gynecology and obstetrics
Induced Abortion
Introduction
In the United States, about half of pregnancies are unintended. About 40% of unintended pregnancies end in induced abortion; 90% of procedures are done during the 1st trimester. In the United States, abortion of a previable fetus is regulated by state-specific restrictions (eg, mandatory waiting periods, gestational age restrictions). In countries where abortion is legal, abortion is usually safe and complications are rare. Worldwide, 13% of maternal deaths are secondary to unsafe induced abortion ( Reference ), and the overwhelming majority of these deaths occur in countries where abortion is illegal. Pregnancy should be confirmed before abortion is induced. Often, gestational age is established by ultrasonography, but sometimes history and physical examination are used to estimate gestational age during the 1st trimester. Further evaluation should be considered if a woman is in the 2nd trimester and has risk factors for complications, eg, Placenta Previa or an anterior placenta plus a history of a uterine scar. Completion of an induced abortion can be confirmed by directly observing removal of uterine contents or via ultrasonography used during the procedure. If ultrasonography is not used during the procedure, resolution of the pregnancy can be confirmed by measuring quantitative serum beta–human chorionic gonadotropin(beta-hCG) levels before and after the procedure; a decrease of > 50% after 1 week confirms resolution. Antibiotics effective against reproductive tract infections (including Chlamydia and Mycoplasmal Mucosal Infections ) should be given to the patient on the day of the abortion. Traditionally, First-trimester abortions often require only local anesthesia, but clinicians trained in using anesthesia may offer sedation in addition. For later abortions, deeper sedation is usually required. Contraception (all forms) can be started immediately after an induced abortion at < 28 weeks gestation. 