The World of Pregnancy

When Is It too Late to Get an Abortion?

You may be wondering when is it too late to get an abortion, and you are right to feel concerned when talking about such a risky medical intervention, not to mention about ending a life.When Is It too Late to Get an Abortion

An abortion is a major decision and extremely difficult to take no matter if you wanted your pregnancy or not. Before deciding anything, it`s best for you to visit a doctor for an examination where you`ll receive an ultrasound and be informed on the procedure.

Lots of women, more exactly the ones with ages between 18 – 25 years old, use the morning-after pill to eliminate a possible fertilized egg, but when it`s too late (when the implantation bleeding took place) and a pregnancy test was taken, an unwanted pregnancy can be interrupted through another method – abortion. Also, this technique is used for preventing a birth of a baby with malformations or severe medical conditions (e.g. amniocentesis).

What Is a Surgical Abortion?

A surgical abortion interrupts a pregnancy through surgical removal of the uterine content. For this type of abortion are used various procedures, depending on the age of the pregnancy. Before and after a surgical abortion there is a physical examination and lab tests that needs to be performed, as well as informing the patient about how the procedure would take place, instructions for self-care after the procedure, subsequent symptoms which require immediate medical intervention and family planning methods.

Causes

The most frequent reasons for which women choose abortion are:

  • Contraception failure – more than half of women who choose to make an abortion were using a contraceptive method during the period in which they became pregnant.
  • Not being able to raise a child;
  • Interruption of an unwanted pregnancy;
  • Preventing the birth of a deformed baby or with serious illness – these fetal problems are most of the times diagnosed during the second trimester of pregnancy during some routine investigations (screening for fetal anomalies);
  • Pregnancy through rape or incest – there are around 13,000 women in this situation every year;
  • Physical or mental condition which puts the pregnant woman`s life in jeopardy if the pregnancy is maintained.

Illegal Abortion

Abortion is legal, with a few restrictions during the week 24 of pregnancy (in the absence of some medical indications, abortion on demand is legal until the week 12). Numerous states ask the woman to think about it for 24 hours after which it has been informed about the implications of abortion.

Illegal abortion is when the procedure is performed by personnel without any proper medical training and presents a much higher risk of complications than that which is achieved by qualified personnel.

Teen Pregnancy

Around 30% from all pregnant women choose abortion. At about 60% from women under 18 years old who have had an abortion, at least one of the parents knows about it and supports their daughter`s choice. The most frequent reasons for which teenagers choose this procedure are:

  • They aren`t mature enough to have a baby;
  • They aren`t capable financially to raise a child;
  • Concern that a child will change their life and compromise their future (and the child`s future) – lots of young mothers don`t manage to get a level of education and a job necessary to avoid raising their child in poverty.

When Is Surgical Abortion Performed?

  • Irregular bleeding: if a patient shows period bleeding between menstruations, the gynecologist can investigate the causes of the symptom through a sample of uterine tissue.
  • Massive bleeding: women with abundant menstruation who accuse massive bleeding during those particular periods of the month and the elimination of important amounts of blood through the vagina after menopause may need surgical abortion.
  • Uterine fibroids and polyps: removal of uterine fibroids and polyps can be performed through curettage.
  • Endometrial cancer: Taking a sample of tissue for detecting endometrial cancer is also performed through curettage.
  • Abortion or post-abortion care: an unwanted pregnancy can be stopped from evolving through curettage. A miscarriage needs the same intervention as the remaining tissue after conception can cause severe bleeding and infections which can put the life of the mother in danger.

When Is It too Late to Get an Abortion?

The answer to this question usually depends on fetal viability, ability of survival if it`s born and what pregnancy stage is the woman in. Generally speaking, any time limits set on abortion are for preventing any risks to the health of the mother and baby.

In the U.S., it also depends on the state in which you choose to make the procedure. It depends by the fetus`s age of viability, which is around 24 weeks – meaning the fetus is able to survive outside the womb at or about 6 months, so if such a procedure is performed after this period of time, it`s seen as “intent to murder.” – More info!

