Abortion procedure

Abortion procedure

Abortion (Termination of Pregnancy)

What is Abortion?

Abortion is when a pregnancy is ended so that it doesn't result in the birth of a child. Sometimes it is called 'termination of pregnancy'. Abortion is used most often to end an unplanned pregnancy. Unplanned pregnancies happen when birth control is not used, is used incorrectly or fails to prevent a pregnancy. Abortion is also used to end a pregnancy when tests reveal that the fetus is abnormal.

There are two types of abortion treatment, 'Medical' and 'Surgical' abortion.

 

 

  1. Medical abortion

What is Medical abortion?

Medical abortion is a procedure that uses medication to end a pregnancy. A medical abortion doesn't require surgery or anesthesia and can be started either in a medical office or at home with follow-up visits to your doctor. It's safer and most effective during the first trimester of pregnancy.

Having a medical abortion is a major decision with emotional and psychological consequences. If you're considering this procedure, make sure you understand what it entails, side effects, possible risks, complications and alternatives.

Before Medical abortion

Why it's done

The reasons for having a medical abortion are highly personal. You can choose medical abortion to complete an early miscarriage or end an unwanted pregnancy. You can also choose to have a medical abortion if you have a medical condition that makes continuing a pregnancy life-threatening.

Risks and Complications

Potential risks of medical abortion include:

. Incomplete abortion, which may need to be followed by surgical abortion

. An ongoing unwanted pregnancy if the procedure doesn't work

. Heavy and prolonged bleeding

. Infection

. Fever

. Digestive system discomfort

You must be certain about your decision before beginning a medical abortion. If you decide to continue the pregnancy after taking medications used in medical abortion, your pregnancy may be at risk of major complications.

Medical abortion hasn't been shown to affect future pregnancies unless complications develop.

Medical abortion isn't an option if you:

. Are too far along in your pregnancy. You shouldn't attempt a medical abortion if you've been pregnant for more than nine weeks (after the start of your last period). Some types of medical abortion aren't done after seven weeks of pregnancy.

. Have an intrauterine device (IUD).

. Have a suspected pregnancy outside of the uterus (ectopic pregnancy).

. Have certain medical conditions. These include bleeding disorders; certain heart or blood vessel diseases; severe liver, kidney or lung disease; or an uncontrolled seizure disorder.

. Take a blood thinner or certain steroid medications.

. Can't make follow-up visits to your doctor or don't have access to emergency care.

. Have an allergy to the medications used.

 

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How you prepare

If you're considering a medical abortion, meet with your doctor to discuss the procedure. Your doctor will likely:

. Evaluate your medical history and overall health

. Confirm your pregnancy with a physical exam

. Do an ultrasound exam to date the pregnancy and confirm it's not outside the uterus (ectopic pregnancy) and not a tumor that developed in the uterus (molar pregnancy).

. Do blood and urine tests

. Explain how the procedure works, the side effects, and possible risks and complications.

Having a medical abortion is a serious decision. If possible, talk with your partner, family or friends. Talk with your doctor, a spiritual adviser or a counselor to get answers to your questions, help you weigh alternatives and consider the impact the procedure may have on your future.

Keep in mind that no doctor is required to perform an elective abortion and that in some states there are certain legal requirements and waiting periods you must follow before having an elective abortion. If you're having an abortion procedure for a miscarriage, there are no special legal requirements or waiting periods required.

During Medical abortion

What you can expect

Medical abortion doesn't require surgery or anesthesia. The procedure can be started in a medical office or clinic. A medical abortion can also be done at home, though you'll still need to visit your doctor to be sure there are no complications.

During the procedure

Medical abortion can be done using the following medications:

 

. Oral mifepristone (Mifeprex) and oral misoprostol (Cytotec). This is the most common type of medical abortion. These medications are usually taken within seven weeks of the first day of your last period.

Mifepristone (mif-uh-PRIS-tone) blocks the hormone progesterone, causing the lining of the uterus to thin and preventing the embryo from staying implanted and growing. Misoprostol (my-so-PROS-tol), a different kind of medication, causes the uterus to contract and expel the embryo through the vagina.

