Types of Abortion

An elective abortion is the deliberate termination of a pregnancy. It is not the same thing as a spontaneous abortion, otherwise known as a miscarriage Miscarriage: a naturally occurring event where a pregnancy ends on its own before 20 weeks. (1).

There are two categories of elective abortion procedures: medical and surgical. The type of abortion procedure used is based on how far along your pregnancy is (gestational age).

Medical abortions involve the use of medication to terminate the pregnancy and can be done within 10 weeks from your last menstrual period (LMP). (4, 5)

Surgical abortions, often referred to as “in-clinic abortions,” terminate the pregnancy through a surgical procedure. Surgical abortions can be done throughout all three trimesters, depending on your state’s abortion laws. (8)

To determine how far along your pregnancy is, The American College of Obstetricians and Gynecologists recommends the use of an ultrasound as the most accurate way. (9) While Focus Women’s Center does not provide abortions, we do offer free ultrasounds to qualifying patients as part of our Pregnancy Verification and Consultation appointment.

If you are pregnant and considering abortion, find out why Focus Women’s Center should be your first step.

MEDICAL ABORTION

RU486 – The ABORTION PILL (within 10 weeks after LMP)

The most common regime for a medical abortion is a two-step process involving a combination of mifepristone (RU486) Generic Name: mifepristone (RU486)
Brand Name: Mifprex
Commonly Called: The Abortion Pill (2 & 3)
and misoprostol. The FDA has approved the use of mifepristone for use up to 70 days (10 weeks) from your last menstrual period (LMP). Please note: The Abortion Pill is NOT the same thing as the Morning-After Pill.

How Does The Abortion Pill Work?

Day 1
The Abortion Pill (mifepristone) is given orally. Mifepristone works by blocking progesterone (the hormone that is needed for the pregnancy to continue), causing the embryo to die. You may experience contractions and bleeding as your body starts to expel the pregnancy. (3, 4, 5)
Day 2 or 3
24-48 hours after taking mifepristone, misoprostol is taken. Misoprostol causes the uterus to contract, expelling the pregnancy. This usually occurs within 2-24 hours of taking it. (4)
What To Expect
After taking misoprostol, the most common side effects include cramps, nausea, weakness, headache, dizziness, diarrhea, vomiting, stomach pain, heavy bleeding (may include large clots in the blood and/or a discernable fetus), and mild fever or chills. These usually occur within 2-24 hours of taking it. Bleeding, spotting, and the passing of blood clots and tissue usually continues for 9-16 days but can continue for 30 days or more. Very rarely, serious and life-threatening bleeding, infections, and other complications can occur following a medical abortion. If you are worried about any side effects and symptoms, you should call your healthcare provider immediately or go to the Emergency Room. (2, 3, 4, 5)
Follow-Up
Between 7-14 days after taking the Abortion Pill, you will need to have a follow-up with the provider to ensure that the abortion was complete and that there are no immediate complications. Your provider may choose to do this over the phone by going over your medical history with you, or with a visit to their office. The office visit may include a physical exam, blood test, or an ultrasound. (2, 6)
Effectiveness
According to some studies, < 5% of medical abortions done within the first 9 weeks (by LMP) of pregnancy do not completely expel and may require surgical evacuation to empty the uterus. In less than 1% of the time, the pregnancy is not terminated and continues to grow. These ongoing pregnancies may be terminated with another surgical abortion or medication. (5)

Please Note: Medical abortions are not effective for terminating ectopic pregnancies Ectopic Pregnancies: When a fertilized egg implants and grows outside of the uterus. This can cause life-threatening bleeding if left untreated. (7) .

Symptoms of a ruptured ectopic pregnancy (which can be life-threatening if not treated) may be confused with some of the common side effects of a medical abortion, such as abdominal pain and bleeding. (2, 7) Therefore, it is important to have an ultrasound to make sure you have an intrauterine pregnancy before having a medical abortion. While Focus Women’s Center does not provide abortions, we do offer free ultrasounds to some of our patients as part of our Pregnancy Verification and Consultation appointment.

SURGICAL ABORTION

These procedures are done in the clinic. The pre-abortion workup for each is the same and usually includes a pregnancy test, medical history, physical exam, and some lab tests. It is important to make sure you are also screened for STDs and that you receive a Rh factor blood test Whether you abort, miscarry, or carry to term - if your blood type is found to be Rh negative, you should receive an injection of RhoGam to prevent severe complications in the fetus in future pregnancies. (10) .

Some clinics may also do an ultrasound to determine gestational age and to rule out an ectopic pregnancy Ectopic Pregnancies: When a fertilized egg implants and grows outside of the uterus. This can cause life-threatening bleeding if left untreated. (7) . (11)

Aspiration Abortion (5, 8, 12, 13, 14)

(First Trimester up to 16 weeks after LMP)

The most common type of first trimester abortion is a vacuum aspiration, also known as a suction abortion. Usually a patient will spend 3-4 hours at the clinic for this procedure, although the procedure itself only takes 5-10 minutes to complete.

