Parenting Pregnancy Medical Termination Of Pregnancy (Medicine Induced Abortion) – Abortion 101

Are you disturbed because of an unwanted pregnancy and do not know what to do? Leave all your fears and learn about abortions in an easy and comprehensive way. You should know what abortion is and what are the modern ways of doing, it in a non-surgical way.

What Is An Abortion (Pregnancy Termination)?

An abortion is the termination of pregnancy before the period of viability (before 20 weeks of pregnancy). It is not at all a modern day procedure. Evidences of abortions being performed dates back to as old as 3500 years and is mentioned in Ebers Papyrus (ca.1550 BCE). The commonly used term miscarriage is synonymous with abortion.

Classification of Abortions

Abortions are broadly classified as spontaneous and induced:

Spontaneous Abortions

Spontaneous abortions are sub-classified as:

  • Threatened
  • Inevitable
  • Missed
  • Septic
  • Incomplete
  • Complete

Induced Abortions

Induced Abortions can be of following sub-types:

  • Legal
  • Illegal (Criminal)

Causes of Abortions

Generally speaking there are three major factors responsible for abortions. They are:

  1. Ovo-fetal Factors (60%)
  2. Maternal Factors (15%)
  3. Prenatal factors

1. Ovo-fetal Factors

  • Chromosomal anomalies such as autosomal trisomy or monosomy
  • Due to presence of knots and twists in the fetal umbilical cord, interference in blood circulation of the fetus might result in abortion
  • Inappropriate and low attachment of placenta
  • Rapid overstretching of the uterus due to twins or hydramnios

2. Maternal Factors (15%)

  • Maternal shock or hypoxia caused due to respiratory, cardiac ailment or severe anemia.
  • Maternal hyperpyrexia or any viral infection may lead to abortion
  • Any injury or trauma to the abdomen either by fall or blow
  • Diabetes mellitus or hypothyroidism may also result in abortions
  • Any psychological factor such as sudden emotional upset
  • Chorion villus sampling, amniocentesis during the early months of pregnancy
  • Exposure to environmental toxins like lead, arsenic, alcohol, radiation
  • Blood group incompatibility
  • Vitamin E and folic acid deficiency

Prenatal Factors

  • Sperm defects
  • Idiopathic- about 25% of the cases fall under this category where the cause is unknown

Pregnancy Trimesters

A pregnancy is divided into three trimesters:

  1. First- first 12 weeks of pregnancy
  2. Second- 13th week till 24 weeks
  3. Third – 25th weeks till 36 week

First Trimester Abortions

There are both surgical and non-surgical methods available for terminating pregnancy during the first trimester.

Surgical Methods

They can be of following two types:

  1. Cervical Dilatation – Dilatation of cervix followed by uterine evacuation by suction evacuation, curettage or vacuum.
  2. Menstrual Regulation (MR) – It is also known as minisuction, or Lunchtime abortion as it is usually done 1-3 weeks after the cessation of menstruation.

Risks Involved in Surgical Methods

  1. Excessive Bleeding
  2. Accidental Uterine perforation
  3. Infection may ascend during the procedure

Non-Surgical Methods/ Medical Methods

Nowadays prostaglandins are widely used either by oral route or as injectables to serve the purpose. They can be used alone or in combination with other abortion-causing drugs. The most common ones are misoprostol and mifepristone.

Methotrexate

The drug is given is to a woman and after a week the gynecologist places misoprostol suppositories in her vagina. In a day or two bleeding occurs and pregnancy terminates as the embryo and other developing tissues are expelled from the vagina.

Mifepristone

Well mifepristone or RU-486 is antiprogesterone in action. The gynecologist gives the appropriate dose of mifepristone to the woman. After 5-7 days misoprostol suppositories are inserted in the vagina of the woman. Within 4-8 hours bleeding occurs and pregnancy usually terminates.

Abortion Pills

Abortion pills are the drugs that are completely different from emergency contraceptives. Abortion pills are usually taken between 7-9 weeks of pregnancy. They bring about an expulsion of the embryo from the uterus.

Birth control pills are the oral contraceptive pills taken by women to avoid pregnancy. Prevention of ovulation is their primary function.

Risks Involved

  • Nausea in about 25% women
  • dizziness
  • vomiting may be seen with misoprostol in about 5 % women
  • Fatigue
  • Headache
  • Breast tenderness
  • Sometimes heavy bleeding may occur that may require surgical intervention
  • The abortion may be an incomplete one and further surgical evacuation may be needed.
  • Some women may experience delayed periods in the nest menstrual cycle

Criteria for Choosing Medical Abortion

Following are some important things to be borne in mind while opting for medical abortion or abortion caused by taking an abortion pill.