If the pregnant woman decides for any abortion, it`s generally recommended to be performed as soon as possible; first of all, because it involves the safety of the mother. Most procedures of this kind generally take place between the week 12 and 13 of pregnancy. There are several circumstances where some medical interventions are performed later, but it`s essential to check the state`s laws.

You may also want to read Hematometra (Hemometra): Causes, Symptoms & Treatment!

Investigations

Specialized investigations have the purpose of diagnosing a pregnancy and see if there are other problems which require any follow up. No matter the pregnancy`s future (keeping it or abortion), the consultation will include a history in which to emphasis other similar pregnancies, abortions or associated diseases, but also a physical examination along with lab tests.

Regardless of the woman`s age, the gynecological consultation is confidential. The gynecologist isn`t allowed to disclose aspects of the consultation to anyone without the patient`s agreement.

The physical examination prior an abortion includes:

  • Vital signs – blood pressure and heart rate (pulse);
  • Heart and lungs investigation;
  • Pelvic exam to determine the uterus`s size (helps in estimating the week of pregnancy), uterus`s shape, the condition of the ovaries and fallopian tubes (for eliminating an ectopic pregnancy);

Laboratory examinations prior an abortion includes:

  • Pregnancy test to confirm the pregnancy – there are other reasons for which a period can be late as well (stress, excessive physical activities, etc);
  • Blood exam to eliminate/confirm an anemia (low amount of iron in blood) – if anemia is confirmed, the doctor will recommend iron supplements before and after the abortion.
  • Determining the blood group and whether or not is Rh positive or negative – if she is Rh negative, she`ll receive a vaccine after abortion known as Rh immune-globulin;
  • Urine exam to eliminate a possible urinary infection;
  • Screening for a STD, if the patient present a risk for such a disease. This screening doesn`t represent a routine investigation before an abortion, but it`s a good idea to do it to reduce the risks for complications (infections);
  • The Pap test to eliminate dysplasia (abnormal cervical cells).Neither this investigation is a routine one before such a procedure, but it`s recommended to patients who present a risk of cervical cancer.

It`s recommended an abdominal ultrasound to see the size and shape of the uterus, as well as the number of fetuses. A transvaginal ultrasound is the most precise method of determining the pregnancy`s age during the first trimester and can diagnose a pregnancy a week before an abdominal ultrasound. – Click here!

Specialized Medical Consultation

If the existence of a pregnancy is possible, it`s necessary to consult a specialist for a pregnancy test, a physical examination and counseling during pregnancy. If it`s mentioned an interruption of pregnancy, the specialist will advise on the available options. The early will the pregnancy interruption be performed, the more options that involve medications there are and the lower the risk of complications.

In case there was an unprotected sexual contact in the last 72 hours, an emergency contraception can be used without taking a pregnancy test. It can be used as emergency contraception and intrauterine device (IUD), which can be mounted no later than 5 to 7 days after the unprotected sexual contact.

Therapeutic Options

As mentioned above, there are 2 options when choosing this procedure: medical and surgical abortion.

Medical Abortion

Medical abortion (induced abortion), meaning using medication to stop a pregnancy, has a 98% efficiency if it`s done during the first 9 weeks of pregnancy. While the pregnancy approaches the end of the first trimester, the medication isn’t sufficient to induce abortion. In this case, it`s also required a surgical abortion to achieve a complete abortion (removing all traces of fetal tissue in the uterus).

The therapeutic plan in an induced abortion includes a first medical consultation and administration of medication, followed after 3 – 4 days by the second consultation and medication (according to another therapeutic plan, the second drug administration is allowed at home as well). Vaginal bleeding lasts for about 14 days. After around 2 weeks from the second consultation, a new consultation is mandatory to see if the abortion didn`t lead to any complications.

There are physical examinations and laboratory tests to be made before and after the procedure, informing the patient about the possible consequences of abortion, self-care guidelines, informing about the possible reasons for which she need to visit a specialist along with family planning.

