Abortion is the elimination of conception materials, pregnancy tissue, or the fetus and placenta (afterbirth). In general, after eight weeks of pregnancy, the words fetus and placenta are used. Pregnancy tissue and conception products apply to tissue produced before eight weeks by the union of an egg and sperm. An abortion that happens without intervention is referred to as a miscarriage or “spontaneous abortion” and occurs in around 30% to 40% of pregnancies. It is called an induced abortion or, less commonly, “induced miscarriage” when deliberate steps are taken to end a pregnancy. In general, the unmodified word abortion refers to induced abortion. When properly performed, abortion is one of the safest medical procedures, but unsafe abortion is a major cause of maternal death, particularly in the developing world.

Preparation

First, your doctor will enquire about your medical history and check it. And if you’ve used a home pregnancy test, you always need another pregnancy test to confirm that you’re pregnant. In certain cases, to decide how many weeks into the pregnancy you are and the size of the baby, you would require an ultrasound to ensure that the pregnancy is not ectopic.

One that develops outside of the uterus is an ectopic pregnancy. An ectopic pregnancy usually develops in the fallopian tube, which is the tube that brings the egg to the uterus from the ovary and is usually referred to as a tubal pregnancy.

Your blood group and whether you are Rh-positive or negative can be determined by a blood test. The Rh protein is formed by most females’ red blood cells. It is considered that these blood cells are Rh-positive. There are red blood cells in certain women that do not contain Rh protein. Rh-negative is known to be these blood cells.

Pregnant women who have Rh-negative blood type are at risk of responding to Rh-positive fetal blood. Since a reaction can harm subsequent pregnancies, Rh-negative women typically receive an injection of Rh immunoglobulin (RhIG) after miscarriage or abortion to prevent Rh-related problems.

Before the Procedure

Your health care provider will also give you some details over the phone when you schedule your appointment. Since in-clinic abortions are known as surgeries, you may have to undergo fasting around midnight, the night before your operation.

You’ll answer questions and fill out some paperwork about your medical background when you arrive at the clinic. If the condition warrants it, you can then get a pre-abortion workup, which includes a physical exam, pregnancy examination, blood test, screening for sexually transmitted diseases, and possibly extra testing. An ultrasound can also be used by certain providers to confirm how far you are in your pregnancy and to search for uterine, fetal, or placental defects.

Pain Management

During the operation, the doctor will also speak about various kinds of pain control available to you.

You would typically get local anesthesia for an in-clinic abortion, meaning that your cervix will be numb, but you will be awake.
Although ibuprofen typically offers adequate pain relief from 600 to 800 milligrams, your doctor can also give you oral medication to calm you down or sedate you slightly so you’re awake but comfortable. You may ask whether a sedative drug can be administered to you via an IV if you want deep sedation, meaning you’re in a light sleep during the operation.

How It’s Done

To end a pregnancy, doctors can use medicine, surgery, or a combination of both. The procedure depends on how far you are in your pregnancy, your medical background, and your choice.

Abortions can be carried out safely with drugs during early pregnancy, before 9 weeks.
Abortions are typically performed surgically for 9 to 14 weeks, while drugs can be used to help soften and open the cervix.

Abortions can be performed after 14 weeks by using labor-inducing drugs that induce uterine contractions or by using these drugs in conjunction with surgery.

Medical abortion

Within 70 days of gestation, abortions can be completed with medicine, and this is called medical abortions. Gestation days are the number of days starting on the first day of your last cycle of menstruation.

A mixture of mifepristone and misoprostol is used most commonly by physicians.

Mifepristone – As a pill, Mifepristone is administered orally. The influence of progesterone, a hormone required for pregnancy, is counteracted by this treatment. Side effects include vomiting, nausea, vaginal bleeding, and pelvic pain. Typically, these effects may be treated with drugs. There can be heavy bleeding in extreme cases. You can be taken to a hospital and given blood transfusions in that situation. Mifepristone is more effective when another drug is administered 24 to 48 hours later, such as misoprostol. This stimulates the uterus to contract. Within 2 weeks, between 92% and 97% of women who receive mifepristone in combination with or accompanied by misoprostol have a full abortion.

Misoprostol – To induce a medical abortion, misoprostol is almost always used in combination with mifepristone. Misoprostol is a drug similar to prostaglandin, which allows the uterus to contract. There are a couple of ways to take this drug. Placing the tablets between your gum and cheek is the best process (called the buccal route). Misoprostol, which is just as safe, can be injected vaginally. It is less effective to swallow the pills or place them under your tongue and also has more side effects, such as nausea, diarrhea, and vomiting.

Methotrexate – Used less commonly, Mifepristone has been approved by the Food and Drug Administration (FDA). However, in women who are allergic to mifepristone or when mifepristone is not available, methotrexate can be used. For a gestational age greater than 49 days, it should not be included. The muscle is normally treated with methotrexate. Within 2 weeks, between 68% and 81% of pregnancies abort; after 45 days, 89% to 91% abort. The drug most commonly used to treat ectopic pregnancies conceived outside the womb is methotrexate. The fast-growing tissue of ectopic pregnancies is destroyed. Pregnancy hormone levels must be controlled until levels are undetectable in the bloodstream of a woman when doctors give methotrexate for the treatment of ectopic pregnancy. When methotrexate is used for surgical abortions where pregnancy is believed to be implanted in the womb, this monitoring is not necessary.

Your doctor can also prescribe doxycycline as an antibiotic to prevent infection.