If you choose this type of medical abortion, you'll likely take the mifepristone in your doctor's office or clinic. Then you will probably take the misoprostol at home, hours or days later.

You'll need to visit your doctor again about a week later to make sure the abortion is complete. This regimen is approved by the Food and Drug Administration (FDA).

. Oral mifepristone and vaginal, buccal or sublingual misoprostol. This type of medical abortion uses the same medications as the previous method, but with a slowly dissolving misoprostol tablet placed in your vagina (vaginal route), in your mouth between your teeth and cheek (buccal route), or under your tongue (sublingual route).

The vaginal, buccal or sublingual approach lessens side effects and may be more effective. These medications must be taken within nine weeks of the first day of your last period.

. Methotrexate and vaginal misoprostol. Methotrexate (Otrexup, Rasuvo, others) is rarely used for elective, unwanted pregnancies, although it's still used for pregnancies outside of the uterus (ectopic pregnancies). This type of medical abortion must be done within seven weeks of the first day of your last period, and it can take up to a month for methotrexate to complete the abortion. Methotrexate is given as a shot or vaginally and the misoprostol is later used at home.

. Vaginal misoprostol alone. Vaginal misoprostol alone can be effective when used before nine weeks of gestation of the embryo. But vaginal misoprostol alone is less effective than other types of medical abortion.

The medications used in a medical abortion cause vaginal bleeding and abdominal cramping. They may also cause:

. Nausea

. Vomiting

. Fever

. Chills

. Diarrhea

. Headache

You may be given medications to manage pain during and after the medical abortion. You may also be given antibiotics, although infection after medical abortion is rare.

Your doctor will let you know how much pain and bleeding to expect, depending on the number of weeks of your pregnancy. You might not be able to go about your normal daily routine during this time, but it's unlikely you'll need bed rest. Make sure you have plenty of absorbent sanitary pads.

If you have a medical abortion at home, you'll need access to a doctor who can answer questions by phone and access to emergency services. You'll also need to be able to identify complications.

 

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After Medical abortion

After the procedure

Signs and symptoms that may require medical attention after a medical abortion include:

. Heavy bleeding — soaking two or more pads an hour for two hours

. Severe abdominal or back pain

. Fever lasting more than 24 hours

. Foul-smelling vaginal discharge

After a medical abortion, you'll need a follow-up visit with your doctor to make sure you're healing properly and to evaluate your uterine size, bleeding and any signs of infection. To reduce the risk of infection, don't have vaginal intercourse or use tampons for two weeks after the abortion.

Your doctor will likely ask if you still feel pregnant, if you saw the expulsion of the gestational sac or embryo, how much bleeding you had, and whether you're still bleeding. If your doctor suspects an incomplete abortion or ongoing pregnancy, you may need an ultrasound and possibly a surgical abortion.

After a medical abortion, you'll likely experience a range of emotions — such as relief, loss, sadness and guilt. These feelings are normal. It might help to talk to a counselor about them.

 

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Preventing pregnancy

Ovulation usually occurs as soon as two weeks after a medical abortion, and another pregnancy is possible even before your period begins. Before the abortion, talk to your doctor about contraception that you can start as soon as the procedure is over.

  1. Surgical Abortion

What is Surgical Abortion?

Surgical abortion involves a quick, minor operation. Surgical abortions are also called in-clinic abortions. They are typically more effective than a medical abortion, with a lower risk of an incomplete procedure.

There are two types of surgical abortion: aspiration abortion and dilation and evacuation (D&E) abortion.

Women up to 14 to 16 weeks pregnant can have an aspiration abortion, while D&E abortions are typically performed at 14 to 16 weeks or after.

You should wait to have sex for at least one to two weeks after a surgical abortion. This can help reduce the risk of infection.

Surgical Abortion types

If a woman is 10 or more weeks into her pregnancy, she is no longer eligible for a medical abortion. Women up to 15 weeks pregnant can have an aspiration abortion, while D&E abortions are typically performed at 15 weeks or after.

. Aspiration abortions

The average clinic visit will last up to three to four hours for an aspiration abortion. The procedure itself should take five to 10 minutes.

