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McKesson Clinical Reference Systems: Women's Health Advisor 2002.2
Illustration
Induced Abortion
What is an induced abortion?
Induced abortion is the act of ending a pregnancy, either
through surgery or by taking medication, with the intention
not to have an infant born alive.
Dealing with an unplanned or unwanted pregnancy is very
difficult. Talking with your partner, family, clergy,
friends, and health care provider may all be helpful in your
decision about what action you should take. Your choices
include continuing the pregnancy and you or your family
raising the child, finding adoptive parents, or ending the
pregnancy by having a legal abortion. The goal of abortion
counseling is to provide information that enables you to
make the best decision for you, and to offer support in that
decision.
What happens before the abortion?
First you will talk with a specially trained counselor to
explore your options, answer your questions, and discuss
your decision. Then your health care provider will take a
medical history and perform a physical exam, including a
pelvic exam. Cells from your cervix (a Pap smear) and
samples of your urine and blood will be taken for lab tests.
You may have an ultrasound exam to determine your stage of
pregnancy.
Your health care provider will tell you about any special
steps you should take before the abortion procedure.
What types of procedures may be performed?
The type of procedure used for an abortion depends on the
stage of pregnancy:
- If it has been just 1 or 2 weeks since your period should
have started, a menstrual extraction might be done. The
oral medication mifepristone (Mifeprex, or RU 486) is
another method that may be used within the first few
weeks of pregnancy.
- If you are less than 13 weeks pregnant (it has been less
than 13 weeks since the first day of your last menstrual
period), the most common procedure is vacuum curettage.
- The procedure most often used between the 13th and 16th
weeks of pregnancy is a dilation and evacuation (D&E).
- For pregnancies 17 weeks or longer, medications may be
used to cause the uterus (womb) to contract and deliver
the fetus and placenta (afterbirth).
How are these procedures performed?
Menstrual extraction
Menstrual extraction is a procedure that can be done only
very early in pregnancy (1 or 2 weeks after your period
should have started). It can be performed in your health
care provider's office.
To do a menstrual extraction, your health care provider
inserts a speculum into your vagina. He or she then places
a small tube into the womb through the cervix (the opening
to the womb). The tube is used to remove the pregnancy
tissue from the womb with a syringe.
Mifepristone
Mifepristone is an oral medicine recently approved by the US
Food and Drug Administration (FDA). It may be used in the
first 7 weeks of pregnancy (counting from the first day of
your last menstrual period). It blocks one of the hormones
you need to stay pregnant and so ends the pregnancy.
One or two days after you take mifepristone you will
probably start having vaginal bleeding. Two days after
taking the mifepristone you will take a medicine called
misoprostol, which causes cramping of the uterus and helps
completely empty the uterus.
About 1 of every 100 women who use mifepristone have heavy
bleeding. If you have heavy bleeding, you may need a
surgical procedure called a D&C. The D&C is a scraping of
the inside of the uterus to remove any remaining pregnancy
tissue and blood clots. It stops the heavy bleeding.
Vacuum curettage
A vacuum curettage (also called a suction dilation and
curettage, or suction D&C) is a surgical procedure performed
in an operating room. Before the procedure you are given
either local or general anesthesia. For local anesthesia
you are given a shot deep inside the vagina into your cervix
to make your cervix numb. In addition to the local
anesthesia, you may be given a sedative through an IV to
make you drowsy. If general anesthesia is used, you will be
asleep during the procedure.
After the anesthetic has taken effect, your health care
provider gently stretches the cervix so a small plastic tube
can be placed through it into the womb. This tube is
attached to a vacuum pump, which suctions the pregnancy
tissue from the womb. Your provider then uses a dull
spoonlike instrument (a curette) to scrape the walls of the
womb and be sure that all of the tissue has been removed.
The procedure generally takes 10 to 20 minutes, and then you
will spend some time in the recovery room.
