Abortions 

Abortion is defined as the termination of pregnancy by the removal of the foetus from the uterus. If this happens without any intervention, then it is termed as a miscarriage. There are two kinds of abortions which are surgical and medical abortions.

Medical abortion is a procedure that uses medication to end a pregnancy, it does not require surgery or anaesthesia and can be started in a medical office. This method is safer and more effective during the first trimester of pregnancy.

Whereas a surgical abortion also known as in-clinic abortions are typically performed for foetuses which are 14 to 16 weeks old.

Medical Abortion

Medical abortions are usually performed in the first trimester and are often an alternative to surgical abortion. It uses the combination of two medications, mifepristone and misoprostol to end a pregnancy up to 9 weeks.

It is a low-risk, non-invasive way to terminate a pregnancy and is around 99 per cent effective. A foetus needs high levels of the progesterone hormone to supplement its growth. Using mifepristone blocks the action of the hormone which stops the pregnancy from proceeding in the uterus. Whereas, Misoprostol causes the cervix to soften and the uterus to contract to allow the pregnancy to be expelled from the uterus.

Procedure

• A medical consultation with a doctor is done to clinically assess your medical and relevant information and arrangements for your ultrasound and blood tests are done
• You will be informed about the different methods of abortion and choose the best method for you
• If you decide on medical abortion, you will be asked to sign consent and will be given relevant information about what to expect, and will be informed about pre- and post-abortion care.
• You will discuss the kind of pain relief and other appropriate medication you may require
• If you have an intrauterine device (IUD) it needs to be removed before you take your medicine
• Your doctor will advise you to take a tablet of mifepristone either at home or clinic and obtain other appropriate medications
• Later, you will be advised to take a tablet of misoprostol 24 to 48 hours later. This softens the cervix and helps your uterus in pushing out the pregnancy.
• Abortion is completed some hours later and might take longer. You will need a day or two of rest and reduced activity.

Medical abortion: what to expect?

After taking the second medication tablet at home, you may experience the following side effects

• Nausea, diarrhoea, dizziness, headache and fever
• Pain-usually within half an hour and much stronger than period pain
• After two to six hours the bleeding settles to the level of your normal period
• Bleeding is usually similar to your period for another three to seven days
• Unpredictable, irregular or prolonged bleeding that can last up to four weeks after medication abortion.

The timing of the pain and bleeding is unpredictable and occasionally starts before taking the second medication but may take up to 24 hours to start.

Advantages and disadvantages of medical abortion

The advantages include:

• For 95 to 98 per cent of pregnancies up to nine weeks, no further treatment is required other than the two doses of medication
• Unlike surgical abortion, medical abortion does not need to take place in a hospital or requires a surgeon, anesthetist or medical staff.
• It is a less clinical and non-surgical procedure, which some women prefer
• It feels more like a natural process
• Can happen in a home environment

The disadvantages are:

• They are more time consuming compared with surgical abortions and there may be more doctor visits and tests
• In a small percentage of cases, the medication may need to be repeated and sometimes a surgical procedure is needed,
• Pain and bleeding last longer than a surgical abortion
• It is difficult to predict the time it will take for a medical abortion to complete
• A separate appointment is needed if you would like an IUD inserted
• Mifepristone is not suitable for some women having medical conditions such as bleeding problems or high BP, who are taking long-term steroid or blood-thinning medicines.

Recovery self-care after medical abortion

Your doctor or nurse will advise you to take complete care of yourself and rest enough the days following after your abortion. You will also be advised to take over-the-counter anti-inflammatory or pain medications to help you with your cramps and hot packs can be helpful for your pain.

To reduce the risk of infection during the week after having the procedure, it is recommended that

• You DO NOT insert anything into your vagina, even tampons
• Do not have vaginal sex
• Do not perform any strenuous activity, including sport or heavy physical work until the bleeding stops
• It is also recommended that you do not go swimming or take baths (showers are allowed)

Risks and Complications of a medical abortion

There are common risks and side effects that go after any medical procedure. Your doctor will inform you about your possible side effects and complications beforehand and what to do if it occurs.

