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Abortion

-is the termination of pregnancy by the removal or expulsion from the uterus of a fetus or embryo prior to viability. A spontaneous abortion (also called a miscarriage) occurs on its own. An induced abortion is the intentional termination of a pregnancy and expulsion of a fetus, whether by surgery or the administration of pharmaceuticals.

Type of abortions

Spontaneous abortion

Vaginal bleeding is the main presenting symptom of spontaneous abortion. Bleeding presents as spotting or menstruation like and may persist for days to weeks. It may precede symptoms of cramping abdominal and suprapubic pain.

Causes of spontaneous abortions:


Abnormal fetal formation up to 50%zygotes are probably never implanted

Treatment of spontaneous abortion Includes expectant management medical evacuation, and surgical uterine evacuation.

Threatened abortion
Presents as vaginal bleeding in the presence of a viable pregnancy with a closed cervix.

Imminent (inevitable)
Occurs when the cervix has dilated and the membranes have ruptured, but the products of conception remain in utero.

Complication of threatened

2 kinds of induced abortions: surgical and chemical

Surgical Abortion Procedures


1. Manual Vacuum Aspiration: within 5-7 weeks after last menstrual period. Dilators (metal rods) are used to stretch the cervical muscle until the opening is wide enough for abortion instruments to pass through the uterus. A hand-held syringe is attached to tubing, which is inserted into the uterus. The fetus is suctioned out.

2. Suction Curettage: after 14 weeks from the last menstrual period, the abortionist uses a dilator or laminaria to open the cervix. laminaria are thin sticks from a kelp species that are inserted hours before the procedure and allowed to slowly absorb water and expand, thereby dilating the cervix. once the cervix is dilated, the abortionist inserts tubing into the uterus and attaches the tubing to a suction machine. suction pulls apart the fetus body and out the uterus. after suction, the doctor and nurses must reassemble the fetus dismembered parts to ensure they have all the pieces.

3. D & C (Dilation and Curettage): less than 13 weeks The cervix is dilated. A suction device is placed in the uterine cavity to remove the fetus and placenta. Then the abortionist inserts a curette (a loop-shaped knife) into the uterus. The abortionist uses the curette to scrape any remaining fetal parts and the placenta out of the uterus.

4. Saline: between 16 and 24 weeks of pregnancy This procedure is conducted in the same manner as amniocentesis (a prenatal test used to diagnose a fetus potential chromosomal abnormalities). A long needle is inserted into the womans abdomen, directly into the amniotic sac. It is at this point that a saline abortion and amniocentesis differ. In a saline abortion, amniotic fluid is removed from the woman and replaced by a strong saline (salt) solution. As the fetus lungs absorb the salt solution, it begins to suffocate. It may struggle and may even have convulsions. The saline also burns off the fetus outer layer of skin. Saline abortion can take one to six hours before the fetus is no longer viable. The woman begins labor after approximately 12 hours, and she may take up to 24 hours to deliver. Because the procedure is often quite long, many times the woman is left to labor alone.

5. Prostaglandin: between 16 and 24 weeks of pregnancy This procedure is conducted in the same manner as a saline abortion, except prostaglandin (a hormone that causes the woman to start labor) replaces saline. Prostaglandin activates contractions. It can cause overly painful or intense labor; there have been cases in which the violence of the contractions ruptured the mothers uterus.1 This type of abortion is not preferred by abortionists because there is a 40% higher chance of a live birth.

6. Hysterotomy: more than 16 to 18 weeks This procedure is the same as a cesarean section (in which the doctor cuts through the abdomen and uterus to deliver the baby), except that in a hysterotomy, no medical attention is given to the baby upon delivery to help it survive. Most often, a wet towel is placed over the babys face so it cant breathe. Sometimes the baby placed in a bucket of water. The goal is to have a baby that wont survive.

7. D & X (Dilation and Extraction): between 12 and 18 weeks This procedure takes three days. During the first two days, the womans cervix is dilated. She is given medication for cramping. On the third day, she receives medication to induce labor. As the woman labors, the abortionist uses an ultrasound to locate the babys legs. The abortionist then grasps a leg with forceps and delivers the baby up to its head. Next, using a scissors, the abortionist creates an opening in the base of the babys skull. A suction catheter is inserted into the skull opening, and the babys brains are suctioned out. The skull collapses, and the rest of the babys body is delivered through the birth canal

Chemical Abortion Options


1. RU-486 (Mifepristone): within 49 days of gestational age Also called the abortion pill. This drug interferes with levels of progesterone, a hormone that keeps the fetus implanted in the wall of the uterus. The woman is prescribed progesterone and then returns to the clinic two days later to receive a prostaglandin drug that induces labor and expels the dead fetus. A third visit may be required if the baby is not expelled, at which time a woman has a 5-8% likelihood of needing a surgical abortion to complete the process. RU-486 is documented to be unsafe for women.

2. Methotrexate and Misoprostol Methotrexate is used for treatment of cancer, and Misoprostol is used for ulcer treatment. In a chemical abortion, these two drugs are used in combination. Methotrexate causes cells in the placenta (the organ that nourishes the fetus) to die. Misoprostol empties the fetus from the uterus by causing the uterus to contract and push the fetus out. Methotrexate is a drug used in chemotherapy and has the potential for serious liver toxicity.

3. Morning After Pill: sometimes used in rape cases Up to 72 hours after intercourse, a woman is administered large doses of birth control pills (or levonorgestrel, also known as Plan B) to prevent the embryo from implanting in the uterus wall. Twelve hours after the first dose, a second dose is given. Large doses of birth control pills work to prevent ovulation and hinder sperm motility.

When to resume intercourse after abortion?


For 2-4 weeks - no sex, no tampons, no douches. After the 2-4 weeks is over, you should NOT have sex again unless you feel physically recovered, and have discussed with your partner what you want to do if an unplanned pregnancy occurs again. Do NOT let yourself be pressured into having sex again before you are physically and emotionally ready, and have had a serious discussion about the course of action for future unplanned pregnancies. You can get pregnant as soon as two weeks after an abortion! Your body normally will go back to it's regular cycle, and release an egg (ovulation) at 2 weeks post-ab. So once you decide you are ready to resume sexual intercourse again, make sure you are using birth control right away.