Medications currently used for an induced abortion are:

  • Misoprostol – this hormone induces labor by dilating the cervix and producing uterine contractions. The drug may be administrated alone, but it`s much more effective if it`s associated with Mifepristone or Methotrexate for abortions during the first trimester of pregnancy.
  • Mifepristone or Methotrexate – Mifepristone, known as RU-486 as well, blocks the usage of progesterone, stops the growth of the placenta, dilates the cervix and prepares the uterus for labor. Methotrexate triggers contractions and cleans the uterus from fetal tissue. This treatment has an efficiency of 95% to 98% for pregnancies of up to 9 weeks.
  • Methotrexate and Misoprostol – Methotrexate stops the growth of the placenta, but it`s less efficient than Mifepristone. Misoprostol triggers contractions and cleans the uterus from the fetal tissues. This treatment has an efficiency of 95% – 99% for pregnancies of up to 7 weeks.

Surgical Abortion

Surgical abortion stops a pregnancy by surgical removal of the uterine content. Depending in how many weeks is the pregnancy, there are different procedures used.

Before and after surgical abortion, there are physical consultations and laboratory tests that are made, as well as informing the patient about possible consequences of abortion, self-care guidelines, informing about possible reasons for which the patient needs to visit a specialist or present at family planning after the procedure.

Surgical techniques used for pregnancies during the first trimester (weeks 3 -12) are:

  • Manual aspiration or mechanical suction performs the aspiration of the entire uterine fetal content through a tube.
  • The dilation of the cervix and curettage of the uterus – it`s a more surgical method than the previous one, which is used for cleaning the uterus with a sharp instrument. This method is usually reserved for cases from which it wasn`t able a complete aspiration of the uterine content.
  • During the second trimester of pregnancy, the surgical method used is the dilation of the cervix and the removal of the uterine content, which in fact a combination between aspiration, dilation and curettage using surgical instruments (such as forceps) to remove the fetal content and the placenta from the uterus. This is a more frequent method for pregnancies during the second trimester than induced abortion, because it presents a lower risk of complications.
  • The non-surgical method for pregnancies during the second trimester is induced abortion using drugs that produce uterine contractions followed by the expulsion of the fetus from the uterus. This method is rarely used due to the increased risk of complications.

Side Effects: Surgical Abortion

Side effects commonly faced by women are cramps, abdominal pain and diarrhea. However, in exceptional circumstances this intervention can cause vomiting, nausea or adverse reactions to anesthesia.

Other Side Effects:

  1. Vaginal Bleeding – their appearance doesn`t mean a big deal, but there are cases when the uterus or cervix are perforated, which can lead to abundant bleeding and it`s recommended a blood transfusion to control the overall health of the woman.
  2. If the anesthesia isn`t done properly, it can cause heart attacks or seizures, and if the situation isn`t controlled adequately, there`s a risk for the patient to lose her life.
  3. If the instruments aren`t sterilized properly during surgical interventions, there may be infections that could put the life of the patient in danger. Other complication which appears during surgical abortion can lead to death.
  4. Inability to give birth again.

Side Effects: Induced (Therapeutic)

The administration of medication to trigger an abortion is an easy method to achieve, but it involves numerous side effects:

Other complications:

  • Bleeding for long periods of time.
  • Infections which lead to infertility.
  • In extreme cases, the patient`s death.
  • Yellow fever.
  • Inability of conceiving another child in the future.

Note: All these complications require immediate medical assistance

Long-Term Side Effects

It was medically proven that women who chosen for either one of the procedures mentioned above will confront with a series of long-term side effects. Among these are: inability to conceive another child, an increased risk of breast cancer, etc.