What To Expect
During an aspiration abortion, a speculum is inserted into your vagina to hold it open to allow for visualization of the cervix. Your cervix will be dilated (opened) either before or during the procedure so that a suction tube can fit through it. A local anesthetic is injected into your cervix to numb it. Your abortion provider may also give you a sedative. Once your cervix is dilated wide enough, a small tube is then inserted through the cervix into the uterus and is attached to a suction device. The pregnancy is then suctioned out. It is common to feel mild to moderate cramping during this portion of the procedure. Sometimes a curette (long, loop-shaped knife) is used to scrape the lining, placenta, and fetus away from the uterus. When this is used, the abortion is called a D&C (Dilation and Curettage). Once the suction tube is removed, the cramping usually decreases in intensity. After the procedure, you will be given antibiotics to help prevent infection and sent to a recovery area to rest.

Side Effects
During an aspiration abortion it is common to experience cramping for 1-4 days afterwards, while bleeding may last for up to two weeks. The bleeding may include blood clots. Many also experience nausea, vomiting, sweating, and feeling faint. Less frequently, patients experience heavy or prolonged bleeding.

Risks
Risks of an aspiration abortion include damage to the cervix, perforation of the uterus, hemorrhaging, and infection due to either retained products of conception, or STDs or bacteria being introduced into the uterus.

Effectiveness
Aspiration abortions have a 99% success rate of terminating pregnancies.

Dilatation and Evacuation (12, 13)

(Second Trimester – 14 to 23 weeks after LMP)
What To Expect

For a Dilation and Evacuation (D&E) you may need to visit the abortion provider anywhere from a few hours to a day before the abortion to have your cervix dilated. The cervix is dilated either by using a medication, laminaria, or dilators. You also may be given a prostaglandin like misoprostol to soften the cervix. For a D&E, you will be given general or regional anesthesia for pain relief. You may also be offered sedation orally or through an IV. Some patients require a shot through the abdomen to stop the fetal heartbeat before the procedure. The procedure itself is similar to the first trimester abortion. However, besides using a vacuum suction, the abortion provider will also use surgical instruments like forceps to remove larger parts, or a curette to scrape the uterine lining. This procedure normally takes between 15-30 minutes to complete. Afterwards, you will be given an antibiotic to help prevent infection and sent to a recovery area to rest.

Side Effects

For a Dilation and Evacuation (D&E), it is common to experience nausea, bleeding, and cramping which may occur for two weeks after the procedure.

Risks

Although rare, risks of a Dilation and Evacuation (D&E) abortion include damage to the cervix, perforation of the uterus, hemorrhaging, blood clots, and infection due to either retained products of conception, or STDs or bacteria being introduced into the uterus.

Effectiveness

Surgical abortions have a 99% success rate of terminating pregnancies.

If you are pregnant and considering abortion, find out why Focus Women’s Center should be your first step.

Sources:

(1) Retrieved from U.S. National Library of Medicine. (2020). Miscarriage.

(2) Retrieved from RxList Inc. (2020) Mifeprex RU486.

(3) Retrieved from Stacey, D. (2019). The abortion pill- RU486.

(4) Retrieved from U.S. Food and Drug Administration (FDA). (2016).Medication guide Mifeprex.

(5) Retrieved from Gynecology and Society of Family Planning Committee on Practice Bulletins, Creinin, M, & Grossman, D. (2014). Medical management of first trimester abortion. The American College of Obstetricians and Gynecologists, 2014(143), 1-18.

(6) Retrieved from Guttmacher Institute. (2020). Medication abortion.

(7) Retrieved from Mayo Foundation for Medical Education and Research. (2020). Ectopic pregnancy.

(8) Retrieved from Gotter, A. (2016). Surgical abortion.

(9) Retrieved from American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice, Pettker, C., Goldberg, J., El-Sayed, Y., Copel, J., & Society for Maternal Fetal Medicine. (2017). Committee opinion: Methods for estimating due date. American College of Obstetricians and Gynecologists, 2017(700), 1-5.

(10) Retrieved from Mayo Foundation for Medical Education and Research. (2020). Rh factor blood test.

(11)  Retrieved from Healthwise Staff. (2019). Surgical abortion care. University of Michigan Health System.

(12) Retrieved from American College of Obstetricians and Gynecologists. (2020). Induced abortion.

(13) Retrieved from American Pregnancy Association. (2020). Surgical abortion procedures.

(14) Retrieved from Mayo Foundation for Medical Education and Research. (2020). Dilation and curettage (D&C).

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