Disclaimer: This is a general overview. Different states and county have different laws pertaining to abortion. Therefore, some options may or may not be available in certain areas. There may also be additional counseling or requirements before an abortion can be performed. Providers that are going to perform abortions have their own governing bodies and must be up to date on the current local and federal laws.
Options for Terminating pregnancy: Medication and surgical abortion are both safe and effective options for the appropriate patient. The more advanced the pregnancy is the more likely complications can arise. Pregnancy must be confirmed in all cases prior to the procedure.
Medication abortion: Can be used up to 70 days gestation, preferably before day 63 of gestation. These medications can only be prescribed by a physician. Mifepristone and Misoprostol are used together to complete termination. Mifepristone is given orally, and Misoprostol is given buccally (held in cheek to dissolve) 24- 72 hours later. At initial visit blood typing and Rh status are determined. If a patient is Rh negative they will also receive a dose of Rh immune globulin. Commonly a second visit is made within 2 weeks to ensure that pregnancy was completely expelled and there are no complications. Patients experience bleeding, cramping, nausea and vomiting usually after the second medication but bleeding and cramping can start after the first medication. Patients should also be asked if they passed tissue, that usually happens after several hours of severe cramping. Once the tissue is passed then cramping and pain usually starts to subside. Antibiotics are frequently given to prevent any serious infections. Infections are very rare, but when they do happen they can be very severe. For patients who did not completely expel the pregnancy require surgical abortion. If they choose to continue with the pregnancy after failed abortion there is a chance of congenital abnormalities as these medications are teratogenic. Contraception is usually addressed at follow up visit as additional ovulation can occur as early as 3 weeks after abortion.
Uterine Aspiration: Most commonly used method of abortion, can be performed up to 14 weeks gestation. The majority of them are performed in outpatient clinical settings. These patients will have blood typing, Rh status and hemoglobin and hematocrit tested. Pulmonary, airway and cardiac functions will also be assessed as these patients may be put under sedation. If a patient is Rh negative they will receive a dose of Rh immune globulin. Generally, these women are given a prophylactic antibiotic the day of the procedure to help prevent any serious infection from occurring. Rates of infection are very low but can be serious when they do occur. The patient is placed in the same position as getting a pap smear (lithotomy position). A paracervical block is a local anesthesia that is injected into the cervix to help control pain. Depending on patient and provider oral pain medication and oral or IV sedation may also be used to control pain during the procedure. The cervix is then dilated using rigid dilators, that is tapered until the correct dilation is reached for the cannula to be inserted. The size cannula used is usually equal to the number of weeks of gestation (ex. 9 weeks of gestation, 9mm cannula). The cannula is a plastic tube that allows the tissue to be sucked through it. These can be flexible, rigid, curved or straight and can be attached to a manual or electrical vacuum aspirator. After the procedure, there is an examination of the tissues to confirm a complete abortion. Depending on how far along the pregnancy is will determine what tissues should be identified. If pregnancy is less then 9 weeks appropriately sized gestational sac is sufficient all the way up to after 12 weeks body parts and placenta should be identified. If there are not sufficient products of conception noted then a repeat aspiration is performed. Post-procedure recovery time is usually 20-30 min depending on patients pain and sedation use. Most women experience mild lower abdominal cramping for 2-4 days after the procedure, similar to period cramps. There may also be light bleeding and small amounts of tissue passed over the next few days. Contraception is usually discussed on the day of the procedure. Periods usually return within 6 weeks of the procedure. Nothing should be placed in the vagina for 2 weeks after the procedure.
Induction termination: Can be used from 14 - 28 weeks of gestation. Performed by inducing labor with medication. Medication is placed in the cervix to help it dilate and thin the cervix. This medication is usually placed for 12-16 hours. The medications used include misoprostol, mifepristone, and oxytocin, usually used in combination. Medication is injected into the fetus to help facilitate the abortion and to prevent a live birth. Fetal expulsion usually occurs within 24 hours of medications. Pain control is usually the same as women going through labor (oral pain medication or epidural). The procedure is done on a labor and delivery floor of a hospital. The procedure is complete once delivery of the fetus and placenta have been complete. This type of abortion is usually long due to the unpredictability of delivery and painful. Women are going to experience bleeding, cramping, nausea and vomiting for hours while waiting for the fetus to be expelled. Occasionally a patient will have a retained placenta that does require surgery. After abortion patients may experience lactation for a short period of time. Contraception can be addressed at the time of the procedure.
