Unwanted pregnancy can put a lot of stress on the physical and mental health of a woman. In such situation, Termination of Pregnancy (TOP) or abortion can be a blessing for her. The termination can be safely performed till the 20 weeks of pregnancy safely. There are two types of procedures available for Medical Termination of Pregnancy.
- Medical Abortion: Use of medicines for termination of pregnancy
- Surgical Abortion: Use of surgical methods for termination of pregnancy
In this article we will be discussing about Medical Abortion.
When to prefer medical abortion?
- If woman prefers medications over surgical procedure
- Up to 70 days of pregnancy, it is considered more effective than surgical abortion
- If woman has congenital deformity of uterus or narrowing of lower part of uterus (cervix)
- The woman can take some medicines at home also which is more convenient
Abortion can be a mentally stressful procedure, so counselling holds an important place in pre-abortion procedures. The main objectives of this counselling are
- Help the woman to take an informed decision
- Provide knowledge about the procedure
- Remove the anxiety related to the procedure
This counselling can be performed by a nurse, doctor or even an experienced counsellor. During counselling the woman is given pregnancy options counselling and informed consent related counselling. A woman may have variety of reasons for opting for an abortion. The counselling helps in taking the correct decision without any mental stress. The counselling also gives an opportunity to prepare the woman for possible adverse effects of the medical abortion.
Your doctor will have to ascertain few things before he/she can administer the procedure. These include following investigations.
- Ultrasonography for confirmation of pregnancy and estimation of duration of pregnancy
- Measurement of vital signs (Temperature, Pulse, Blood Pressure, Respiratory Rate, )
- Blood grouping
- Lab tests for sexually transmitted diseases
Following medicines can be used to induce abortion during early pregnancy
- Mifepristone and Misoprostol
- Methotrexate and Misoprostol
Mifepristone and Misoprostol:
This is the most commonly used regimen for an embryo of 7. Misoprostol is an antagonist of progesterone. Progesterone is a hormone essential for continuation of pregnancy. Thereby, misoprostol inhibits the further development of the embryo. Misoprostol is a prostaglandin, a chemical which contracts the uterus. Therefore it is administered after mifepristone. This regimen has shown the success rate of 92-97%.
Contraindications of this regimen:
- Ectopic pregnancy (implantation of embryo outside uterine cavity)
- Ovarian tumour
- Presence of Intra Uterine Device
- Kidney or liver disease
- Heart Disease
- Problem in blood coagulation
- Treatment with corticosteroids
- Aged more than 35 years and
- Heavy smokers
How this regimen is used (FDA regimen)?
It requires 3 days and at least 2 visits to a clinic are required for this method.
During initial visit, history is taken and examination of the woman is done followed by pre-abortion counselling and investigations. Once the consent is obtained and contraindications are excluded, a tablet containing 200 mg of Mifepristone (RU-486) is given orally to the woman and advised to re-visit on day 2-or 3
Day 2 0r 3
She is given the second tablet containing misoprostol (800 microgram) on day 3 at clinic. She is kept under observation for at least 4 hours. Usually following consumption of second tablet, there will be bleeding from vagina and cramps will be felt in the abdomen. This is due to contraction of uterus and expulsion of aborted products of pregnancy. Antibiotics may also be given to prevent the infection. A pain killer medicine can be given to alleviate the pain.
Follow up visit-
She is advised to visit on day 15 for re-examination and to ascertain that the abortion is complete. It also gives an opportunity for a doctor to check the health status of the woman.
The side effects of this regimen:
Abdominal pain and bleeding are the most common side effects. The other side effects include vomiting and diarrhoea. In rare cases, this method may fail and has to be followed up by a surgical method.
Methotrexate and Misoprostol
This was a common method in the past, but following introduction of mifepristone, this method has been used occasionally now a day. Methotrexate is more commonly used in the cancer chemotherapy. It inhibits the multiplication of cells. It mainly affects all those cells which are rapidly multiplying. These also include embryo!
Contraindications of this regimen:
- Severe anaemia
- Corticosteroid therapy
- Diseases of guts, adrenal gland, liver, kidney, cardiovascular system and blood clotting
- Intra Uterine Device is present
- Anticoagulant therapy
- Decreased RBCs, Platelets or WBC
How this regimen is used?
It is important to note that this regimen is not approved by FDA for medical abortion. But occasionally when other regimen is contraindicated, this regimen is used. This regimen is less costly but takes longer time (as long as 7 days).
All the procedures remain same as in the earlier method except the medicine. Methotrexate (50 mg/m2) orally on the first day and the woman is asked to revisit on the 7th day.
She is given Misoprostol (800 micrograms) inside vagina. This usually induces the bleeding and uterine contractions. The dose of misoprostol may have to repeat after 24 hrs, in case the first dose fails. A pain killer medicine may be given to alleviate the pain.
Follow up visit-
Just like in the earlier regimen the woman is asked for a follow up visit on the 15th day.
The side effects of this regimen:
These include nausea, vomiting and diarrhoea. In rare cases there may be suppression of bone marrow leading to decreased red and white blood cell counts. It has been said that the failure rate of this regimen is higher than the earlier regimen.
Apart from these two regimens, misoprostol alone can also be used for medical abortion, but the failure rate is too high.
Frequently Asked Questions:
to moderate abdominal pain depending on their pain threshold and the gestational age
of the pregnancy.
the type of abortion that is done and the gestational age of the pregnancy. So generally the price would vary.
VIP Patients may elect to have the entire facility and staff dedicated solely to their needs and care, in which case we close the facility to any other patient on that particular day. No other patient will be scheduled or seen during your entire visit, thus keeping our clinic completely private. Our entire staff will be dedicated to your care, and your care alone.
To schedule an VIP abortion appointment in Los Angeles, please call at – 213-394-0530
For those who are not conversant with medical terminologies, abortion generally refers to the termination of a pregnancy before that age of intrauterine life by which it is able to survive outside the mother either by itself or through the aid of medical intervention. Abortion can either be on personal or medical grounds. They may occur spontaneously or through medical or surgical procedures. It is said that a good percentage of spontaneous early pregnancy abortions are due to a severely malformed foetus or genetic anomaly. There are also a host of reasons why people may want to consider an abortion and there are medical related scenarios where an abortion can be life saving for the mother. These are however beyond the scope of this current article. In this article the aim would be to discuss surgical abortion and 20 of the frequently asked questions about it. We would try to answer these questions as a way to help you further understand and better appreciate the whole concept of surgical abortion.
Before going on to ask about the frequent questions on surgical abortion, it is important to know what exactly surgical abortion is? Surgical abortion refers to the emptying of the contents of the uterus between 12 to 14 weeks of pregnancy. This implies 12 to 14 weeks after a missed period or early in the 1st trimester of pregnancy. It can however also be performed around 20 weeks which is about the mid trimester of pregnancy. There are different procedures that can be used to carry out an abortion and the choice would depend on the stage of pregnancy at which the abortion is to be done and other features of the pregnancy as well as the woman in question. Three of the procedures are highlighted below:
- Vacuum Aspiration: this is usually done with the aid of a vacuum aspirator and this is carried out for pregnancies that are generally below 16 weeks of gestation.
- Dilatation and Evacuation (D & E): This is the procedure that has replaced the previously known D & C which is dilatation and curettage, this D & E is much safer and avoids the predisposition to uterine scarring or puncture that was quite common with D & C, especially in the hands of inexperienced abortionists. D & E is done for pregnancy that are between 12 and 20 weeks.
- Dilatation and Extraction: Also referred to as D & E, this surgical abortion procedure is done for those who are above 21 weeks pregnant.