Sex and Health: Abortion

There are two kinds of abortion, surgical and medical.

SURGICAL ABORTION

The method used depends on how long you have been pregnant - the number of days since the first day of your last period.

First Trimester (7-13 weeks): Dilation & Aspiration (D&A)

With few exceptions, surgically induced abortions are performed by a procedure known as dilation and aspiration. During this procedure, the cervix or neck of the uterus (womb) must be opened to remove the fetus. In the first 12 weeks of pregnancy this is generally accomplished by sequentially inserting tapered rods of increasing width called "dilators". Usually, the cervix needs to be opened no more than 1/4"-1/2" in the first trimester. This can be done with anywhere between 1 to 8 dilator insertions, depending on the stage of the pregnancy and the resistance of the individual cervix, and will cause cramping (much like menstrual cramps). Once the cervix has been adequately dilated, the fetus is removed by inserting a hollow plastic tube called a "vacurette" and applying suction. Generally, the plastic tube is moved in and out or is rotated to enhance the suction force at the tip of the vacurette. This is sometimes followed by curetting (scraping) the walls of the uterus to ensure that no fetal tissue or parts are left behind that might cause subsequent problems.

Second Trimester (13-26 weeks): Dilation & Evacuation (D&E)

Abortion performed in the middle months of pregnancy is a significantly different procedure from the first trimester. The procedures used require greater time and skill and entail somewhat greater risk. The essential difference is the cervix must be dilated to increasing diameters as the fetus grows. The extent to which the cervix can be safely dilated with dilators varies, dependent upon the woman's cervix. Most experienced physicians will avoid the use of mechanical dilators beyond the 14th week of pregnancy; some will avoid them after the 10th week. As a general rule, the method of choice for dilating the cervix beyond the 12th week involves the use of osmotic dilators. Osmotic dilators are stalks of material, which absorb water and expand once placed inside the cervix, they are inserted and left overnight (this will cause cramping). The next morning, the cervix will have dilated and softened. The fetus and placenta are removed in parts with forceps. Suction is then used to scrape the uterus to ensure no fetal parts remain. Sharp curettage may or may not be performed as a final step. This type of abortion is performed under sedation combined with local anesthesia.

*After 24 weeks of pregnancy, abortions are usually performed only for serious health reasons.

Possible complications following surgical abortions:
• infection
• incomplete abortion
• heavy bleeding
• damage to the uterus or nearby internal structures
• cervical tears
• continued pregnancy

MEDICAL ABORTIONS (for use up to 7 weeks, or 49 days)

Currently, the three drugs used for early non-surgical abortions are Methotrexate, Mifepristone (RU-486), and Misoprostol. In this procedure, either Methotrexate or Mifepristone is taken first and Misoprostol is taken a few days later.

Methotrexate is a drug approved by the FDA for the treatment of cancer and certain chronic diseases. When being administered to induce an abortion, Methotrexate is given to the women in the form of an injection or shot, the dose of which is determined by the woman's height and weight. Methotrexate halts the implantation process that occurs during the first several weeks after conception. The most common side effects of a single dose include nausea, diarrhea, cramping, and/or sores in the mouth. Less often, vomiting, headaches, dizziness, sleeplessness, and/or vaginal bleeding may occur.

Another medication that may be used is Mifepristone (RU-486). Mifepristone was developed and tested specifically as an abortion-inducing agent. Mifepristone is taken orally, and works by blocking the hormone progesterone that is necessary to sustain pregnancy. Without progesterone, the lining of the uterus breaks down, the cervix softens, and bleeding begins.

With the use of either Methotrexate or Mifepristone, a second drug, Misoprostol, is administered several days after Methotrexate or 2 days after taking Mifepristone. Misoprostol acts on the uterus to create contractions and bleeding, similar to those of a spontaneous abortion or "miscarriage". When taken after abortion-inducing drugs, it causes the uterus to expel the fetus. The contractions usually occur 2 to 4 hours after insertion of the suppositories. Heavy bleeding is expected at times, followed by several abdominal cramps. Generally, cramping will be milder after the fetus has been expelled. The fetus and fetal tissue may be expelled at an unexpected time or place.

For most women, the abortion will be complete within four hours of taking the second medicine. Depending on which medication is used, however, the process, including bleeding may last between one and two weeks for some women.

A follow-up appointment is necessary to make sure the abortion is complete and there is no risk of infection. If the abortion was not complete, a surgical abortion must be performed to ensure all the fetal tissue has been removed. U.S. trials of Mifepristone indicate that 2 in 25 women will have to follow up their medical abortion with a surgical abortion (Spitz, Irving, et al., New England Journal of Medicine, 1998).