In rare cases, there is a chance of the baby being born deformed when a pregnancy continues after the use of these drugs. In the use of misoprostol, the risk is greater. If the pregnancy tissue does not leave the body entirely within two weeks of medical abortion, or if a woman bleeds excessively, then the abortion may need to be completed through surgery.
About 2% to 3% of women who have a medical abortion may need to have a surgical operation, often called vacuum aspiration, usually suction dilation and curettage.

There should not be a medical abortion for a woman if she:

• Is pregnant for more than 70 days (counted from the first day of the last menstrual period)
• Has trouble with bleeding or takes medicine for blood thinning
• Has or is taking some steroid drugs with chronic adrenal failure
• Cannot attend the medical visits needed to ensure the completion of the abortion
• Has no recourse to emergency services
• Has uncontrolled convulsion disorder (for misoprostol)
• Has acute intestinal inflammatory disorder (for misoprostol)

Surgical abortion

• Menstrual aspiration – This procedure is performed within one to three weeks after a missed menstrual period, also called menstrual extraction or manual vacuum aspiration. The remaining tissue of an incomplete miscarriage can also be removed by this method (also called a spontaneous abortion). The physician inserts a tiny, flexible tube through the cervix into the uterus and uses a handheld syringe to suck the material from the inside of the womb for pregnancy. To reduce the pain caused by dilating the cervix, local anesthesia is usually applied to the cervix. Only the region injected is numbed by local anesthesia, and you remain conscious. Medication administered intravenously (into a vein) can reduce anxiety and the general response of the body to pain. The duration of menstrual aspiration is around 15 minutes or less.
• Suction or aspiration abortion – This operation can be performed up to 14 weeks after the first day of the last menstrual cycle, also called a suction D&C (for dilation and curettage). The procedure most commonly used to abort a pregnancy is suction D & C. To avoid infection, a single dose of antibiotics, usually, doxycycline is prescribed before the operation. The cervix is dilated (widened), and the uterus is inserted into a rigid hollow tube. The uterine contents are sucked out by an electric pump. It takes about 15 minutes to process. To alleviate the discomfort caused by dilating the cervix, local anesthesia is typically administered to the cervix. Intravenous (into a vein) medication can help to reduce anxiety and relieve pain.

Dilation and curettage (D and C) – The cervix is dilated in dilation and curettage, and devices with sharp points, known as curettes, are used to clear the tissue from pregnancy. To ensure that all the contents of the uterus are eliminated, suction is also used. The earlier this procedure is performed in pregnancy, the less dilated the cervix has to be, which makes the procedure simpler and safer.
Dilation and evacuation (D and E). This is the most common treatment that takes between 14 and 21 weeks to end a pregnancy. It is similar to D and C suction but with larger tools. It is necessary to dilate or spread the cervix open to a size larger than required for a D and C. To ensure that all the pregnancy tissue is extracted, suction is used along with other special instruments or forceps. It takes more time for the operation than most abortion procedures.

Abdominal hysterotomy – It is a major surgery to extract the fetus through an incision in the abdomen from the uterus. This is uncommon, but it might be required if it is not possible to do a D and E. In this procedure, anesthesia will render you unconscious.

Follow-Up

An early pregnancy medical abortion typically requires three or four visits to get abortion medication and to assure that all the pregnancy tissue has passed through. Abortion-related bleeding can last up to two weeks.
Most everyday activities will typically be resumed within hours of a surgical abortion that uses local anesthesia for 9 to 14 weeks, as long as no sedatives have been used. Do not drive or use unsafe equipment for at least 24 hours if you have received sedatives or are unconscious, as in general anesthesia. In either case, to prevent infection and to allow the cervix and uterus to return to normal shape and size, avoid sexual activity for 2 weeks. Around 2 weeks after the operation, most women are recommended to follow up at the doctor’s office.

Depending on how far you have been in your pregnancy and if there have been complications, you will usually resume most everyday activities from a few days to a few weeks after a late second-trimester abortion. After the treatment, you can need to stop sexual intercourse for two to six weeks. In general, about two weeks after the operation, you can see your doctor. Based on the situation, your doctor will give you clear advice regarding resuming everyday activities and working.

Cramps may be treated with ibuprofen or acetaminophen. Following a late second trimester abortion, cramping can be worse. You may be told not to showers or use tampons, or have sex for at least two weeks after having a medical or surgical abortion. This will help to reduce the risk of the uterus becoming infected. Vaginal spotting or bleeding up to one to two weeks after a surgical abortion is common for a few days. This depends on how far the pregnancy has been at the time of the abortion.

Risks

Infection, bleeding, and incomplete abortion are the risks of medical abortion, meaning that some of the pregnancy tissue remains. These issues are uncommon and can be cured. An incomplete abortion is managed by repeating the dose of medication given to end the pregnancy or by taking a D and C suction. With antibiotics, an infection can be treated. Excessive bleeding and possibly dilation and curettage is treated with medication. Rarely, if the bleeding is unusually heavy, a blood transfusion may be necessary.

The risks are quite low for surgical abortion. Continued bleeding, incomplete removal of pregnancy tissue, infection of the uterus (endometritis), and perforation of the uterus (poking a hole in the womb) during the surgical procedure are the main risks of D and C, and D and E. To remove tissue that was not removed during the first procedure or to repair a perforated uterus, a second surgical procedure may be required.

After an uncomplicated abortion, women rarely become infertile. However, when surgical abortion leads to endometritis or is complicated by heavy bleeding, perforation, or incomplete removal of tissue from pregnancy, infertility may result.