Are you thinking about an abortion, and you have a lot of doubts? You are right to feel concerned when talking about such a risky intervention, not to mention about the fact that you`ll be ending a life.
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).
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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 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.
When Is Surgical Abortion Performed?
- Irregular bleeding: if a patient shows period bleeding between menstruation, 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.
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.
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.
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.