  • The pregnancy is not more than 8 weeks old
  • Woman is capable to give a written and verbal consent
  • Access to an emergency unit within 2 hours if such situation arises
  • Agreement with the doctor to come for a follow-up at least two times
  • Doctor also takes your acceptance that in case of failure by a medical pill , you may have to go for a surgical procedure

Exclusions

Women who have any of the following ailments are completely forbidden to take abortion pills, other health issues

  • Liver, heart or kidney ailment
  • Severe anemia
  • Adrenal failure
  • Blood disorders
  • Anticoagulant medication consumption
  • Severe diarrhea
  • Any allergy to mifepristone or misopristol or any prostaglandin allergy
  • Ectopic pregnancy

Follow Up

Follow up is required after a week to ensure that the abortion is complete and the products of conception are completely expelled out form the uterus. If the abortion is incomplete surgical intervention should be done.

Second trimester Abortions

For second trimester abortions medical methods are the preferred ones. Common medical methods include:

Medical Methods

Ethacridine lactate

Emcredyl or Rivanol is the commonly used drugs in this category. The drug is instilled in the uterine cavity with the help of a sterile catheter. About 150 ml of the drug is introduced in the uterus and the catheter is then clamped to prevent the backflow and is tied to the tigh of the woman. Usually within 48-72 hours the fetus is aborted. This process is cheap and safe. This procedure can be hastened by intravenous oxytocin in drip. Oxytocin initiates uterine contractions and facilitates expulsion of fetus.

Prostaglandin

Cerviprime a prostaglandin gel is inserted in the uterus via cervix. The woman is asked to lie for about 1 hour and then the next day the process is hastened by intravenous oxytocin drip. Within 24 hours abortions is complete.

Misoprostol

It can be either administered oral or can be placed in the vagina. Two tablets of mifepristone should be given then either an oral or vaginal dose of misoprostol should be given.
Uterine cramps and contractions set in and fetus is expelled out of the vagina.
With the complete expulsion of fetus cramps and pain stops.

Other Drugs

Hypertonic saline, glucose, urea etc are not safe to use.

Risks Involved

  • There may be a chance of catching infection
  • Heavy bleeding may occur so hospitalization may be needed
  • Products of conception may be retained which means the abortion may be an incomplete one, surgical evacuation may be needed.

Surgical Methods

Aspiratomy – It is similar to the first trimester medical regulation. Prostaglandins are used to dilate the cervix and is done between 13-20 weeks of pregnancy

Hysterotomy - It is procedure where the woman’s abdomen is opened followed by opening of uterus and then the products of conception are removed under direct vision. It is quite similar to Caesarean Section.

Hysterectomy – This is complete removal of uterus along with its content in totality.

Important Point

Remember, an early detection of pregnancy followed by its early termination is the safer than second trimester abortions.
Prerequisites of Induced Abortion:

Here are listed some of the mandatory tests that are a must before any abortion:

  • Thorough medical examination that includes blood pressure estimation, and weight measurement
  • Internal examination for the confirmation of pregnancy
  • Confirmation of pregnancy by urine test
  • Routine urine analysis
  • Complete blood count with Hb estimation
  • Test Blood group and Rh factor
  • In some cases ultrasound may be needed

Consent

Before going for abortion you have to give consent that allows the obstetrician to perform m the process.

  • Married woman’s written consent is sufficient enough for the procedure to be performed. Husband’ consent is not a must
  • Unmarried girl but above 18 years- own written consent is sufficient
  • Unmarried girl below 18 years- written consent of the guardian
  • A mentally unstable woman- guardian’s written consent
  • Consent laws are varies in different countries, your local gynecologist will be the better person to inform you about the laws.

A written consent ensures that the obstetrician has well informed the patient about the risks and threats involved in the procedure to be performed.

Imperative Counseling

Counseling is an important step before going for any abortion. It is done by the obstetrician and it provides all the significant reasons to the woman why she should continue her pregnancy and should not unnecessarily opt for termination unless there is a risk involved.

Counseling is important as it serves the following purposes:

  • To assuage the anxiety of the woman
  • To provide all relevant information about the risks and methods of the procedure to be performed
  • It screens any guilt or psychiatric ailment
  • Guides her in avoiding any unplanned pregnancies in future

We would love to hear your thoughts, experiences of going through medical termination of pregnancy (if any). Please leave us a comment and let us know. Subscribe our RSS to receive pregnancy tips, articles.

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