ABORTION - THE

TERMINATION OF AN
UNWANTED PREGNANCY

Definition
An abortion signifies the termination of a
pregnancy prior to the fetus being capable to live
in the outside world (20 weeks according to the
WHO or a baby over 500g). It can be spontaneous
or induced.

Indications
The induced or intentional termination of a pregnancy can
be conducted in cases of the pregnancy being unwanted or
if indications for it exist
1. Medical indications - the health or life of the mother
are at risk due to the pregnancy or because of childbirth
2. Eugenic indications - the baby has malformations
which can be seen through ultrasound examination, or the
baby has chromosomal or genetic disorders that are
established, or there exists a real chance for the baby to be
harmed due to the mothers exposure to noxae during the
first trimester (infections, medication, chemicals)
3. Legal indications - rape, incest, sexual intercourse with
a minor or incapacitated person, abuse of position
4. Social indications - if conditions for raising the child do
not exist

 The intentional termination of a pregnancy is the

oldest method of family planning. Previously,
abortions were most often unsafe or they carried
a high risk of complications, morbidity and
mortality of the mother.

 Today, it is assessed that 22 million abortions per

year continue to be unsafe(results in the death of
around 47 thousand women.)
Unsafe abortion is defined by WHO as a
procedure for the termination of an unwanted
pregnancy which is performed by persons with
inadequate professional training or in a setting
that is not in accordance with minimal medical
standards, or both. In almost all developed
countries (classified as such by the United Nations
Population Division), safe abortions are legally
available

 With the exception of a number of countries,

access to safe abortion in developing countries is
limited to a small number of specific conditions.
In countries in which abortion is very limited by
law, the unequal availability of safe abortions
occurs. In such situations, abortions that fulfill
safety requirements can become a privilege of the
rich, while poor women do not have options but
instead resort to going to unprofessional persons
which can cause the disability and death of those
women.

 The termination of pregnancy is banned in Ireland,

Poland, Andorra, Liechtenstein and Luxembourg.
There are still a high number of abortions in
Serbia compared to the rest of Europe, because
the lowest use of trusted methods of
contraception (hormonal tablets and the IUD)
occurs in Serbia as well as due to a lack of
knowledge and numerous prejudices towards
these methods.

 From the medical and civilizational aspect, the

intentional termination of a pregnancy is the least
acceptable method of birth control. The need for
its use depends on the family planning model that
is prevalent in a society.
In Serbia, the intentional termination of
pregnancies has been the predominant method of
birth control for many decades.

 In our country, abortion can be conducted upon

personal request up to the 10th week of gestation
(counting from the 1st day of the last menstruation,
that is amenorrhea period to 70 days, thereby the
length of the embryo or crown rump length of
30mm).
For an abortion to be conducted, it is necessary to
confirm the gestational age of the pregnancy, and
in terms of documentation, a personal identification
card is necessary.
Girls aged 16 and 17 who have a personal
identification card can personally request that an
abortion be conducted without the signature of
their parents.

 Prior to an abortion being conducted, other than

diagnosing the gestational age, it is necessary to
take a detailed anamnesis of existing illnesses,
previous operations, and medications that the
woman is taking.
If a vaginal infection exists, it should be healed
prior to the intervention. After the abortion,
preventive antibiotics and uterotonics are
prescribed, a check-up is scheduled, and advice
regarding contraceptives is given

 Terminations of pregnancies that are past 10

weeks can be conducted only when strictly
defined reasons or indications exist that can be
medical, eugenic or legal

indications
Legal indications are conditions within which the
pregnancy occurred due to violence: rape, incest,
sexual intercourse with minors and incapacitated
persons. Those cases must have been reported
and there must exist a police report on the
reporting of the criminal act.

 In cases when there exists one of these indications for the

termination of a pregnancy the woman is to address the
following commissions with a request and the necessary
documentation:
The consilium of the institution (3 gynecologists from the local
institute and 3 reserve members) in which the pregnancy is
being terminated decides upon requests for the termination of
pregnancies between 10 to 20 gestational weeks.
The ethical board in its structure has 5 members and 5
deputies. The president is the professor of obstetrics and
gynaecology and the members are professors of pediatrics,
neuropsychiatry, internal medicine and law. They decide upon
requests for the termination of pregnancies past 20 gestational
weeks.

 The termination of pregnancy is the oldest method of

family planning. It is believed that even in prehistoric
times
Throughout history, various methods for induced
abortion were utilized such as the use of various plants,
chemical agents, sharp instruments, pressure on the
stomach and various others.
Social attitudes towards abortion and laws in reference
to it varied throughout human history. The oldest written
law regarding abortion is in the Hammurabi code, 1760
B.C. According to it, a person who, through an attack,
causes a woman to have a spontaneous miscarriage, is
penalized, and the punishment is financial in a value
that depends on the social status of the woman.

 The oldest written evidence on the intentional termination of

pregnancy is in the Egyptian Ebers papyrus, 1550 B.C. In the
Assyrian law, 1075 B.C. the death penalty is specified for a
woman who obtains an abortion against the wishes of her
husband.
In ancient Greece, abortion was generally not punished, and the
Stoics believed that the fetus is a human being only once it
inhales air, and as such, abortion was morally acceptable to
them.
The mint plant was used (pennyroyal, squaw mint, mentha
pulegium) which is used as tea and as food, in aromatherapy,
but in higher doses can be poisonous, as well as other plants
used for abortions.
The Greeks often used the silphium plant for abortions, a
relative of todays wild dill, which was also used as a
contraceptive.

 Soranus, a Greek physician from the 2nd century,

believed that abortion is justified due to health
indications and in cases of emotional immaturity.
In his work, Gynaecology, for abortion, he
recommends heavy exercise, energetic jumping,
carrying heavy objects, riding animals.
He also prescribed a large number of recipes for
herbal baths, cervical fittings, and bloodletting,
but he advised against the use of sharp objects to
trigger abortions due to the possibility of organ
perforation.