  1. Breast cancer – The risk for this type of cancer is doubled after a single abortion, and it increases proportionally with the number of abortions.
  2. Ovarian & cervical cancer – Women who had one single abortion show a 2.3 times higher risk of cervical cancer as opposed to those who have never had an abortion. Patients who had 2 or more abortions confront with a 4.9 times higher risk of developing this type of cancer. Also according to recent studies, the risk of ovarian and liver cancer is influenced by single or multiple abortions. In addition, these women may manifest severe hormonal disorders accompanied by unwanted pregnancies and cervical lesions, which also increase the risk of cancer.
  3. Womb perforation – Around 3% from the women who suffer from miscarriage or induced abortion confront with womb perforation – the most frequent physical side effect. Also, most uterine lesions remain undiagnosed and untreated if a laparoscopy isn`t performed for a careful analysis of the internal structures of the mucus. Laparoscopy is also useful for starting any criminal investigation in case of negligence during such a procedure. The risk of suffering a womb perforation is higher in case of women who already have birth once and those who receive generally anesthesia during the process of abortion. A damage of the uterus can lead to severe complications which can only be resolved through hysterectomy, but also can cause other internal injuries and long-term complications.
  4. Cervical laceration – One percent for abortions performed during the first trimester of pregnancy cause cervical lacerations and open wounds which require suturing. Minor wounds and lacerations, which aren`t treated properly, may eventually deteriorate the woman`s reproductive function, which on long term leads to infertility. Post-abortion lesions can lead to numerous complications, such as: cervical incompetence, complications during birth, premature birth, etc.
  5. Ectopic pregnancy – According to most recent studies, multiple abortions significantly increases the risk of an ectopic pregnancy. This type of pregnancy can lead to infertility and puts the life of the patient in jeopardy.
  6. Placenta previa – Abortion increases the risk of placenta previa in future pregnancies (a circumstance which threatens both the life of the mother and baby) with a percentage of 15%. The abnormal development of the placenta due to uterine deterioration increases the risk of secondary physical effects of perineal death, uncontrolled abundant bleeding during birth and congenital abnormalities.
  7. Inflammatory-pelvic disease – This is a side effect which can also put the life of the woman in question in danger, and which also increases the risk of infertility and ectopic pregnancy. Consequently, it`s recommend for the doctor to treat the disease before performing the abortion.
  8. Endometriosis – The inflammation of the endometrium (uterine mucosa) is a frequent post-abortion side effect, encountered especially among teenagers. This shows a 2.5 times higher risk of developing endometriosis after abortion unlike women with ages between 20 and 29 years old.
  9. Congenital abnormalities – Abortion is associated with cervical and uterine lesions which increase the risk of premature birth and abnormal development of the placenta during pregnancy. These reproductive complications are the main causes of malformations in newborns.
  10. Other immediate complications – Ten percent of women who experienced an abortion show immediate complications, from which 2% are considered life-threatening. The most severe physical side effects which can appear during and after an abortion are: infections, embolism, anesthesia complications, convulsions, uterus rupture or perforation, cervical lesions, septic shock and hemorrhage.

Emotional/Psychological Side Effects

Most women show strong emotions after an abortion, known as post-traumatic stress syndrome. After this procedure, most women are overwhelmed by emotional reactions among which we outline:

  • The feeling of guilt which can lead to a desire of suicide.
  • Eating disorders and abuse of medication.
  • Disturbances in family or sexual life.

An abortion doesn`t only affect from a physical point of view but an emotional one as well, leading to the appearance of some mental disorders. This decision can lead to major depressions and change the life of a woman completely.

Recovery after Abortion

A woman who underwent such a procedure will experience for a few hours a series of cramps similar to those from during menstruation. Pain can be relieved with medication using ibuprofen or naproxen.

If a general anesthesia was performed, it will be required bed rest for 24 hours. Mild vaginal bleeding can be experienced for the next few days after the procedure.

It`s recommended an immediate visit to the doctor in case the patient`s condition worsen and shows fever of more than 40 degrees Celsius, the severe pain persists, or she experiences massive bleeding or vaginal discharges with bad odor.

Sexual contact is forbidden for 2 weeks after a surgical abortion because the cervix is dilated and prone to infections.

Possible Future Pregnancies

Induced abortion doesn`t affect the ability of a woman to become pregnancy again. A new pregnancy is possible even during the first few weeks after the abortion.

It`s recommended to avoid sexual contact until the moment when the organism is completely healed – at least 1 – 3 weeks. The specialist will recommend using a condom when becoming sexually active again to prevent an infection or becoming pregnant again. There are also other contraceptive methods that can be used depending on the woman`s lifestyle.

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