Safe abortion methods
Medically supervised methods of abortion are referred to as safe abortion methods. As recommended by the World Health Organisation there are 3 safe abortion methods depending on the duration of pregnancy and medical condition:
-Manual vacuum aspiration
-Dilatation and evacuation
Safe abortion services – where to go?
An institution approved for medical termination of pregnancy as per the MTP Act 1971 of Indian Government. A good institution will usually only follow safe abortion methods
How early can pregnancy following unprotected intercourse be detected?
A test to detect beta HCG levels in the blood can detect pregnancy as early as 7-12 days after conception ( 1week before a missed period). In case of a negative test, it must be repeated if the period is missed.
How early can abortion be induced?
If pregnancy is confirmed, abortion can be induced as early as 3 weeks from the first day of last normal menstrual period of a woman with regular cycles.
If a woman wishes to terminate an unintended or unplanned pregnancy when during pregnancy is the ideal time for her to seek medical help for abortion?
As soon as the pregnancy has been confirmed. Abortion during early weeks of pregnancy is associated with lesser complications and higher success rates. At the Chennai Abortion Clinic, we follow a tiered treatment plan to patients which usually starts with Pre-Abortion Counselling.
A focused, interactive process through which the woman receives support, additional information and guidance from a trained person in an environment conducive to openly sharing thoughts, feelings, and perceptions.
Information is provided regarding abortion methods, pain management, potential complications, a period after which normal activities can be resumed and follow up plan including future prevention of unintended pregnancy by contraception. A woman deciding to have an safe abortion method is allowed to choose from the available methods depending on the duration of pregnancy and her medical condition.
Pre-abortion counseling does not involve imposing personal values or beliefs on the woman seeking an abortion.
Concerned about confidentiality and privacy around abortion?
The guiding principles by WHO state abortion service providers should promote and protect:
-Women’s and adolescents health and their human rights
-non-discrimination based on factors such as age, race, social or economic status
-voluntary and informed decision making
-confidentiality and privacy
Legal boundaries of medical or surgical abortion:
A mentally sound adult pregnant woman’s consent alone is adequate to proceed with induction of abortion.
If the pregnancy is of less than 12 weeks from the first day of last normal menstrual period of a woman with regular cycles, abortion can be induced in the opinion of 1 registered medical practitioner. If the pregnancy is more than 12weeks, induction of abortion can proceed if two registered medical practitioners are of the opinion that continuation of the pregnancy would cause physical or mental harm to the mother.
The MTP Act 1971 has provision for unintended pregnancy occurring following the failure of contraception as a continuation of such pregnancy may cause anguish and grave mental harm in the mother.
Ultrasound scan precedes induction of abortion so as to rule out an ectopic pregnancy(pregnancy within the uterine tubes or anywhere other than the uterine cavity) and confirm an intrauterine pregnancy.
1. Mifepristone with misoprostol:
It involves the use of two different drugs; mifepristone is taken orally followed by misoprostol administered either vaginally or sublingually 24-48 hours after mifepristone. Misoprostol may be repeated at regular intervals for up to 5 doses.
The dosing of the drugs and time interval between administration depends on the duration of pregnancy.
The drugs can be self-administered in the convenience of the woman’s residence under medical supervision.
There will be considerable uterine cramping and pain associated with vaginal bleeding as part of the expulsion of the conceptus regarding which you will be counseled by the doctor. You will also be detailed on when to seek medical help.
2. Misoprostol alone:
Less effective and may need follow up to ensure complete expulsion of products of conception.
1. Manual Vaccum aspiration
It is the procedure done if the pregnancy is of less than 12 weeks. A cannula is inserted through the uterine opening (os) and an aspirator is used to generate a negative pressure and withdraw contents from within the uterus. The procedure is repeated until all of the products of conception have been evacuated. Vaginal bleeding may continue for a few weeks post procedure. The procedure may be performed under sedation or regional anesthesia. It is a performer as a day care procedure and the woman may be discharged after few hours of observation.
2. Dilatation and evacuation:
It is the method employed in pregnancies of more than 12-14 weeks duration. It involves dilating the uterine opening (os) and sucking out the concepts using a cannula of larger caliber connected to an aspirator. The procedure is preceded by administering misoprostol so as to soften the uterine cervix.
The complete evacuation of the uterus is confirmed by examining for completeness of the membranes and the fetal parts. As in vacuum aspiration, vaginal bleeding may persist for a few weeks post procedure. It is a daycare procedure done under regional anesthesia.
Ultrasound scan to confirm complete evacuation of the uterus usually follows medical or surgical abortion.
Post-abortion pain management:
-Mainly reassurance and emotional support
-Vaginal douching and sexual intercourse needs to wait until heavy vaginal bleeding stops.
-Plenty of fluids to be taken orally so as to maintain hydration
-To avoid strenuous activities
-To seek medical help if heavy vaginal bleeding persists, intensity of cramping increases or fever persists beyond 24 hrs
Post-abortion follows up and counseling:
The woman will be reviewed after 7-14 days post procedure for clarifying doubts if any, reassurance and providing psychological support.
The possibility of regaining fertility as early as 2 weeks post-abortion even prior to the next menses is stressed upon.
Counselled regarding future contraception and helped to make an informed choice regarding the same from the available options if the woman desires to.