Dilation and evacuation (D&E)
A D&E is a surgical procedure performed if you are 13 to 21
weeks pregnant. Because the fetus is larger, the cervix
needs to be opened more than for a vacuum curettage. To do
this safely, the cervix needs to be prepared 24 to 48 hours
before the procedure. This is done in the office, where
your health care provider gently places some sticks into the
cervix. The sticks, usually made from a type of seaweed
called laminaria, absorb water from the body and cause the
cervix to open up. After placement of the sticks, you will
go home. Your cervix will be examined the next day. If it
has opened enough, the D&E will be performed. If not, a
second set of sticks will be inserted and the D&E will be
done the following day.
The D&E is performed in the operating room, usually using
general anesthesia so you are asleep during the procedure.
The procedure is similar to a suction curettage. After the
sticks are removed, the cervix may be gently opened more
with metal rods. The pregnancy tissue is removed with
forceps and suction. You are given medication through an IV
to contract the uterus. The uterus is scraped to be sure
all the tissue has been removed. The procedure takes about
30 minutes. Afterward you will spend time in the recovery
room.
Medically induced second-trimester abortions
Certain medications may be used for abortions after the
14th to 16th weeks of pregnancy. These medications cause
contractions that lead to labor and delivery. Medically
induced abortions are usually done in the hospital.
The most commonly used medication is prostaglandin E2
(PGE2). Your health care provider places a suppository of
the medicine in your vagina. After the medication is given,
in addition to contractions, you may have nausea, fever, and
diarrhea, but these side effects can be controlled with
medications.
A less commonly used procedure is a saline abortion, which,
like PGE2, causes labor and delivery. With this procedure
your abdomen is numbed with a local anesthetic. Then saline
(a salt solution) or another medication is injected through
the skin of your abdomen and into the amniotic fluid in the
womb to start contractions.
After the fetus is delivered by any of these procedures, you
may need to have a dilation and curettage (D&C) to remove
any pregnancy tissue remaining in the womb.
These procedures will require you to be in the clinic 6 to
24 hours for labor, delivery, and recovery.
What happens after the procedure?
After each of these procedures, you are observed for one or
more hours to check for complications. The length of time
in recovery depends on the type of procedure you had and the
method of anesthesia. In general, you are observed for
about 2 hours after a suction curettage, 4 hours after a
dilation and evacuation, and 6 hours after a medically
induced second-trimester abortion.
When you are ready to go home, you will be given an
antibiotic to prevent infection and a drug to contract the
uterus. Your health care provider will tell you how long to
wait until you have intercourse again. You may have a
discussion about ways to prevent pregnancy and your
provider may prescribe a method for you. Someone should
drive you home.
It is normal to have some cramping after the abortion while
the uterus contracts to its normal size. It is also normal
to have some small amounts of bleeding from the vagina for
several days. Most women are able to return to their normal
daily activities within a day or so after the abortion if
there are no complications.
Make sure you follow all of your health care provider's
instructions for care after the abortion, including seeing
your provider for a follow-up appointment 2 to 3 weeks after
the abortion.
What are the possible complications of an abortion?
Abortions performed by licensed health care providers are
generally very safe. The rate of complications from
abortions done by licensed health care providers is very
low. Possible complications include:
- perforation (a result of a surgical instrument going
through the uterus and possible injuring an abdominal
organ)
- infection
- excessive bleeding
- failure to end the pregnancy
- difficulty becoming pregnant after several abortions.
Report any of the following symptoms of possible
complications to your health care provider promptly:
- severe abdominal pain
- fever
- foul-smelling discharge from the vagina
- bleeding that is more than a heavy period or consists of
large blood clots
- signs of continued pregnancy such as breast tenderness,
fatigue, and nausea.
Some women experience depression after having an abortion.
This may occur immediately after the abortion or weeks or
months later. If you are feeling depressed, your health
care provider will find support and counseling for you.
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