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How It's Done

Doctors can use medications, surgery or a combination of both to end a pregnancy. The method depends on how far along in the pregnancy you are, your medical history and your preference. Abortions during early pregnancy, before 9 weeks, can be done safely with medications. Abortions between 9 and 14 weeks usually are done surgically, although medications may be used to help soften and open the cervix. After 14 weeks, abortions can be done using labor inducing medications that cause uterine contractions or by using these medicines in combination with surgery.

Medical abortion
Abortions completed with medication, called medical abortions, are done within 49 days from the start of the pregnancy. Pregnancy usually starts two weeks after the first day of a menstrual period, so this corresponds to nine weeks from the last menstrual period. Medications used to induce abortion include:

  • Mifepristone (Mifeprex). Known as RU-486, mifepristone is taken orally as a pill. Approved for use in the United States in 2000, this drug counters the effect of progesterone, a hormone necessary for pregnancy. More than 3 million women in Europe and China have received this drug to end a pregnancy.

    Side effects include nausea, vomiting, vaginal bleeding and pelvic pain. These symptoms usually can be treated with medications. In rare instances, there may be heavy bleeding. In that case, you may be admitted to a hospital and given blood transfusions.

    Mifepristone is more effective when another medication, such as misoprostol (Cytotec), is taken 24 to 48 hours later. It causes the uterus to contract. Between 92% and 97% of women who receive mifepristone in combination with, or followed by, misoprostol have a complete abortion within 2 weeks.

  • Misoprostol (Cytotec). Misoprostol is almost always used in conjunction with mifepristone to induce a medical abortion. Misoprostol is a prostaglandin-like drug that causes the uterus to contract. One form can be taken by mouth. The other is inserted into the vagina. The vaginal form is less likely to cause diarrhea, nausea and vomiting. However, the vaginal form is associated with a higher risk of infection. To decrease the risk of infections, many doctors now prefer the oral form of misoprostol, followed by a 7 day course of the antibiotic doxycycline.

  • Methotrexate. Methotrexate is used less often since the U.S. Food and Drug Administration (FDA) approved mifepristone. However, methotrexate may be used in women who are allergic to mifepristone or when mifepristone is not available. Methotrexate usually is injected into a muscle. Between 68% and 81% of pregnancies abort within 2 weeks; 89% to 91% abort after 45 days. Methotrexate is the medication most often used to treat ectopic pregnancies, which are implanted outside the womb. It kills the fast-growing tissue of ectopic pregnancies. When doctors give methotrexate to treat ectopic pregnancy, pregnancy hormone levels must be monitored until levels are undetectable in a woman's bloodstream. This monitoring is not necessary when methotrexate is used for medical abortions, where the pregnancy is known to be implanted in the womb.

In rare instances when a pregnancy continues after the use of these medications, there is a risk that the baby will be born deformed. The risk is greater with the use of misoprostol. If the pregnancy tissue does not completely leave the body within two weeks of a medical abortion, or if a woman bleeds heavily, then a surgical procedure may be needed to complete the abortion. Approximately 2% to 3% of women who have a medical abortion will need to have a surgical procedure, usually suction dilation and curettage (D and C), also called vacuum aspiration.

A woman should not have a medical abortion if she:

  • Is more than 49 days pregnant

  • Has bleeding problems or is taking blood thinning medication

  • Has chronic adrenal failure or is taking certain steroid medications

  • Cannot attend the medical visits necessary to ensure the abortion is completed

  • Does not have access to emergency care

  • Has uncontrolled seizure disorder (for misoprostol)

  • Has acute inflammatory bowel disease (for misoprostol)

Surgical abortion

  • Menstrual aspiration. This procedure, also called menstrual extraction or manual vacuum aspiration, is done within one to three weeks after a missed menstrual period. This method can also be used to remove the remaining tissue of an incomplete miscarriage (also called a spontaneous abortion). A doctor inserts a small, flexible tube into the uterus through the cervix and uses a handheld syringe to suction out the pregnancy material from inside the womb. Local anesthesia is usually applied to the cervix to decrease the pain of dilating the cervix. Local anesthesia numbs only the area injected and you remain conscious. Medication given intravenously (into a vein) can lessen anxiety and the body's general response to pain. Menstrual aspiration lasts about 15 minutes or less.

  • Suction or aspiration abortion. Sometimes called a suction D & C (for dilation and curettage), this procedure can be done up to 13 weeks after the first day of the last menstrual period. Suction D & C is the procedure most commonly used to end a pregnancy. The cervix is dilated (widened) and a rigid hollow tube is inserted into the uterus. An electric pump sucks out the contents of the uterus. The process takes about 15 minutes. Local anesthesia is usually applied to the cervix to minimize the pain of dilating the cervix. Medication given intravenously (into a vein) may help to decrease anxiety and relieve pain.

  • Dilation and curettage (D and C). In a dilation and curettage, the cervix is dilated and instruments with sharp edges, known as curettes, are used to remove the pregnancy tissue. Suction is often used to make sure all the contents of the uterus are removed. The earlier in pregnancy this procedure is done, the less the cervix has to be dilated, which makes the procedure easier and safer.

  • Dilation and evacuation (D and E). This is the most common procedure for ending a pregnancy between 14 and 21 weeks. It is similar to a suction D and C but with larger instruments. The cervix has to be dilated or stretched open to a size larger than required for a D and C. Suction is used along with forceps or other special instruments to ensure all the pregnancy tissue is removed. The procedure takes more time than other abortion procedures.

  • Abdominal hysterotomy. This is a major operation to remove the fetus from the uterus through an incision in the abdomen. This is rare but may be necessary if a D and E cannot be done. Anesthesia will make you unconscious for this surgery.

Induction of labor
After 14 weeks of pregnancy, abortion can be done by giving medication that causes the woman to go into labor and deliver the fetus and the placenta. The procedure usually requires hospitalization for more than a day because it involves a labor and delivery. Sometimes dilation and evacuation is necessary to completely remove the placenta. Labor can be induced in one of three ways:

  • Invasive. Injecting labor inducing medications by passing a needle through the abdomen and into the uterus, usually within the amniotic sac

  • Noninvasive. Giving labor inducing medications by mouth, intravenously (into a vein), through an injection into a muscle, or inserted in the vagina

  • A combination of invasive and noninvasive approaches. Usually necessary when abortion is done late in the second trimester, before 24 weeks

Page 4 of 9     Next Page:  Abortion (Termination Of Pregnancy) Follow-Up
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From Health A-Z, Harvard Health Publications. Copyright 2007 by the President and Fellows of Harvard College. All rights reserved. Written permission is required to reproduce, in any manner, in whole or in part, the material contained herein. To make a reprint request, contact Harvard Health Publications. Used with permission of StayWell.

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