The medical facts about induced abortion The types of abortion How abortions are performed

An induced abortion is a procedure with few risks. The earlier you seek advice, the better.

What is Induced Abortion?

Abortion occurs when the fetus is expelled from a woman's uterus. When a procedure is done to end a pregnancy, it is called "induced abortion." Most abortions are done in the first 12 weeks of pregnancy.

Before the procedure, a test is done to confirm the pregnancy. The doctor will ask questions about your health and perform a physical exam. Blood tests will be done. An ultrasound exam may be done to confirm the date of the pregnancy. In most cases, a counselor is available to answer any questions.

Types of Abortion

Induced abortion can be done in several ways. Some are done by surgery, and others are done with medication. The type of abortion depends on a woman's choice and health, where the abortion is performed, and the length of the pregnancy, which is measured in weeks from the first day of a woman's last normal period. The later in pregnancy abortion is done, the more complex the procedure and the higher the risk.

Menstrual Aspiration

Menstrual aspiration can be done within 1–3 weeks after a missed period. With this method, a syringe is used to remove the pregnancy from the lining of the uterus.

Suction Curettage

Suction curettage is the most common type of abortion. The contents of the uterus are removed by a suction device that is inserted into the uterus. It also may be called vacuum curettage. It can be done up to 12 weeks of pregnancy. After that time, this procedure may be called dilation and evacuation (D&E).

Just before the procedure, local anesthesia is applied around the cervix to numb it. Sedatives may or may not be used. Sometimes general anesthesia is used so the woman is not awake during the procedure.

For the procedure, a speculum is inserted into the vagina to hold it open. This is similar to a pelvic exam. Then a device called a dilator is inserted into the cervix to stretch the opening so a suction tube can fit through.

Dilation often is done at the time of the procedure. In some cases, other methods can be used to dilate the cervix before the procedure. For instance, laminaria are thin rods that are inserted into the cervix. They absorb moisture and swell. This slowly stretches the cervix, which can take several hours or even overnight. Another way to dilate the cervix is with a drug called misoprostol. It may be given a few hours before the procedure. It can be taken by mouth or placed in the vagina.

After the cervix is dilated, a small, flexible, plastic tube is inserted into the uterus. It is attached to a suction or vacuum pump, which removes the pregnancy. This part of the procedure takes about 10 minutes. The further along the pregnancy is, the longer the procedure will take. A woman may be able to go home as soon as an hour afterward.

Your doctor will give you antibiotics before the abortion to help prevent infection. Soreness or cramping may occur for a day or two after the procedure, and bleeding may last for up to 2 weeks.

Medical Abortion

With a medical abortion, certain drugs are taken to cause an abortion. It only can be done early in pregnancy. For this option, a woman must be no more than 9 weeks pregnant.

A medical abortion does not require surgery or anesthesia, but multiple visits to the doctor are needed. For some types, the drugs can be taken at home. In this case, it is important that a woman understands the process. She needs to know what is normal and what is not.

There are four types of medical abortion:

1. Mifepristone and misoprostol pills
2. Mifepristone pills and vaginal misoprostol
3. Methotrexate and vaginal misoprostol
4. Vaginal misoprostol alone

Mifepristone and misoprostol pills. This is the most common type of medical abortion. It must be performed within 49 days (7 weeks) of the first day of the last period. A woman must visit her doctor three times to take the medications:

• Mifepristone (also called RU–486) blocks the action of the hormone progesterone. Without progesterone, the lining of the uterus thins and prevents the embryo from staying implanted and growing.
• Misoprostol, a prostaglandin, causes the uterus to contract and expel the embryo through the vagina.

During the third visit (within 14 days of the first visit), a follow–up exam is done to make sure the abortion is complete. This method is very effective.