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SEX & HEALTH: ABORTION

There are two kinds of abortion, surgical and medical. SURGICAL ABORTION The method used depends on how long you have been pregnant - the number of days since the first day of your last period. First Trimester (7-13 weeks): Dilation & Aspiration (D&A) With few exceptions, surgically induced abortions are performed by a procedure known as dilation and aspiration. During this procedure, the cervix or neck of the uterus (womb) must be opened to remove the fetus. In the first 12 weeks of pregnancy this is generally accomplished by sequentially inserting tapered rods of increasing width called "dilators". Usually, the cervix needs to be opened no more than 1/4"-1/2" in the first trimester. This can be done with anywhere between 1 to 8 dilator insertions, depending on the stage of the pregnancy and the resistance of the individual cervix, and will cause cramping (much like menstrual cramps). Once the cervix has been adequately dilated, the fetus is removed by inserting a hollow plastic tube called a "vacurette" and applying suction. Generally, the plastic tube is moved in and out or is rotated to enhance the suction force at the tip of the vacurette. This is sometimes followed by curetting (scraping) the walls of the uterus to ensure that no fetal tissue or parts are left behind that might cause subsequent problems. Second Trimester (13-26 weeks): Dilation & Evacuation (D&E) Abortion performed in the middle months of pregnancy is a significantly different procedure from the first trimester. The procedures used require greater time and skill and entail somewhat greater risk. The essential difference is the cervix must be dilated to increasing diameters as the fetus grows. The extent to which the cervix can be safely dilated with dilators varies, dependent upon the woman's cervix. Most experienced physicians will avoid the use of mechanical dilators beyond the 14th week of pregnancy; some will avoid them after the 10th week. As a general rule, the method of choice for dilating the cervix beyond the 12th week involves the use of osmotic dilators. Osmotic dilators are stalks of material, which absorb water and expand once placed inside the cervix, they are inserted and left overnight (this will cause cramping). The next morning, the cervix will have dilated and softened. The fetus and placenta are removed in parts with forceps. Suction is then used to scrape the uterus to ensure no fetal parts remain. Sharp curettage may or may not be performed as a final step. This type of abortion is performed under sedation combined with local anesthesia. After 24 weeks of pregnancy, abortions are usually performed only for serious health reasons. Possible complications following surgical abortions: • infection • incomplete abortion • heavy bleeding • damage to the uterus or nearby internal structures • cervical tears • continued pregnancy MEDICAL ABORTIONS (for use up to 7 weeks, or 49 days)* Currently, the three drugs used for early non-surgical abortions are Methotrexate, Mifepristone (RU-486), and Misoprostol. In this procedure, either Methotrexate or Mifepristone is taken first and Misoprostol is taken a few days later. Methotrexate is a drug approved by the FDA for the treatment of cancer and certain chronic diseases. When being administered to induce an abortion, Methotrexate is given to the women in the form of an injection or shot, the dose of which is determined by the woman's height and weight. Methotrexate halts the implantation process that occurs during the first several weeks after conception. The most common side effects of a single dose include nausea, diarrhea, cramping, and/or sores in the mouth. Less often, vomiting, headaches, dizziness, sleeplessness, and/or vaginal bleeding may occur. Another medication that may be used is Mifepristone (RU-486). Mifepristone was developed and tested specifically as an abortion-inducing agent. Mifepristone is taken orally, and works by blocking the hormone progesterone that is necessary to sustain pregnancy. Without progesterone, the lining of the uterus breaks down, the cervix softens, and bleeding begins. With the use of either Methotrexate or Mifepristone, a second drug, Misoprostol, is administered several days after Methotrexate or 2 days after taking Mifepristone. Misoprostol acts on the uterus to create contractions and bleeding, similar to those of a spontaneous abortion or "miscarriage". When taken after abortion-inducing drugs, it causes the uterus to expel the fetus. The contractions usually occur 2 to 4 hours after insertion of the suppositories. Heavy bleeding is expected at times, followed by several abdominal cramps. Generally, cramping will be milder after the fetus has been expelled. The fetus and fetal tissue may be expelled at an unexpected time or place. For most women, the abortion will be complete within four hours of taking the second medicine. Depending on which medication is used, however, the process, including bleeding may last between one and two weeks for some women. A follow-up appointment is necessary to make sure the abortion is complete and there is no risk of infection. If the abortion was not complete, a surgical abortion must be performed to ensure all the fetal tissue has been removed. U.S. trials of Mifepristone indicate that 2 in 25 women will have to follow up their medical abortion with a surgical abortion (Spitz, Irving, et al., New England Journal of Medicine, 1998).

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