women s health issues
Abortion
Methods of Abortion
Abortion methods include Surgical abortion (surgical evacuation): Removal of the contents of the uterus through the cervix Medications to cause (induce) abortion: Use of medications to stimulate contractions of the uterus, which expel the contents of the uterus The method used depends in part on how long a woman has been pregnant. Ultrasonography is usually done to estimate the length of the pregnancy. Surgical abortion can be used for most pregnancies up to 24 weeks. Medication abortion can be used for pregnancies that are less than 11 weeks or that are more than 15 weeks. For abortions done early in the pregnancy, only a local anesthetic may be needed. Conscious sedation (medications that relieve pain and help women relax but allow women to remain conscious) may also be used. Rarely, a general anesthetic is needed. Before a surgical abortion, women are given antibiotics that are effective against infections in the reproductive tract. After any abortion (surgical or medication), women with Rh-negative blood are given injection of Rh antibodies called Rho(D) immune globulin. If the fetus has Rh-positive blood, a woman who has Rh-negative blood may produce antibodies to the Hemolytic Disease of the Fetus and Newborn . These antibodies can destroy the fetus's red blood cells. Treatment with Rho(D) immune globulin reduces the risk that the woman's immune system will make these antibodies and endanger subsequent pregnancies. Treatment with immune globulin may be optional before 8 weeks of pregnancy. The contents of the uterus are removed through the vagina. Different techniques are used depending on the length of the pregnancy. They include Dilation and Curettage (D and C) with suction Dilation and evacuation (D and E) (a Medication abortion ) can also be used to dilate the cervix. Typically for pregnancies of less than 14 weeks, dilation and curettage (D and C) with suction is used. A speculum is used in the vagina to enable the clinician to see the cervix. A local anesthetic (such aslidocaine) is injected into the cervix to reduce discomfort, and the cervix is dilated. Then a flexible tube attached to a vacuum source is inserted into the uterus to remove the fetus and placenta. The vacuum source may be a handheld syringe or similar instrument or an electrical suction machine. Sometimes a small, sharp, scoop-shaped instrument (curet) is inserted to remove any remaining tissue. This procedure is done gently to reduce the risk of scarring and infertility. For pregnancies between 14 and 24 weeks long, dilation and evacuation (D and E) is usually used. After the cervix is dilated, suction and forceps are used to remove the fetus and placenta. A sharp curet may be used gently to make sure all products of conception have been removed. -releasing Intrauterine Devices (IUDs) (IUD), can be started as soon as the abortion is completed. Medication abortions can be used for pregnancies of less than 11 weeks or more than 15 weeks. For an abortion during early pregnancy (less than 11 weeks), the abortion process can be completed at home. For an abortion later in pregnancy, the woman typically is admitted to the hospital to take the medications that will induce labor. In the United States from 2014 to 2017, medication abortion accounted for 53% of abortions done for pregnancies of less than 11 weeks. Medications used to induce abortion includemifepristone(RU 486), followed by a prostaglandin, such asmisoprostol. Mifepristone,taken by mouth, blocks the action of the hormoneprogesterone, which prepares the lining of the uterus for pregnancy.Mifepristonealso makes the uterus more sensitive to the second medication that is given (the prostaglandin). Clinicians confirm the completion of the abortion by one of the following: Ultrasonography A urine test to measure human chorionic gonadotropin (hCG) on the day the medication is given and 1 week later (hCG is produced early in pregnancy) After a medication abortion, a urine pregnancy test 5 weeks Prostaglandinsare hormonelike substances that stimulate the uterus to contract. They may be used withmifepristone. Prostaglandins may be held in the mouth (next to the cheek or under the tongue) until they dissolve or placed in the vagina. For abortions in pregnancies that have lasted less than 11 weeks, the most common regimen involves takingmifepristonetablet, followed bymisoprostoltaken 1 to 2 days later.Misoprostolis held next to the cheek until it dissolves, or it is placed in the vagina. The woman may takemifepristoneandmisoprostolon her own or have a doctor give it to her. This regimen causes abortion in about 95% of pregnancies that have lasted 8 to 9 weeks 87 to 92% of pregnancies that have lasted 9 to 11 weeks An additional dose ofmisoprostolimproves effectiveness in pregnancies that have lasted longer than 9 weeks. If a medication abortion is unsuccessful, a surgical abortion may be required. In pregnancies that have lasted more than 15 weeks, women remain in the clinic or hospital until the abortion is complete.Mifepristonetablets can be taken, followed in 1 to 2 days by a prostaglandin, such asmisoprostol, ormisoprostolcan be taken alone. 