Who Is At Risk? Some women should not have a medical abortion. This includes women who: Had the first day of their last period more than 49–63 days ago (depending on the method) Have or might have an ectopic pregnancy Have chronic adrenal failure Have a seizure disorder that is not controlled Take a medicine to thin their blood Have a bleeding problem Take certain steroid medicines Cannot attend all doctor visits or understand the effects of treatment Have an allergy to the medicines used Do not have access to emergency care Have an intrauterine device (IUD) in place A medical abortion may not be an option for women with severe liver, kidney, or lung disease, high blood pressure that is not well controlled, diseases of the heart and blood vessels or severe anemia. Women who find the process of medical abortion difficult may want to consider surgery.

Mifepristone pills and vaginal misoprostol. This type of medical abortion must be performed within 63 days (9 weeks) of the first day of the last period. It uses the same drugs as the first method, but in different doses. Instead of taking a misoprostol pill, the misoprostol is placed in the vagina after the mifepristone is taken. A woman can do this at home. This method is faster, costs less, has fewer side effects, and works better than other methods of medical abortion.

Methotrexate and vaginal misoprostol. This type of medical abortion must be performed within 49 days (7 weeks) of the first day of the last period. It is very effective, but it may take up to 4 weeks for abortion to occur. Methotrexate is given as a shot at the doctor's office. The woman then uses misoprostol vaginally at home a few days later. She must visit the doctor about a week after the methotrexate is given. A vaginal ultrasound exam is done to confirm that abortion has occurred. If abortion has not occurred, another dose of misoprostol is given.

Vaginal misoprostol alone. This type of medical abortion must be performed within 56 days (8 weeks) of the first day of the last period. This method uses only misoprostol, given vaginally. Side effects can be worse with this method than with others, and it is less effective.

Do I Need Anyone's Permission or Consent? Abortion has been legal in the United States since 1973. However, no doctor is required to perform an abortion. In some states, there are special legal requirements and waiting periods. For instance, most states require that minors get consent from their parents, tell their parent(s), or gain court approval before they can have an abortion.

Labor–Inducing Abortion

For abortions later in pregnancy, labor may be induced with drugs that can be put in the vagina, injected into the uterus, or given through an intravenous (IV) line. Prostaglandins, the most widely used drugs for labor–inducing abortions, cause the uterus to contract. Other agents—such as saline, urea, or oxytocin—are used less often. Sometimes more than one drug is used to induce labor.

These drugs usually cause labor within 12 hours and the abortion usually occurs within 12–24 hours. Labor–inducing drugs may cause side effects such as nausea, fever, vomiting, and diarrhea.

Where Is the Abortion Performed?

Where an abortion is done depends on a number of factors:

• How it will be done
• Then length of the pregnancy
• The health of the woman

Who Performs the Abortion? Abortions are done by a doctor or other health professional who has been trained to do the procedure. A woman's regular doctor may perform abortions. If not, he or she may be able to recommend someone who does. The state's medical society, the local health department, or a family planning clinic also can provide information about abortion services. The National Abortion Federation can provide information and help locate providers in certain areas. The hotline number is (800) 772-9100 or information can be found at http://www.prochoice.org.

Early surgical and medical abortions can be done safely in a doctor's office or clinic. Later abortions often are performed in hospitals or in special clinics.

After the abortion, counseling (including information on birth control) and recovery care should be available. A woman should be sure that the facility she selects has a full range of services on hand and all the options and details are discussed.

Risks

Abortion is a low–risk procedure. An early abortion has less risk than a later one. Fewer than 1 in 100 women have complications from an early abortion. For later abortions, up to 2 in 100 women have complications. Although an abortion is low risk, as with any surgery or medicine, problems may occur.

Incomplete Abortion

Although rare, in some cases the pregnancy is not removed completely. Bleeding and infection may occur. If the abortion is incomplete, the doctor may need to perform follow–up curettage.

Infection

An infection can occur if bacteria from the vagina or the cervix get into the uterus after an abortion. The doctor will prescribe drugs to prevent this and can treat the infection if it happens.

Hemorrhage

Some bleeding after an abortion is normal. Bleeding is rarely heavy enough to require a blood transfusion.

