Abortion

Overview

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An abortion is a procedure that is performed to end a pregnancy. In the United States, abortion is a safe and legal option for women who cannot or choose not to continue with a pregnancy. Deciding to have an abortion is a very personal decision. Any woman considering abortion should understand the risks and benefits of the various types of abortion, as well as the alternatives to abortion, including parenting and adoption. This section focuses on abortion early in pregnancy (< 14 weeks).

Types of Abortion Procedures 

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There are two basic ways abortions are performed:

  • With a "medical" or "medication abortion," you take medicine to end the pregnancy.
  • With a "surgical" abortion, a doctor does a procedure to remove the pregnancy.

The type of abortion you have depends on how far along you are in your pregnancy, and your personal preference.
You may prefer a medical abortion if:

  • You would prefer to be in the privacy of your home, or
  • You would prefer to avoid having a procedure to remove the pregnancy. However, in 2 percent of cases, medication abortion does not end or completely remove the pregnancy tissue from inside the uterus and a surgical procedure is needed.

You may prefer a surgical abortion if:

  • You prefer to have the abortion completed in one visit,
  • You are not comfortable with the idea of heavy vaginal bleeding and passing pregnancy tissue at home.

Initial evaluation:
For both medication and surgical abortion, you will have the following before the procedure.

  • An ultrasound to confirm the pregnancy and determine how far along your pregnancy is.
  • A blood test to determine your blood type. If you have a negative blood type (e.g., A negative), you will be given an injection of a medication called Rh immune globulin (RhoGAM®) after the abortion. This helps prevent your immune system from causing complications in future pregnancies.
  • A test for the sexually transmitted infections gonorrhea and chlamydia, done at the time of the procedure.
  • You will also discuss options for birth control. You can become pregnant again quickly after medication or surgical abortion, even before your next menstrual period. You can start using most methods (pill, patch, vaginal ring, injection, intrauterine device [IUD], implants) on the day of a surgical abortion.

With Abortion abortion, you can start birth control when your doctor confirms that your pregnancy has ended.

Medication Abortion

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Medication abortion involves taking two different medications to end an early pregnancy (< 9 weeks).

Initial evaluation:
You will be given two medications, mifepristone and misoprostol. Information about these medications is available online (see www.earlyoptionpill.com or www.prochoice.org/about_abortion/facts/medical_abortion.html).

  • You will take the mifepristone in the office. This medication stops the pregnancy from further developing. Most women do not feel any differently after taking it, but some may have mild cramping or light bleeding.
  • You will take the misoprostol at least 24 hours after you have taken the mifepristone, at home.

Expected side effects:
Abdominal pain, cramps, and vaginal bleeding are expected side effects with medication abortion. Some women also have fever, nausea, vomiting, or diarrhea.

Pain and cramps:
Most women will have abdominal pain and cramps after taking the misoprostol. These cramps may be mild or strong. The pain usually improves after the pregnancy has passed out of your uterus, within 4 to 6 hours after taking the misoprostol.
You can take 600 to 800 mg of ibuprofen (Advil or Motrin) every 6 to 8 hours for pain, if needed. Some doctors and nurses also give a prescription for a stronger pain medication to use if needed. You can also use a heating pad. If you have severe pain that is not relieved by these treatments, call your doctor immediately.

Vaginal bleeding:
You should expect to have vaginal bleeding with a medication abortion. The bleeding may be heavy, especially in the first few hours after you take the misoprostol. The bleeding usually decreases after you pass the pregnancy tissue out of your uterus, and then continues for several days to several weeks. It should be lighter than a menstrual period after the first week.
If you are bleeding so heavily that you soak through one menstrual pad per hour for two hours in a row, you should call your healthcare provider or clinic immediately. If you do not have bleeding at all after you take the medications, you should also call your healthcare provider.

Fever, nausea, vomiting, diarrhea:
Some women experience a mild fever, nausea, vomiting, or diarrhea after taking the misoprostol. This usually gets better on its own. If you develop a fever greater than 100.4ºF (38ºC) or if you have chills, vomiting, or diarrhea that does not go away within a day of taking the medications, call your doctor or nurse.
How effective is medication abortion? — Medication abortion is very effective in ending pregnancies that are up to 49 days (less than 7 weeks). It is nearly as effective in ending pregnancies up to 63 days (9 weeks).
If medication abortion is not effective in ending your pregnancy, you will need to have a surgical abortion. Continuing a pregnancy after taking mifepristone or misoprostol is not safe due to the risk of birth defects from the medications.

Surgical Abortion

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Surgical abortion is a procedure that is done in a clinic or hospital to end a pregnancy. The procedure is done by removing the pregnancy tissue from the uterus.
Some form of anesthesia is given. The procedure usually takes less than 15 minutes.
It is possible to have a surgical abortion after 14 weeks.

Expected side effects:
Vaginal bleeding, abdominal pain, and cramping are expected side effects after a surgical abortion.

Abdominal pain and cramping:
Most women have some abdominal pain and cramping after a surgical abortion. You can take 600 to 800 mg ibuprofen (Advil, Motrin) every 6 to 8 hours for pain, if needed.
If you have severe pain that does not get better with these treatments or if your pain continues for more than a few days after the procedure, call your healthcare provider.

Vaginal bleeding:
It is normal to have some vaginal bleeding after a surgical abortion. Usually the bleeding is less than what you have with a normal menstrual period. The bleeding usually lasts a few days to a few weeks, and should become lighter after the first few days. You may also pass blood clots.
If you are bleeding so heavily that you soak through one menstrual pad per hour for two hours in a row, you should call us immediately.

When to Seek Help After Abortion — Call your healthcare provider if:

  • You are bleeding so heavily that you soak through one menstrual pad per hour for two hours in a row.
  • You have severe pain that is not relieved by pain medications.
  • You have shaking chills or develop a temperature greater than 100.4ºF or 38ºC.
  • You have foul-smelling or pus-like vaginal discharge.

In addition, you should be aware of signs that your abortion was not complete. Call your healthcare provider if:

  • You do not have vaginal bleeding after a medication abortion.
  • Your pregnancy symptoms (breast tenderness, nausea) do not resolve within one week after your abortion. You should not do a home pregnancy test, even if you still feel pregnant, because it can be positive for up to 6 weeks after having an abortion.
  • You do not have a menstrual period within 6 weeks after your abortion.

Follow Up Care:
About one week after a medication abortion, you should have a follow up visit with your doctor or nurse. It is very important to go to this visit to be sure you are no longer pregnant.
You should not have sex or put anything in your vagina (tampons, douches) for two weeks after an abortion. Putting anything in the vagina before this time could lead to a serious infection.

Sources:
http://www.uptodate.com/contents/patient-information-abortion-the-basics?source=search_result&search=abortion&selectedTitle=1~150

http://www.uptodate.com/contents/patient-information-abortion-pregnancy-termination-beyond-the-basics?source=search_result&search=abortion&selectedTitle=3~150