 The ancient Romans accepted the Greek attitudes and

they did not judge abortion up to the advent of
Christianity.
In Italy, in the year 1115, a punishment of up to 3 years in
prison was given for abortion prior to the first movements
of the revivification of the fetus (the 18th to the 20th
week), and then 10 years for an abortion after that time
In the 13th century, Pope Innocent III defined that the
fetus becomes a person at the moment when it begins
moving in the abdomen, and abortion after that time
becomes murder, while prior to that it is seen as a lesser
sin.
Pope Gregory XIV, in the year 1591 issued a decree that
abortion is allowed in the first 116 days from conception 19 gestational weeks.

 The death penalty for abortion was abolished in

Austria in 1787, and in France in 1791. Instead of that,
long-term prison sentences were introduced.
abortions continued to occur in the 19th century,
regardless of prohibitions in the United Kingdom and
USA which existed since the Victorian era. In the
majority of American states, abortion was prohibited in
the period between 1820 and 1900. In that time,
abortions were generally performed in an unsafe
manner.


In the 20th century, the Soviet Union (in the year
1919), Iceland (in the year 1935) and Sweden (in the
year 1938) were among the first countries that
legalized some or all forms of abortion.
In the year 1935, in Nazi Germany, a law was passed
that allowed abortions for women that were
considered as having hereditary diseases while
abortion was prohibited for women who belonged to
the real German bloodline.
In the 70s, abortion was legalized in many European
countries.

methods
The first methods for the intentional termination
of pregnancy in ancient times were non-surgical
(without instruments). The following were
recommended: hard physical work, jumping,
climbing, diving, fasting, laying on hot coconut
husks, running hot water over the abdomen, and
various other means. As well, various plant and
chemical materials were used.

 Sanskrit records recommended that women sit on a pot

with cooked or diced onions.
In South-East Asia, massage with pressure on the
abdomen was practiced for ages.
Japanese documents mention abortions since the 12th
century especially among village women due to difficult
living conditions and hunger.
In early modern times, English women attempted to
terminate pregnancies through intensive exercise and the
tightening of a pregnancy belt which was otherwise used
to support the pregnant belly.
in Germany tea mixture existed which included marjoram,
thyme, parsley, and lavender. One special drink was made
from triturated ants, camel saliva, hairs from the tail of a
black-tailed deer, and all of this was dissolved in bear fat!

 In the middle ages, many recipes for abortion-inducers

existed in the Islamic world.
One instrument was used as a dilator, and the other
with an annular blade as a curette, a hook instrument
for extraction and a copper needle.
these instruments were used if the fetus was
improperly positioned in the uterus which could
endanger the life of the woman. Saint Augustine
mentions a surgical method for removing a dead fetus
from the uterus. He believes that murder is the
termination of pregnancy which is performed when the
fetus has developed organs and looks like a human.
Like Aristotle, he also questions - when does life begin?
Does it begin even before the fetus starts moving?

 In the 19th century, with the advancement of

medicine, anaesthesiology and surgery, new abortion
techniques appear in different regions.
In the second half of the 19th century, in America and
England, abortion was more frequently punished. The
number of abortions among women of the middle and
higher classes was increased, and cheaper, but
unsafe, methods were available to women of the lower
classes. Women of Jewish origin in Manhattan used the
old Indian method of sitting on hot water vapor.
In America in the 19th century, women attempted to
dilate the cervix through various methods - candles,
knitting needles, hair rollers, spoons, knives,
catheters, feather holders, glass spikes.

 At the beginning of the 20th century, abortion was very

unsafe and more risky than childbirth, up until around 1930.
It is believed that one out of 6 abortions in the USA in the
early 20th century ended with the death of the woman.
The curette was made in France in 1723, and was used for
abortions from the year 1842. In the late 19th century, the
use of the D&C method began (opening of the cervix) and
curettage.

The vacuum aspirator started to be used in the USSR, Japan,
and China in the 19th century, and only in 1960 in England
and the USA. The plastic Karman cannula as an extension
for the vacuum aspirator is in use since 1970. Ultra-early
manual aspiration - menstruation regulation - interception
has been performed since 1971.

 Termination of pregnancy with medication

Synthetic prostaglandins were used for the termination of

pregnancy during the 70s (20th century) in various forms in the
form of injections - intravenous, intramuscular, as well as
tablets for oral, vaginal, sublingual, buccal use. They act by
causing uterine contractions and the dilation of the cervix.
Mifepristone - antiprogestin alone led to complete abortions in
only 60-70% of cases, and this percentage was reduced with
the increase of the gestational age of the pregnancy that is
being terminated. When it was discovered in 1985 that it also
causes contractions of the uterus, softening of the cervix, and
as the most important element, that it increases the sensitivity
of the uterus to the effects of prostaglandins by five times, the
combined provision of mifepristone and prostaglandin E1 was
attempted, and it was determined that this method is a very
good and effective method for early terminations of pregnancy.

 Countries in which the termination of early pregnancy

with a combination of mifepristone and misoprostol first
began were France - the country in which the first
mifepristone (Mifegyne) was produced, and China.
From the year 1988, terminations of pregnancy up to
the 7th week of gestation (49 days since the first day of
the last menstrual period - amenorrhea) were
conducted in these countries.
in 1992 for abortions up to the 9th week of 35 countries
across the world - Europe, the USA, South Africa, China,
Israel, and others. The WHO recommends this method
for the termination of early pregnancies even up to the
12th-14th weeks, and in the second trimester with the
use of mifepristone and the continuation of repeated
doses of misoprostol.