What is a medical abortion?
Medical abortion procedures are available to terminate a pregnancy during the early weeks of the first trimester. Prior to seeking a medical abortion procedure, it is recommended that you obtain a sonogram to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating or gestational age.
Types of medical abortions
What is RU-486 Mifepristone (Mifeprex) and Misoprostol?
Mifepristone (Mifeprex) and Misoprostol are drugs used in a medical abortion procedure within the first seven to nine weeks of pregnancy. It is also referred to as RU-486 or the abortion pill. A physical exam is given to determine if you are eligible for this medical abortion procedure. You are not eligible if you have any of the following: ectopic pregnancy, ovarian mass, IUD, corticosteroid use, adrenal failure, anemia, bleeding disorders or use of blood thinners, asthma, liver or kidney problems, heart disease, or high blood pressure.
How does it work?
Mifepristone is given orally during your first office visit. Mifepristone blocks progesterone from the uterine lining, causing the fetus to die. This alone, may cause contractions to expel the fetus. Misoprostol tablets are given orally or inserted vaginally during the second office visit which occurs 36 to 48 hours later. You will return home where the misoprostol will start contractions and expel the fetus. This may occur within a few hours or in some cases up to two weeks after taking the misoprostol. A physical exam is given two weeks later to ensure the abortion was complete and that there are no immediate complications.
What are the side effects of RU-486?
The side effects and risks of Mifepristone & Misoprostol include the following:
The procedure is unsuccessful approximately 8-10% of the time, thus requiring an additional surgical abortion procedure to complete the termination.
Cramping, nausea, vomiting, diarrhea, heavy bleeding and/or infection may occur.
RU-486 is not advised for women who have anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease, or use an intrauterine device (IUD).
What is MTX: Methotrexate & Misoprostol?
MTX is a medical abortion procedure used up to the first seven weeks of pregnancy.
Methotrexate is given orally or by injection during the first office visit. Misoprostol tablets are given orally or inserted vaginally during the second office visit which occurs 5 to 7 days later. You will return home where the misoprostol will start contractions and expel the fetus. This may occur within a few hours or up to a few days.
How does it work?
A physical exam is given 7 days later to ensure that the abortion procedure is complete and that no complications are apparent. Methotrexate is primarily used in the treatment of cancer and rheumatoid arthritis because it attacks the most rapidly growing cells in the body. In the case of an abortion, it causes the fetus and placenta to separate from the lining of the uterus. The use of this drug for this purpose is not approved by the FDA.
What are the side effects of MTX?
The side effects and risks of Methotrexate & Misoprostol include the following:
Procedure is unsuccessful approximately 10% of the time, thus requiring an additional surgical abortion procedure to complete the termination.
Cramping, nausea, diarrhea, heavy bleeding, fever.
MTX is not advised for women who have anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease, or use an intrauterine device (IUD).
What is a surgical abortion?
Surgical abortion procedures vary based on the stage of pregnancy. Prior to seeking a surgical abortion procedure, it is recommended that you obtain a sonogram to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating or gestation.
Types of Surgical Abortions
What is Suction Aspiration?
Suction aspiration is a surgical abortion procedure performed during the first 6 to 12 weeks gestation. It is also referred to as suction curettage or vacuum aspiration.
How is suction aspiration performed?
Your abortion provider may give you pain medication and misoprostol in preparation of the procedure. You will lie on your back with your feet in stirrups and a speculum is inserted to open the vagina. A local anesthetic is administered to your cervix. Then a tenaculum is used to hold the cervix in place for the cervix to be dilated by cone shaped rods. When the cervix is wide enough, a cannula, which is a long plastic tube connected to a suction device, is inserted into the uterus to suction out the fetus and placenta. The procedure usually lasts 10-15 minutes, but recovery may require staying at the clinic for a few hours.
What are the possible side effects and/or complications of suction aspiration?
