Induced Abortion

What is an induced abortion?

Induced abortion is the act of ending a pregnancy. It may be done with surgery or medicine. It prevents the live birth of a baby.

Dealing with an unplanned or unwanted pregnancy is very difficult. Talking with your partner, family, clergy, friends, and health care provider may help you decide what to do. You may choose to continue the pregnancy and raise the child yourself. Perhaps you will want to find someone to adopt the baby. Or you may decide to end the pregnancy by having a legal abortion.

What happens before an abortion?

First you talk with a specially trained counselor to explore choices and answer questions. The goal of counseling is to provide information that will help you make the best decision for you. Then your health care provider will take a medical history and perform a physical exam, including a pelvic exam. Cells from your cervix (a Pap test) and urine and blood samples will be taken for lab tests. You may have an ultrasound exam to determine your stage of pregnancy.

If you decide to have an abortion, your provider will tell you about any special steps you need to take before the procedure.

What types of procedures may be performed?

The type of procedure used for an abortion depends on the stage of pregnancy:

• If it has been just 1 or 2 weeks since your period should have started, a menstrual extraction might be done. Medicine, such as the oral medicine mifepristone (Mifeprex, or RU 486), is another method that may be used within the first few weeks of pregnancy.
• If it has been less than 13 weeks since the first day of your last menstrual period, the most common procedure is vacuum curettage.
• The procedure most often used between the 13th and 16th weeks of pregnancy is a dilation and evacuation (D&E).
• For pregnancies after 16 weeks, medicines may be used to cause the uterus (womb) to contract and deliver the fetus and placenta (afterbirth).

How are these procedures performed?

Menstrual extraction

Menstrual extraction is a procedure that can be done only very early in pregnancy. It can be performed in your health care provider's office.

For this procedure, your provider inserts a speculum into your vagina. A small tube is then placed into the womb through the cervix. (The cervix is the opening to the womb.) The tube is used to remove the pregnancy tissue from the womb with a syringe.

Medicines used early in pregnancy

Mifepristone (Mifeprex, or RU 486) is a medicine you can take by mouth to cause an abortion. It may be used within 7 weeks of the first day of your last period. It ends the pregnancy by blocking one of the hormones you need to stay pregnant. The earlier in the pregnancy the medicine is taken, the more likely it is to be effective.

One or two days after you take mifepristone you will probably start having vaginal bleeding. Two days after taking the mifepristone you will take a medicine called misoprostol. This second medicine causes cramping of the uterus and helps completely empty the uterus.

After you have taken both medicines your health care provider may want you to have an ultrasound scan to make sure the abortion has occurred and all pregnancy tissue is gone.

For about every 100 women who use mifepristone, 1 woman has heavy bleeding. If you have heavy bleeding, you may need a surgical procedure called a D&C. The D&C is a scraping of the inside of the uterus. It removes any remaining pregnancy tissue and blood clots. It stops the heavy bleeding.

Mifepristone cannot be used if you have certain medical conditions. Discuss this with your health care provider.

Other combinations or types of medicines may be prescribed by your health care provider to end a pregnancy.

Vacuum curettage

A vacuum curettage is a surgical procedure performed in an operating room. It is also called a suction dilation and curettage, or suction D&C. Before the procedure you are given either local or general anesthesia. For local anesthesia you are given a shot deep inside the vagina into your cervix. The shot numbs your cervix. You may also be given a sedative through an IV to make you drowsy. If general anesthesia is used, you will be asleep during the procedure.

After the anesthetic has taken effect, your provider stretches the cervix so a small plastic tube can be placed through it into the womb. This tube is attached to a vacuum pump. The pump suctions the pregnancy tissue from the womb. Your provider then uses a dull spoonlike instrument (a curette) to scrape the walls of the womb and be sure that all of the tissue has been removed. The procedure generally takes 10 to 20 minutes. You will then spend some time in the recovery room.

Dilation and evacuation (D&E)

A D&E is a surgical procedure performed if you are 13 to 21 weeks pregnant. Because the fetus is larger, the cervix needs to be opened more than for a vacuum curettage. To do this safely, the cervix needs to be prepared 24 to 48 hours before the procedure. At the office your provider will gently place some sticks into your cervix. The sticks are usually made from a type of seaweed called laminaria. They absorb water from the body and cause the cervix to open up. After placement of the sticks, you will go home. Your cervix will be examined the next day. If it has opened enough, the D&E will be performed. If not, a second set of sticks will be inserted and the D&E will be done the following day.

The D&E is performed in the operating room. General anesthesia is usually used, so you are asleep during the procedure. The procedure is similar to a suction curettage. After the sticks are removed, the cervix may be gently opened more with metal rods. The pregnancy tissue is removed with forceps and suction. You are given medicine through an IV to contract the uterus. The uterus is scraped to be sure all the tissue has been removed. The procedure takes about 30 minutes. Afterward you will spend time in the recovery room.

Medicines and saline used for second-trimester abortions

Certain medicines may be used for abortions after the 14th to 16th weeks of pregnancy. These medicines cause contractions that lead to labor and delivery. Medically induced abortions are usually done in the hospital.

The medicine used most often is prostaglandin E2 (PGE2). Your provider places a suppository of the medicine in your vagina. The medicine may cause nausea, fever, and diarrhea. These side effects can be controlled with other medicines.

A less commonly used procedure is a saline abortion, which, like PGE2, causes labor and delivery. With this procedure your abdomen is numbed with a local anesthetic. Then saline (a salt solution) or another medicine is injected through the skin of your abdomen and into the amniotic fluid in the womb. This starts contractions.

After the fetus is delivered by any of these procedures, you may need to have a dilation and curettage (D&C) to remove any pregnancy tissue remaining in the womb.

What happens after the procedure?

After each of these procedures, you are observed for 1 or more hours to check for complications. The length of time in recovery depends on the type of procedure you had and the method of anesthesia. In general, you are observed for about 2 hours after a suction curettage, 4 hours after a dilation and evacuation, and 6 hours after a medically induced second-trimester abortion.

When you are ready to go home, you will be given an antibiotic to prevent infection and a drug to contract the uterus. Your provider will tell you how long to wait until you have intercourse again. You may discuss ways to prevent pregnancy, and your provider may prescribe a method for you. Someone should drive you home.

It is normal to have some cramping after the abortion while the uterus contracts to its normal size. It is also normal to have some small amounts of bleeding for several days. Other possible side effects from a medical abortion are:

• headaches
• nausea and vomiting
• feeling warm or having chills
• dizziness
• tiredness.

Most women are able to return to their normal daily activities within a day or so after the abortion if there are no complications.

Make sure you follow all of your provider's instructions for care after the abortion, including a follow-up appointment.

What are the possible complications of an abortion?

Abortions performed by licensed health care providers are generally very safe. The rate of complications from abortions done by licensed providers is very low. Possible complications include:

• perforation (a tear that may happen if a surgical tool goes through the uterus), and possible injury to an another organ, which would require more surgery
• infection
• excessive bleeding
• failure to end the pregnancy
• psychological problems after the abortion
• scar tissue inside the uterus
• trouble becoming pregnant after several abortions.

Report any of the following symptoms of possible complications to your health care provider promptly:

• severe abdominal pain
• fever over 100°F (37.8°C)
• dizziness or fainting
• foul-smelling discharge from the vagina
• bleeding that is more than a heavy period or consists of large blood clots
• signs of continued pregnancy such as breast tenderness, fatigue, and nausea.

Some women become depressed after having an abortion. This may occur right after the abortion or weeks or months later. If you are feeling depressed, your provider will find support and counseling for you.