What Is It?
Abortion is the removal of pregnancy tissue, products of conception or the fetus and placenta (afterbirth) from the uterus. The terms fetus and placenta usually are used after eight weeks of pregnancy, while the other terms describe tissue produced by the union of an egg and sperm before eight weeks. Each year approximately 1.2 million women in the United States choose to end a pregnancy. Other terms for an abortion include elective abortion, induced abortion, termination of pregnancy and therapeutic abortion.
What It's Used For
In the United States, abortion is used most often to end an unplanned pregnancy. Unplanned pregnancies happen when birth control is not used, is used incorrectly or fails to prevent a pregnancy. Abortion is also used to end a pregnancy when tests reveal that the fetus is abnormal. Therapeutic abortion refers to an abortion recommended when the mother's health is at risk.
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.
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's 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.
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. Medications used to induce abortion include:
In rare instances when a pregnancy continues after the use of these medications, there is a risk that the baby will be born deformed. The risk is greater with the use of misoprostol. If the pregnancy tissue does not completely leave the body within two weeks of a medical abortion, or if a woman bleeds heavily, then a surgical procedure may be needed to complete the abortion. Approximately 2% to 3% of women who have a medical abortion will need to have a surgical procedure, usually suction dilation and curettage (D and C), also called vacuum aspiration.
A woman should not have a medical abortion if she:
Induction of labor
After 14 weeks of pregnancy, abortion can be done by giving medication that causes the woman to go into labor and deliver the fetus and the placenta. The procedure usually requires hospitalization for more than a day because it involves a labor and delivery. Sometimes dilation and evacuation is necessary to completely remove the placenta. Labor can be induced in one of three ways:
A medical abortion of an early pregnancy usually requires three or more visits to get abortion medication and make sure all the pregnancy tissue has passed. Bleeding related to the abortion may last up to two weeks.
You usually can resume most daily activities within hours after a surgical abortion that uses local anesthesia between 9 and 14 weeks, as long as no sedatives were used. If you received sedatives or were unconscious, as with general anesthesia, don't drive or use dangerous machinery for at least 24 hours. In either case, avoid sexual activity for 2 weeks to prevent infection and to allow the cervix and uterus to return to normal shape and size. Most women are advised to follow up at the doctor's office about 2 weeks after the procedure.
You usually can resume most daily activities a few days to a couple of weeks after a late second trimester abortion, depending on how far along you were in your pregnancy and whether there were complications. You may need to avoid sexual activity for two to six weeks after the procedure. In general, you should visit your doctor about two weeks after the procedure. Your doctor will give you specific advice about resuming daily activities and working based on your circumstances.
Cramps can be treated with acetaminophen (Tylenol) or ibuprofen (Advil and others). Cramping may be worse after a late second trimester abortion. After a medical or surgical abortion, you may be told not to use tampons or douches or have sex for at least two weeks. This will help to decrease the risk of an infection of the uterus. Vaginal spotting or bleeding is common for a few days up to one to two weeks after a surgical abortion, depending on how far along the pregnancy was at the time of the abortion.
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.
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.
Women rarely become infertile after an uncomplicated abortion. However, infertility may result when surgical abortion leads to endometritis or is complicated by heavy bleeding, perforation or incomplete removal of pregnancy tissue.
When to Call a Professional
Contact your doctor for any of the following problems:
American College of Obstetricians and Gynecologists
P.O. Box 96920
Washington, DC 20090-6920
American Medical Women's Association (AMWA)
100 North 20th St.
Philadelphia, PA 19103
Planned Parenthood Federation of America
434 W. 33rd St.
New York, New York 10001
American College of Nurse Midwives
8403 Colesville Road
Silver Springs, MD 20910
Association of Reproductive Health Professionals
1901 L Street, NW
Washington, DC 20036
Alan Guttmacher Institute
125 Maiden Lane
New York, N.Y. 10038
Toll Free: 800-355-0244
One Dag Hammarskjold Plaza
New York, New York 10017
National Women's Health Network
1413 K Street, NW
Washington, DC 20005