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Abortion

What is an abortion?

Abortion is the termination of a pregnancy. It can be induced (abortion) or spontaneous (miscarriage). There two types of induced abortion: RU-486 (Abortion Pill) and Surgical Abortion  

If you are considering an abortion, it is important to be educated concerning all aspects of the procedure. Abortion, whether medical or surgical, comes with risks to the mother. You should also consider that miscarriage, or natural loss of the pregnancy is common. According to the American College of Obstetricians and Gynecologists (ACOG), an estimated 15-20% of all clinically recognized pregnancies will naturally end in a miscarriage.

 

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Abortion

For more detailed information see Patient Education/Abortion Education

Medical Abortion

A medical abortion causes the termination of a pregnancy by using a combination of medications.  The CDC updated guidelines to now allow women to take the medication 21 days later into a pregnancy, increasing the allowable window from 49 days from last menstrual period to 70 days from last menstrual period

The FDA also decreased the dosage of one of the drugs on the market that medical societies previously criticized as being too high. In most states, the number of doctor's visits women will have to make in cases of medical abortion is now reduced to two days. Ultrasound is used to determine if the pregnancy is in the uterus and the gestational age obtained will ensure the 70 days is adhered to

An example of an abortion appointment might include receiving your first medicine, Mifepristone at the clinic on the day your abortion is scheduled. Mifepristone works by blocking the hormone progesterone. Without progesterone, the uterine lining breaks down and your pregnancy cannot continue.

The second medicine given is misoprostol. It causes the uterus to contract and empty. You'll take the second medicine 24-48 hours after taking mifepristone. Your healthcare provider will give you instructions on how and when to take the second medicine. Misoprostol will cause you to have cramps and bleed vaginally. 

You may see large blood clots and/or tissue as your pregnancy (embryo) is expelled. More than half of women abort within four or five hours after taking the second medicine. For others, it takes longer. Most women abort within a few days. It's normal to have some bleeding or spotting for up to four weeks after the abortion. 

The medications are taken to end a viable pregnancy.

Surgical Abortion Suction Aspiration

"How is aspiration performed?

Aspiration is a surgical abortion procedure performed during the first 6 to 16 weeks gestation. It is also referred to as suction aspiration, suction curettage, or vacuum aspiration. Your abortion provider will give you medication for pain and possibly sedation. You will lie on your back with your feet in stirrups, and a speculum is inserted to open the vagina.

local anesthetic is administered to your cervix to numb it. Then a tenaculum (a surgical instrument with long handles and a clamp at the end) is used to hold the cervix in place for the cervix to be dilated by absorbent rods that vary in size.

The rods may also be put in a few days prior to the procedure. When the cervix is wide enough, a cannula, which is a long plastic tube connected to a suction device, is inserted into the uterus to suction out the fetus and placenta.

The procedure usually lasts 10-15 minutes, but recovery can require staying at the clinic for a few hours. Your doctor will also give you antibiotics to help prevent infection."  http://americanpregnancy.org/unplanned-pregnancy/surgical-abortions/  retrieved 10/13/17

Dilation and Evacuation (D&E)

This surgical procedure is generally performed from 16-24 weeks of pregnancy. The doctor generally first insert laminaria (thin sticks of seaweed) into the cervix 1-2 days before the procedure to start the dilating process. These dried seaweed sticks absorb moisture and expand, causing the cervix to open. On the day of the procedure, the physician will use dilating rods to further enlarge the cervical opening. The fetus is dismembered and removed with forceps, along with the placenta and other tissue. A curette may then be used to scrape the uterus to make sure that all tissue has been removed. It is important that all of the fetal parts are identified to help ensure a complete abortion.

Dilation and Extraction (D&X)

This procedure is used for 20 weeks to full term. This procedure takes three days. During the first two days, the cervix is dilated and medication is given for cramping. On the third day, the woman receives medication to start labor. After labor begins, the abortion doctor uses ultrasound to locate the positioning of the fetus. Using forceps the fetus is delivered up to the head. Next, scissors are inserted into the skull to create an opening. A suction catheter is placed into the opening to remove the skull contents. The skull collapses and the fetus is removed.

Anesthesia for Surgical Abortion

Three options are available for pain relief during a surgical abortion:

  1. Local anesthesia: A local anesthetic is injected into the cervix to cause a numbing effect before dilation.
  2. Local anesthesia with sedation: Along with a local anesthetic injected into the cervix, a medication usually oral, is given to help the woman relax or become "sleepy" during the procedure.
  3. General anesthesia: Anesthetic medications are given intravenously to cause the woman to be "asleep", completely unaware of her surroundings.

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"I would return to Alternatives because 'the staff is nice and non-judgmental'."

What are some of the possible side effects of abortion?

Approximately 1 in 100 women having an early abortion will have complications and 1 in 50 women will experience side effects after a later abortion.

Depending on the abortion procedure done the following non-anticipated side effects may occur:

  • Cramping of the uterus, or pelvic pain
  • nausea
  • Diarrhea
  • Headache
  • Dizziness
  • Fatigue
  • Emotional or psychological distress

What are the risks of abortion?

The side effects from anesthesia may include:

  • Allergic reactions to medications
  • Problems breathing

Side effects after a surgical abortion include:

  • Heavy bleeding, blood clots vaginally
  • Infection—Your health care provider will prescribe antibiotics to prevent this. Antibiotics are also prescribed for infections diagnosed after an abortion.
  • Infection of the fallopian tubes (which can cause scarring and increase chances of infertility)
  • Puncture (perforation) of the uterus
  • Scarring of the uterine lining (suction tubing, curettes, and other abortion instruments may cause permanent scarring of the uterine lining)
  • Damage to the cervix (creating complications with future pregnancies)
  • Death, in rare circumstances

In cases when a medical abortion fails to terminate the pregnancy, a surgical abortion will become necessary to complete the abortion.

What questions should I ask when consulting an abortion provider?

When considering an abortion, it is important to realize it is not a risk-free procedure and needs to be treated seriously. For your safety and future reproductive health, there are several very important questions to ask an abortion provider.

Is this facility a licensed medical clinic? What are my legal rights?

To receive more information on patients rights, you may contact Alternatives for a confidential consultation. Call the number above. Remember, we are here to help.

Is the person performing the procedure a licensed OB/GYN physician?

Make sure to speak with the physician before going through with the procedure regarding anesthesia choices, how the procedure is done, and the possible complications.

 

Alternatives Medical Clinic is committed to providing the evidence-based medical care and education you need to decide with confidence how you will proceed concerning your unique situation.

While we do not perform abortions or provide abortion referrals, our services are an important first step when faced with an unplanned pregnancy. We do not make any money based on your decision and are committed to providing our free, confidential services in a friendly, safe and non-judgmental atmosphere.

 

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References

  1. RU-486-know the facts about the "abortion pill" Before You Decide, FOF 2014, F00903T
  2. http://americanpregnancy.org/unplanned-pregnancy/surgical-abortions/  retrieved 10/13/2017
  3. American College of Obstetricians and Gynecologists Induced Abortion, 2001.
  4. Warren Hern, Abortion Practice, 1990, Philadelphia: J.P. Lippincott Company

 

 

 

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