Abortion

Abortion is the removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterus.

Preparation

Your doctor will ask about your medical history and examine you. Even if you used a home pregnancy test, another pregnancy test often is needed to confirm that you are pregnant. In some cases, you will need an ultrasound to determine how many weeks into the pregnancy you are and the size of the fetus, and to make sure the pregnancy is not ectopic. An ectopic pregnancy is one that is growing outside of the uterus. An ectopic pregnancy usually occurs in the tube that carries the egg from the ovary to the uterus (Fallopian tube) and is commonly called a tubal pregnancy.

A blood test will determine your blood type and whether you are Rh positive or negative. The Rh protein is made by the red blood cells of most women. These blood cells are considered Rh positive. Some women have red blood cells that do not produce Rh protein. These blood cells are considered Rh negative. Pregnant women who have Rh-negative blood are at risk of reacting against fetal blood that is Rh positive. Because a reaction can harm future pregnancies, Rh-negative women usually receive an injection of Rh immunoglobulin (RhIg) to prevent Rh-related problems after miscarriage or abortion.

How It Is Done

Doctors can use medications, surgery or a combination of both to end a pregnancy. The method depends on how far along in the pregnancy you are, your medical history and your preference. Abortions during early pregnancy, before 9 weeks, can be done safely with medications. Abortions between 9 and 14 weeks usually are done surgically, although medications may be used to help soften and open the cervix. After 14 weeks, abortions can be done using labor inducing medications that cause uterine contractions or by using these medicines in combination with surgery.

Medical abortion

Abortions completed with medication, called medical abortions, are done within 49 days from the start of the pregnancy. Pregnancy usually starts two weeks after the first day of a menstrual period, so this corresponds to nine weeks from the last menstrual period

A woman should not have a medical abortion if she:

• Is more than 49 days pregnant
• Has bleeding problems or is taking blood thinning medication
• Has chronic adrenal failure or is taking certain steroid medications
• Cannot attend the medical visits necessary to ensure the abortion is completed
• Does not have access to emergency care
• Has uncontrolled seizure disorder (for misoprostol)
• Has acute inflammatory bowel disease (for misoprostol)
• Surgical abortion

Roughly one-half of all abortions are done during the first 8 weeks of pregnancy and about 88% during the first 12 weeks of pregnancy


Risks

The risks of a surgical abortion are quite low. The main risks of D and C and D and E are continued bleeding, infection of the uterus (endometritis), incomplete removal of pregnancy tissue and poking a hole in the womb (perforation of the uterus) during the surgical procedure. A second surgical procedure may be required to remove tissue that was not removed during the first procedure or to repair a perforated uterus.

The risks of a medical abortion include infection, bleeding and incomplete abortion, meaning some of the pregnancy tissue remains. These problems are rare and can be treated. An incomplete abortion is handled by repeating the dose of medication to end the pregnancy or doing a suction D and C. An infection can be treated with antibiotics. Excessive bleeding is treated with medications and possibly dilation and curettage. Rarely, a blood transfusion may be necessary if bleeding is unusually heavy