Common side effects that most women will experience following the procedure include cramping, nausea, sweating, and feeling faint. Less frequently, complications include possible heavy or prolonged bleeding, blood clots, damage to the cervix and perforation of the uterus. Infection due to retained products of conception or infection caused by an STD or bacteria being introduced to the uterus can cause fever, pain, abdominal tenderness and possibly scar tissue. Contact you healthcare provider immediately if your symptoms persist or worsen.
What is Dilation & Curettage (D&C)?
Dilation and curettage is a surgical abortion procedure performed during the first 12 to 15 weeks gestation.
How is dilation and curettage performed?
Dilation and curettage is similar to suction aspiration but with the introduction into the cervix of a curette. A curette is a long, looped shaped knife that scrapes the lining, placenta and fetus away from the uterus. A cannula may be inserted for a final suctioning. This procedure usually lasts 10 minutes with a possible stay of up to 5 hours.
What are the possible side effects and/or complications of dilation & curettage?
The side effects and possible complications of dilation and curettage are the same as suction aspiration as noted above with the exception that there is a slight increased chance for perforation of the uterus.
Contact your healthcare provider immediately if your symptoms persist or worsen.
What is Dilation & Evacuation (D&E)?
Dilation and evacuation is a surgical abortion procedure performed between 15 to 21 weeks gestation.
How is dilation & evacuation performed?
In most cases, 24 hours prior to the actual procedure, your abortion provider will insert laminaria or a synthetic dilator inside your cervix. When the procedure begins the next day, your abortion provider will clamp a tenaculum to the cervix to keep the uterus in place and cone-shaped rods of increasing size are used to continue the dilation process.
The cannula is inserted to begin removing tissue away from the lining. Then using a curette, the lining is scraped to remove any residuals. If needed, forceps may be used to remove larger parts. The last step is usually a final suctioning to make sure the contents are completely removed. The procedure normally takes about 30 minutes. Some clinics may perform the procedure in a hospital setting because of the greater risk for complications. The fetal remains are usually examined to ensure everything was removed and that the abortion was complete.
What are the side effects and risks of dilation & evacuation?
The common side effects for most women include nausea, bleeding and cramping which may occur for two weeks following the procedure. Although rare, the following are additional risks related to dilation and evacuation: damage to uterine lining or cervix, perforation of the uterus, infection, and blood clots. Contact your healthcare provider immediately if your symptoms persist or worsen.
What is Induction Abortion?
Induction abortion is a procedure that uses salt water, urea, or potassium chloride to terminate the viability of the pregnancy.
How is induction abortion performed?
Your abortion provider will insert prostaglandins into the vagina and pitocin will be given intravenously. Laminaria is then usually inserted into your cervix to begin dilation. This procedure is rarely used, and normally only occurs when there is a medical problem or illness in the fetus or mother.
What are the side effects of induction abortion?
The side effects are similar to dilation and evacuation, although in rare cases it is possible for the mother�s blood stream to be accidentally injected with saline or other medications. Excessive bleeding and cramping may also be experienced. Contact your healthcare provider immediately if your symptoms persist or worsen.
What is Dilation and Extraction (D&X)?
The dilation and extraction procedure is used after 21 weeks gestation. The procedure is also known as D & X, Intact D & X, Intrauterine Cranial Decompression and Partial Birth Abortion.
How is dilation and extraction performed?
Two days before the procedure, laminaria is inserted vaginally to dilate the cervix. Your water should break on the third day and you should return to the clinic. The fetus is rotated and forceps are used to grasp and pull the legs, shoulders and arms through the birth canal. A small incision is made at the base of the skull to allow a suction catheter inside. The catheter removes the cerebral material until the skull collapses. Then the fetus is completely removed.
What are the side effects and risks related to dilation and extraction?
The side effects are the same as dilation and evacuation. However, there is an increase chance for additional emotional problems because of further fetal development. Contact your healthcare provider immediately if your symptoms persist or worsen.
Sources
American Pregnancy Association (2006). Types of Abortion Procedures. Retrieved August 24, 2006