Methods of Abortion

What are the Methods of Abortion?

Abortion is the termination of pregnancy. It is done either by removal (surgically) or expulsion of the fetus or embryo (with medicines) before the completion of the gestation period, when it is unable to survive on its own.

Purposefully inducing an abortion is known as Induced Abortion. Abortion that happens spontaneously is called as Spontaneous Abortion. Induced Abortions can be of two types: Chemical (using medication) and Surgical.

Death of fetus before 24 weeks of gestation is called as Miscarriage. A baby born dead after completion of 24 weeks of gestation is called as Still Birth.

An Ultrasound is done first to decide, which method of abortion is suitable for a patient along with details of patient's medical and drug history. Ultrasound is also useful in determining the gestation period, viability of the pregnancy and to rule out ectopic pregnancy.

Methods of Abortion: It greatly depends upon the stage of pregnancy: first, second and third trimester.

First Trimester

• Mifepristone and Misoprostol: It is a medical abortion using drugs. This method of abortion can be used up to nine weeks of gestation. Mifepristone is the first drug that needs to be taken. Misoprostol is given within 24-48 hours after taking the first pill. Heavy bleeding and cramps can be expected one to four hours after taking Misoprostol.

• Methotrexate and Misoprostol: Methotrexate causes placental cell death. While Misoprostol causes contraction and expulsion of the fetus. Methotrexate is a chemotherapy drug used in treatment of cancers. This drug is banned in certain countries.
• Manual Vacuum Aspiration: It is a minimal invasive procedure done as early as 3-12 weeks since the last period. It requires local anesthesia on the cervix. It uses a handheld syringe to remove uterine contents.
• Aspiration: This procedure can be opted to terminate pregnancy up to 16 weeks of gestation. Also, known as Suction Curettage or Vacuum Aspiration, it requires local anesthesia on the cervix. It is done by introducing a plastic tube connected to a suction device to remove the fetus and the placenta.

Second Trimester

• Dilation and Curettage: This procedure can be opted to terminate pregnancy up to 16 weeks of gestation. It is also called as Suction Curettage or Vacuum Aspiration.
• Dilation and Evacuation: It is a surgical procedure to terminate pregnancy after 16 weeks of gestation. Usually, a laminaria or a synthetic dilator is inserted into the cervix 24 hours prior to the procedure to dilate the cervix. The procedure is performed under local anesthesia. A cannula, a long tube, is used to remove the tissue from the lining, following which curettage is done to remove residual tissue. Finally, suction aspiration is done to make sure the abortion is complete. A course of antibiotics is given to prevent infection.
• Induction Abortion: It is used for termination of pregnancy after 15 weeks of gestation. It is done by inducing labor with drugs. Drugs are given intravenously or/ and injected into the uterus. Prostaglandins, Pitocin and salt solution are commonly employed for this purpose.

Third Trimester

• Induction Abortion: This can be performed any time after 15 weeks of gestation. In case of difficulty in delivering the fetus through induction (with drugs given intravenously or/and injected into the uterus), hysterotomy is done to empty the contents of the uterus.
• Dilation and Extraction: It is commonly employed after 21 weeks of gestation. It is also known as intrauterine cranial decompression or Partial birth abortion. Laminaria are inserted two days before the procedure for cervical dilatation. On the third day, amniotic sac is expected to rupture, following which forceps are used to expel the fetus. A suction catheter is used for removal of cerebral material leading to skull collapse and fetal removal.

What to Expect After an Abortion?

• Cramping: It is common to experience cramping for a few days after an abortion. Pain relievers like ibuprofen or paracetamol can be taken with the consent of your doctor. Aspirin should be avoided, as it increases bleeding. In case of severe cramping despite medication, infection should be suspected.

• Bleeding: Bleeding with clots, and slight bleeding or spotting that lasts upto four weeks are common side-effects after an abortion. If heavy bleeding and/or passing huge clots even after a week, seek medical help immediately.
• Breast Tenderness: Breast tenderness after an abortion can last upto two weeks. If the period of gestation was longer at the time of abortion, tenderness would be higher. Wearing a supportive bra and taking pain medication would help.

What are the Possible Complications of an Abortion?

The risk of developing complications with an abortion in early weeks of pregnancy is less. With progressing pregnancy, chances are high for developing severe complications and even death from an abortion.

• Fever is a sign that there could be a possible infection after the procedure. In case, fever develops after an abortion, seek medical help immediately to prevent further complications.
• Uterine Perforation is a hole in the uterus.
• Retained Products of Conception requiring Dilatation and Evacuation: Left over products of conception after an abortion requires a procedure to completely evacuate the fetus and placenta
• Profuse Bleeding
• Cervical Laceration Hysterectomy Inability to Conceive may happen due to infection or complication from the procedure.
• Injury to the Bowel or Bladder
• Complications from Anesthesia

Health Tips

• Cramping after an abortion can be eased by using a heating pad along with pain relief medications
• Rest, lying down on the side you have pain and/or massaging the abdomen from the navel downwards relieves from cramping after an abortion.
• Ice packs can be used every two hours for relief from breast tenderness. It is best to avoid squeezing milk or massaging the breasts after an abortion.
• Sexual intercourse, strenuous activities, lifting heavy objects, tub baths and swimming should be avoided at least for two weeks after an abortion.
• Tampons and douching is also not advised due to the risk of developing infection.
• Adequate rest and good nutrition help in speedy recovery after an Abortion.

References:

1. Abortion - (https://en.wikipedia.org/wiki/Abortion)
2. Category: Methods of abortion - (https://en.wikipedia.org/wiki/Category:Methods_of_abortion)
3. Abortion Procedures - (https://americanpregnancy.org/unplanned-pregnancy/abortion-procedures/)

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