infection of the uterus
• Infection of the fallopian tubes (which can cause scarring and interfere with fertility (infertility)
• Puncture (perforation) of the uterus, or damage to the cervix (rare)
• Emotional or psychological distress

The risks of surgical abortion increase as a woman gets further along in her pregnancy. That's why it's important to make a decision about abortion as early as possible, when the procedure is safest.

The risks of abortion using medication include:

• Prolonged bleeding
• Incomplete abortion necessitating a surgical abortion
• Nausea
• Vomiting
• Diarrhea
• Pain

Expectations after surgery

Most women who undergo surgical abortions done in appropriate medical facilities recover without any physical complications.

Some women feel ambivalent about ending a pregnancy, and may need psychological and emotional support at the time of their procedure. It's important to seek counseling before making this very difficult decision.

Convalescence

Physical recovery usually occurs within a few days, depending on the stage of the pregnancy. A small amount of vaginal bleeding and mild uterine cramping should be expected for a few days.

A hot bath or use of a heating pad or hot water bottle on the abdomen may help relieve discomfort. Strenuous activity should be avoided for a few days following an abortion. Tampons may be used after 3 days. Sexual intercourse should be avoided for 2 to 3 weeks. A normal menstrual period should occur 4 to 6 weeks after the operation.

It's important to begin using birth control immediately after the abortion procedure. It is possible to get pregnant again even before having a normal menstrual period.

Illustrations

Abortion procedure

Page Content:

Suction curettage ; suction curettage; suction dilation and curettage