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Abortion

From Wikipedia, the free encyclopedia

Abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus or embryo, resulting in or caused by its death.[2] An abortion can occur spontaneously due to complications during pregnancy or can be induced, in humans and other species. In the context of human pregnancies, an abortion induced to preserve the health of the gravida (pregnant female) is termed a therapeutic abortion, while an abortion induced for any other reason is termed an elective abortion. The term abortion most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages. Worldwide 42 million abortions are estimated to take place annually with 22 million of these occurring safely and 20 million unsafely.[3] Whilematernal mortality seldom results from safe abortions, unsafe abortions result in 70,000 deaths and 5 million disabilities per year.[3] One of the main determinants of the availability of safe abortions is the legality of the procedure. Forty percent of the world's women are able to access therapeutic and elective abortions within gestational limits.[4] The frequency of abortions is, however, similar whether or not access is restricted.[4] Abortion has a long history and has been induced by various methods including herbal abortifacients, the use of sharpened tools, physical trauma, and other traditional methods. Contemporary medicine utilizes medications and surgical procedures to induce abortion. The legality, prevalence, and cultural views on abortion vary substantially around the world. In many parts of the world there is prominent and divisivepublic controversy over the ethical and legal issues of abortion. Abortion and abortion-related issues feature prominently in the national politics in many nations, often involving the opposing prolife and pro-choice worldwide social movements (both self-named). Incidence of abortion has declined worldwide, as access to family planning education and contraceptive services has increased.[5]

Types
Spontaneous
Main article: Miscarriage Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus due to accidental trauma or natural causes before approximately the 22nd week of gestation; the definition by gestational age varies by country.[6] Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors. A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth". When a fetus dies in utero after about 22

weeks, or during delivery, it is usually termed "stillborn". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap. Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman.[7]Most miscarriages occur very early in pregnancy, in most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulation and pregnancy found that 61.9% of conceptuses were lost prior to 12 weeks, and 91.7% of these losses occurred subclinically, without the knowledge of the once pregnant woman.[8] The risk of spontaneous abortion decreases sharply after the 10th week from the last menstrual period (LMP).[7][9] One study of 232 pregnant women showed "virtually complete [pregnancy loss] by the end of the embryonic period" (10 weeks LMP) with a pregnancy loss rate of only 2 percent after 8.5 weeks LMP.[10] The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus,[11] accounting for at least 50% of sampled early pregnancy losses.[12] Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.[11] Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion.[12] A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.[13]

Induced
A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the embryo or fetus, which increases in size as it ages.[14]Specific procedures may also be selected due to legality, regional availability, and doctor-patient preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as therapeutic when it is performed to:

save the life of the pregnant woman;[15] preserve the woman's physical or mental health;[15] terminate pregnancy that would result in a child born with a congenital disorder that would be selectively reduce the number of fetuses to lessen health risks associated with multiple

fatal or associated with significant morbidity;[15] or

pregnancy.[15]

An abortion is referred to as elective when it is performed at the request of the woman "for reasons other than maternal health or fetal disease."[16]

Methods
Medical
Main article: Medical abortion "Medical abortions" are non-surgical abortions that use pharmaceutical drugs. Medical abortions comprise 10% of all abortions in the United States[17] and Europe.[citation needed] Combined regimens include methotrexate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention.[18] Misoprostol can be used alone, but has a lower efficacy rate than combined regimens. In cases of failure of medical abortion, vacuum or manual aspiration is used to complete the abortion surgically.

Surgical
In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.
[19]

Manual vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, placenta and

membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is used. D&E consists of opening thecervix of the uterus and emptying it using surgical instruments and suction. Dilation and curettage (D&C), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable.[20] Other techniques must be used to induce abortion in the second trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with hypertonic

solutions containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus's head before evacuation. IDX is sometimes called "partial-birth abortion," which has been federally banned in the United States. Ahysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.[21] From the 20th to 23rd week of gestation, an injection to stop the fetal heart may be used as the first phase of the surgical abortion procedure[22][23][24][25][26] to ensure that the fetus is not born alive.[27]

Other methods
Historically, a number of herbs reputed to possess abortifacient properties have been used in folk medicine: tansy, pennyroyal, black cohosh, and the now-extinct silphium (see history of abortion).[28] The use of herbs in such a manner can cause seriouseven lethalside effects, such as multiple organ failure, and is not recommended by physicians.[29] Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducingmiscarriage.[30] Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage.[31] One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld.[31] Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of nonsurgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.[32]

Health risks
See also: Health risks of unsafe abortion Abortion, when legally performed in developed countries, is among the safest procedures in medicine.[33]
[34]

In such settings, risk of maternal death is between 0.21.2 per 100,000 procedures.[35][36][37][38] In Unsafe abortions (defined by the World Health Organization as those performed by unskilled

comparison, by 1996, mortality from childbirth in developed countries was 11 times greater.[39][40][41][42][43]
[44]

individuals, with hazardous equipment, or in unsanitary facilities) carry a high risk of maternal death and other complications.[45] For unsafe procedures, the mortality rate has been estimated at 367 per 100,000.[46]

Physical health
Surgical abortion methods, like most minimally invasive procedures, carry a small potential for serious complications.[47] Surgical abortion is generally safe and the rate of major complications is low[48] but varies depending on how far pregnancy has progressed and the surgical method used.[49] Concerning gestational age, incidence of major complications is highest after 20 weeks of gestation and lowest before the 8th week.[49] With more advanced gestation there is a higher risk of uterine perforation and retained products of conception,
[50]

and specific procedures like dilation and evacuation may be required.[51]

Concerning the methods used, general incidence of major complications for surgical abortion varies from lower for suction curettage, to higher for saline instillation.[49] Possible complications include hemorrhage, incomplete abortion, uterine or pelvic infection, ongoing intrauterine pregnancy, misdiagnosed/unrecognized ectopic pregnancy, hematometra (in the uterus), uterine perforation and cervical laceration.[52] Use of general anesthesia increases the risk of complications because it relaxes uterine musculature making it easier to perforate.[53] Women who have uterine anomalies, leiomyomas or had previous difficult first-trimester abortion are contraindicated to undertake surgical abortion unless ultrasonography is immediately available and the surgeon is experienced in its intraoperative use.[54] Abortion does not impair subsequent pregnancies, nor does it increase the risk of future premature births, infertility,ectopic pregnancy, or miscarriage.[34] In the first trimester, health risks associated with medical abortion are generally considered no greater than for surgical abortion.[55]

Mental health
Main article: Abortion and mental health No scientific research has demonstrated that abortion is a cause of poor mental health in the general population. However there are groups of women who may be at higher risk of coping with problems and distress following abortion.[56] Some factors in a woman's life, such as emotional attachment to the pregnancy, lack of social support, pre-existing psychiatric illness, and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion.[57] The American Psychological Association (APA) concluded that abortion does not lead to increased mental health problems.[58] Some proposed negative psychological effects of abortion have been referred to by anti-abortion advocates as a separate condition called "post-abortion syndrome." However, the existence of "postabortion syndrome" is not recognized by any medical or psychological organization

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Submitted to: Mrs. Lyleth Ledesma Submitted by: John Mc Rolyn B. Fangco