Damage to the Uterus

During a surgical abortion, the tip of a device may pass through (perforate) the wall of the uterus or tear the cervix. If this happens, further surgery may be needed. Other organs, such as the bowel and bladder, also can be injured if this occurs. In these cases, surgery will be needed to repair the organ. The risk of perforation or tear of the cervix is less than 1 in 1,000 abortions. The risk increases with the length of the pregnancy.

Death

The risk of death from abortion is lower than 1 in 100,000 women who have suction curettage. For women who have a medical abortion, the risk of death is about 1 in 100,000. The risk of a woman dying from giving birth is at least 10 times greater than the risk from an early abortion.

Afterward

Effects after abortion vary. Many women have a wide range of feelings about having an abortion. It can be a stressful time. Some women may feel relieved, sad, or both at the same time. If unhappy feelings do not go away, counseling may be needed.

Some side effects may occur with induced abortion:

• Abdominal pain and cramping
• Nausea
• Vomiting
• Diarrhea
• Bleeding

In most cases, it is safe to resume normal activities after an abortion. The doctor will explain any limits to activity.

If any of these problems occur, it may be necessary to call the doctor:

• Severe abdominal or back pain
• Bleeding that is heavier than a normal period
• Foul–smelling discharge
• A fever (above 100.4ºF)

Normal menstruation usually starts again 4–6 weeks after an abortion. Pregnancy is possible soon after the abortion, so birth control is needed right away. Choosing a method depends on many factors, such as age, health, and how likely it is to be used consistently and correctly. Among the most effective methods are birth control pills and the IUD. Condoms also should be used to prevent sexually transmitted diseases. Most doctors agree that one abortion does not affect future pregnancies.

There have been reports that women who have an abortion have an increased risk of breast cancer. Recent studies have not found a link between abortion and breast cancer. Why a woman develops breast cancer is based on many other factors besides abortion. Family history, health habits, age, and number of pregnancies also seem to play a role.

Finally...

An induced abortion is a procedure with few risks. The earlier you seek advice, the better. Get care as soon as possible. Make sure that all your questions are answered before, during, and after any procedure. Follow–up with medical care, and use birth control if you do not want to become pregnant.

Glossary

Anemia: Abnormally low levels of blood or red blood cells in the bloodstream. Most cases are caused by iron deficiency, or lack of iron.

Anesthesia: Relief of pain by loss of sensation.

Cervix: The lower, narrow end of the uterus, which protrudes into the vagina.

Ectopic pregnancy: A pregnancy in which the fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes.

Embryo: The developing fertilized egg of early pregnancy.

Prostaglandin: A chemical that is made by the body that has many effects, including causing the muscle of the uterus to contract, usually causing cramps.

Sedatives: Agents or drugs that ease nervousness or tension.

Speculum: An instrument used to spread the walls of the vagina.

Ultrasound: A test in which sound waves are used to examine internal structures. During pregnancy, it can be used to examine the fetus.

Uterus: A muscular organ located in the female pelvis that contains and nourishes the developing fetus during pregnancy.

Vagina: A tubelike structure surrounded by muscles leading from the uterus to the outside of the body.

This Patient Education Pamphlet was developed by the American College of Obstetricians and Gynecologists. Designed as an aid to patients, it sets forth current information and opinions on subjects related to women's health. The average readability level of the series, based on the Fry formula, is grade 6–8. The Suitability Assessment of Materials (SAM) instrument rates the pamphlets as "superior." To ensure the information is current and accurate, the pamphlets are reviewed every 18 months. The information in this pamphlet does not dictate an exclusive course of treatment or procedure to be followed and should not be construed as excluding other acceptable methods of practice. Variations taking into account the needs of the individual patient, resources, and limitations unique to the institution or type of practice may be appropriate.

Copyright © June 2007 by the American College of Obstetricians and Gynecologists. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, posted on the Internet, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without prior written permission from the publisher.

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