Aspiration abortions, also called vacuum aspirations, are the most common type of surgical abortion. During this procedure, you’ll be given pain medication, which can include a numbing medication that is injected into the cervix. You may also be given a sedative, which will allow you to stay awake but be extremely relaxed.

Your doctor will first insert a speculum and examine your uterus. Your cervix will be stretched open with dilators either before or during the procedure. Your doctor will insert a tube through the cervix into the uterus, which is attached to a suction device. This will empty the uterus. Many women will feel mild to moderate cramping during this portion of the procedure. The cramping typically decreases after the tube is removed from the uterus.

Immediately after the procedure, your doctor may check your uterus to ensure that it is completely empty. You’ll be given antibiotics to prevent infection.

The actual aspiration procedure takes approximately five to 10 minutes, though more time may be needed for dilation.

. D&E

A D&E abortion is typically used after the 15th week of pregnancy. The procedure takes between 10 and 20 minutes, with more time potentially being needed for dilation.

This procedure starts the same way as an aspiration abortion, with the doctor applying pain medication, checking your uterus, and dilating your cervix. Like the aspiration abortion, the doctor inserts a tube attached to a suction machine to the uterus through the cervix and, combined with other medical tools, it will gently empty the uterus.

After the tube has been removed, your doctor will use a small, metal loop-shaped tool called a curette to remove any remaining tissue that is lining the uterus. This will ensure that the uterus is completely empty.

 

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Preparation

Before your surgical abortion, you’ll meet with a healthcare provider who will go over all of your options with you to help you find the right one. Before the appointment for your abortion, there will be some preparation required, including:

. Arrange for someone to drive you home after the procedure.

. You can’t eat for a certain amount of time before the procedure, which will be specified by your doctor.

. If your doctor gives you pain or dilation medication at an appointment before the procedure, follow the instructions carefully.

. Don’t take any medications or drugs for 48 hours before the procedure without discussing it with your doctor first. This includes aspirin and alcohol, which can thin the blood.

Potential risks and complications

While abortions are typically extremely safe and most women have no complications outside of common side effects, the likelihood of complications increases slightly as the gestational period increases.

Potential complications from surgical abortions include:

. Infection: can be serious and may require hospitalization. Symptoms include fever, abdominal pain, and unpleasant-smelling vaginal discharge. The chance of infection increases if you have a sexually transmitted infection.

. Cervical tears or lacerations: can often be resolved with stitches after the procedure if necessary.

. Uterine perforation: which can occur when an instrument punctures the uterine wall.

. Hemorrhaging: which can result in bleeding sufficient enough that a blood transfusion or hospitalization is needed.

. Retained products of conception: when part of the pregnancy is not removed.

. Allergic or adverse reactions to medications: including pain medication, sedatives, anesthesia, antibiotics, and/or dilation medication.

What to expect after a surgical abortion

It’s recommended that women rest for the rest of the day after the abortion. Some women will be able to return to most normal activities (except for heavy lifting) the next day, though some may take an extra day or so. The recovery period for a D&E abortion may last longer than that for an aspiration abortion.

Common side effects

Immediately after the procedure and during the recovery period, you may experience some side effects. Common side effects of surgical abortions include:

. Bleeding, including blood clots

. Cramping

. Nausea and vomiting

. Sweating

. Feeling faint

Once your healthcare provider ensures that your health is stable, you will be discharged home. Most women experience vaginal bleeding and cramping similar to a menstrual cycle for two to four days.

When to see your doctor

Some side effects are symptoms of potentially emergent conditions. You should call your clinic or seek immediate medical attention if you experience the following symptoms:

. Passing blood clots that are larger than a lemon for more than two hours

. Bleeding that is heavy enough that you have to change your pad twice in one hour for two hours straight.

. Foul-smelling vaginal discharge

. Fever

. Pain or cramping that gets worse instead of better, especially after 48 hours

. Pregnancy symptoms that persist after one week

After abortion care tips

After your abortion, your doctor or clinic will provide you with specific after-care instructions. Sometimes this isn’t enough to reduce unpleasant side effects.

To reduce side effects and increase your comfort after an abortion, you can:

. Use heating pads, which can ease cramps.

