An “abortion” is the termination of unwanted pregnancy. It can be spontaneous (also called miscarriage) or induced. Abortion can be induced surgically (e.g., by vacuum aspiration, or dilatation and curettage) or medically (e.g., using an antiprogestogen and/or prostaglandins), safely or unsafely.
Methods of abortion
The method for inducing abortion will depend upon the duration of the pregnancy, the training and skills of the provider, the facilities available and the preference of the woman. In most cases, the gestation can be determined reliably from the date of the LMP (last menstrual period) and the findings on pelvic examination.
Ultrasound investigation is necessary only when there is clinical doubt about the period of gestation or suspicion of ectopic pregnancy. Unless the woman has a serious pre-existing medical condition, or the chosen method requires an inpatient stay, both surgical and medical abortion should be done as outpatient procedures.
Medical methods of abortion
The most safe and widely used medical regimens to terminate pregnancy combine treatment with the antiprogestogen mifepristone and with a prostaglandin, such as misoprostol. Medical methods of abortion up to 9 weeks are safe and effective. From 9 to 14 weeks, surgical abortion is at present recommended since the efficacy of medical abortion with current dosage regimens is lower, blood loss is greater, and products of conception are more likely to be retained. Beyond 14 weeks, when the placenta tends to be completely expelled, medical methods of inducing abortion offer a safe and effective alternative to surgical procedures.
Fewer than 5% of women undergoing medical abortion will require surgical intervention for continuing pregnancy or incomplete abortion. Services that offer medical abortion must have access to facilities for surgical intervention.
Side effects of medical methods include:
- Cramping and prolonged menstrual-like bleeding. Bleeding usually lasts for 9 days but can be prolonged for up to 45 days in rare cases;
Instruments for surgical abortion
Surgical methods of abortion
Types of surgical techniques are vacuum aspiration and dilatation with curettage.
Vacuum aspiration is a very safe procedure, which involves evacuating the contents of the uterus through a plastic or metal cannula attached to a vacuum source. The vacuum can be generated either by an electric pump or with a hand-held plastic 60-ml syringe. Available aspirators can accommodate different sizes of plastic cannulae, ranging from 4 to at least 12 mm in diameter.
It is the preferred surgical method up to 12 weeks since the LMP, and some skilled practitioners can do it safely at up to 15 weeks. A paracervical block or light sedation, or both, are required.
Dilatation and curettage (D&C)
Dilatation and curettage (D&C) involves dilating the cervix with mechanical dilators or pharmacological agents and using sharp metal curettes to scrape the walls of the uterus. It is less safe than vacuum aspiration and more painful. It is applicable for abortion up to 12 weeks, although specially skilled providers can do it up to 14 weeks. D&C should be used only where vacuum aspiration or a medical method is not available, since sharp curettage carries higher risks. Health service managers should make every effort to replace sharp curettage with vacuum aspiration.
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