The typical side-effect of a medical abortion includes:

• Pain from the uterine cramping
• Unpredictable, irregular or prolonged bleeding

Some of the complications include:

• Haemorrhage 
• Retained products such as pieces of tissue may remain to cause ongoing bleeding
• Continued pregnancy
• Infection

Surgical abortion methods

Surgical abortion involves the removal of pregnancy through the vagina by surgical means. To have a surgical abortion, the cervix must be open wide enough to allow the surgical instruments into the uterus. One can opt for a surgical abortion if you are 12 weeks pregnant or less, abortion can also occur after 12 weeks of the gestation period in the second trimester using different methods. Some of the common methods of surgical abortion include suction (vacuum) aspiration, dilation and evacuation method.

Vacuum abortion 

This is the most common method of surgical abortion which is performed using ‘suction aspiration’. To have this procedure you need to be in your first trimester of pregnancy which means you should be pregnant 12 weeks or less.

In most cases, your cervix does not need to be prepared or dilated for this procedure. But if your more than 10-12 weeks pregnant your doctor might need to open your cervix before getting started. Your doctor might insert little sticks made of sterile seaweed that absorb moisture and expand called luminaria.

When you are comfortable and sedated your doctor will insert a medical tool called a speculate into your vagina to keep it open and an anesthetic will be inserted in your cervix to numb it. A small tube attached to either a hand-held syringe or a suction machine will be inserted into your uterus and clear out its contents. This procedure will take up to several minutes and you will be kept under observation for 30 minutes.

Dilation and Evacuation

If your more than 12 weeks pregnant, an ultrasound will be taken to date your pregnancy. Your doctor will prepare your cervix for your abortion before beginning with anything. This abortion is usually done when you’re 14 weeks or more in your gestation period.

In order to prepare your cervix for the surgery, your doctor might need to insert laminaria sticks, which might be left overnight. You might also be given medication such as misoprostol either by mouth or vaginally to soften your uterus. Your doctor might also use tools to help dilate your cervix and prepare you for surgery.

Your doctor will insert an anesthetic into your cervix and use a gripping tool to hold your cervix in place. The main difference between a vacuum suction and D&E method is that the use of forceps and other medical tools such as curettage.

Your doctor might use an ultrasound to guide them through the procedure and will likely use suction or vacuum to make sure everything inside is cleared out. Some medical providers also use medication to stop the fetal heartbeat before beginning this procedure.

Recovery for surgical abortion

You will probably experience some light cramping for a few days and light bleeding for up to two weeks. Most pain and cramping is treated with over-the-counter painkillers. You might need to take a few days of rest after your surgical procedure and should not lift anything heavy for a few days.

Ask your doctor when it will be okay to have sex or use a tampon again. It may be up to a month before you can have anything inside your vagina.

Most doctors will advise you to come back for a follow-up appointment in one or two weeks to make sure you have physically recovered and no longer pregnant. If you have severe pain, high fever, or heavy bleeding you should contact your emergency doctor right away.

Complications: surgical abortion

Complications can occur in around 3 per cent of surgical abortion cases and depend upon how many weeks pregnant you are. The abortions performed in the first trimester are the safest.

Some of the rare complications include:

• Haemorrhage – the bleeding after an abortion should be similar to a menstrual period if heavy bleeding occurs that means that the abortion may not be complete
• Infection – the common signs such as high fever may indicate an infection. This can be due to incomplete abortion or sexually transmitted infection
• Injury to the uterus- The surgical instruments used for an abortion can injure the uterus. This complication is very rare and can be recognized and treated straight away
• Injury to the cervix – The cervix is stretched during an abortion. If you have multiple procedures it can weaken the cervix.

You should visit a doctor immediately if

• Your bleeding becomes heavy
• Develop a fever
• Experience severe cramping or abdominal pain

These symptoms can indicate an infection.