. Stay hydrated, especially if you’re experiencing vomiting or diarrhea.

. Have a support system in place, as some women experience emotional changes from the drastic hormone shift.

. If possible, plan on staying in for a day or two, so that you can rest and recover in the comfort of your own home.

. Take medication like ibuprofen to lessen cramps and pain.

. Massage your abdomen at the site of the cramps.

. Wear a tight-fitting bra to relieve breast tenderness.

Menstruation and sex

Your period should return four to eight weeks following your abortion. Ovulation can occur without noticeable signs or symptoms, and often before you resume normal menstrual cycles, so you should always use contraception. You should wait to have sex for at least one to two weeks after the abortion, which can help reduce the risk of infection. You also should wait for this period of time to use tampons, or insert anything into the vagina.

Bleeding after an abortion

Many women will experience bleeding after an abortion. During this time period, you may experience days with light to heavy spotting.

It’s also normal to pass blood clots, though passing large clots (the size of a golf ball) for more than two hours is not normal.

Consistent heavy bleeding is defined as going through two or more maxi pads in one hour, or bleeding heavily for 12 hours or more. This may be a sign of complications, and especially so if the blood is bright red after the first 24 hours post-abortion, as compared to a darker red, or if it accompanies a stabbing, persistent pain.

After abortion birth control use

You can get pregnant almost immediately after having an abortion, so you must use contraception right away to avoid pregnancy.

If you don’t start contraception immediately after the abortion, wait to have sex until you’ve completed your first week of the contraceptive or use backup contraception like condoms. If your doctor inserted an IUD, it will start to prevent pregnancy immediately, though you should still wait two weeks to prevent serious infections.

10 common Questions about this abortion

1What does an abortion feel like?
For most people, it feels like strong period cramps. Your doctors and nurses will help make your abortion as comfortable as possible. You'll get pain and numbing medications that will make it hurt less and you may get sedation. You may have a little cramping after your abortion.
2How abortions are performed?
Method of surgical abortion. Most abortions are performed using 'suction (vacuum) aspiration'. To have this procedure you need to be in your first trimester (first three months) of pregnancy. (This means you are 12 weeks pregnant or less.)
3How late can you have an abortion?
Due to the risk of viability—and the corresponding legal implications that can come with a live birth—most experts recommend induced fetal demise for abortions after 18 to 20 weeks gestation.
4What states allow abortion?
The following states have or had initiatives regarding abortion: Colorado. Main article: Colorado Amendment 48 (2008) ... Kansas. ... Louisiana. ... Mississippi. ... North Dakota. ... Oklahoma. ... South Dakota. ... Texas.
5What is the name of the abortion pill?
Mifepristone Mifepristone, also known as RU-486, is a medication typically used in combination with misoprostol to bring about an abortion during pregnancy. This combination is more than 95% effective during the first 49 days of pregnancy. It is also effective in the second trimester of pregnancy.
6How is a second trimester abortion performed?
Dilation and evacuation (D&E) is one of the methods available for a second-trimester abortion. A D&E is done to completely remove all of the tissue in the uterus for an abortion in the second trimester of pregnancy.
7What happens in a partial birth abortion?
In the U.S., a federal statute defines "partial-birth abortion" as any abortion in which the life of the fetus is terminated after having been extracted from the mother's body to a point "past the navel [of the fetus]" or "in the case of head-first presentation, the entire fetal head is outside the body of the mother" ...
8What is the most common method of abortion?
Modern methods use medication or surgery for abortions. The drug mifepristone in combination with prostaglandin appears to be as safe and effective as surgery during the first and second trimester of pregnancy. The most common surgical technique involves dilating the cervix and using a suction device.
9What is trigger law on abortion?
Trigger law. From Wikipedia, the free encyclopedia. A trigger law is a nickname for a law that is unenforceable, but may achieve enforceability if a key change in circumstances occurs.
10What causes missed abortion?
Autoimmunity is possible cause of recurrent or late-term miscarriages. In the case of an autoimmune-induced miscarriages the woman's body attacks the growing fetus or prevents normal pregnancy progression. Autoimmune disease may cause genetic abnormalities in embryos which in turn may lead to miscarriage.

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