Dilation and evacuation: Can be used from 14-28 weeks of gestation. Osmotic dilators are placed in the cervical canal usually 1-2 days prior to the procedure to thin and dilate the cervix. This helps reduce the chance of cervical trauma. Osmotic dilators absorb moisture and expand in the cervical canal. If the cervix is not fully dilated the day of the procedure mechanical dilation can be performed. Sometimes administration of misoprostol, mifepristone or both is also used in addition to osmotic dilators. Cervical dilation must be at least 14-19 mm to allow forceps to be passed into the uterus. Prophylactic antibiotics are usually given shortly before the procedure and after the procedure. The day of the procedure the patient is placed in the same position as a pap smear (lithotomy position), a paracervical block and IV conscious sedation is administered. A speculum is placed similar to that during a pap smear so the cervix can easily be visualized. A suction cannula is passed into the cervical opening to remove amniotic fluid prior to fetal extraction. Forceps are carefully passed through the opening to bring fetal parts and placenta through the opening. After all fetal parts and placenta tissue has been removed the uterine lining is lightly scraped with the suction cannula to remove any remaining fragments. The patient may experience some mild cramping and bleeding after the procedure that is short lived. After abortion patients may experience lactation for a short period. Contraception can be addressed at the time of the procedure. A follow-up visit after about 2 weeks is common to make sure patients are healed and no complications are present.
Ginger Todd PA-C
Medication abortion: Can be used up to 70 days gestation, preferably before day 63 of gestation. These medications can only be prescribed by a physician. Mifepristone and Misoprostol are used together to complete termination. Mifepristone is given orally, and Misoprostol is given buccally (held in cheek to dissolve) 24- 72 hours later. At initial visit blood typing and Rh status are determined. If a patient is Rh negative they will also receive a dose of Rh immune globulin. Commonly a second visit is made within 2 weeks to ensure that pregnancy was completely expelled and there are no complications. Patients experience bleeding, cramping, nausea and vomiting usually after the second medication but bleeding and cramping can start after the first medication. Patients should also be asked if they passed tissue, that usually happens after several hours of severe cramping. Once the tissue is passed then cramping and pain usually starts to subside. Antibiotics are frequently given to prevent any serious infections. Infections are very rare, but when they do happen they can be very severe. For patients who did not completely expel the pregnancy require surgical abortion. If they choose to continue with the pregnancy after failed abortion there is a chance of congenital abnormalities as these medications are teratogenic. Contraception is usually addressed at follow up visit as additional ovulation can occur as early as 3 weeks after abortion.
Uterine Aspiration: Most commonly used method of abortion, can be performed up to 14 weeks gestation. The majority of them are performed in outpatient clinical settings. These patients will have blood typing, Rh status and hemoglobin and hematocrit tested. Pulmonary, airway and cardiac functions will also be assessed as these patients may be put under sedation. If a patient is Rh negative they will receive a dose of Rh immune globulin. Generally, these women are given a prophylactic antibiotic the day of the procedure to help prevent any serious infection from occurring. Rates of infection are very low but can be serious when they do occur. The patient is placed in the same position as getting a pap smear (lithotomy position). A paracervical block is a local anesthesia that is injected into the cervix to help control pain. Depending on patient and provider oral pain medication and oral or IV sedation may also be used to control pain during the procedure. The cervix is then dilated using rigid dilators, that is tapered until the correct dilation is reached for the cannula to be inserted. The size cannula used is usually equal to the number of weeks of gestation (ex. 9 weeks of gestation, 9mm cannula). The cannula is a plastic tube that allows the tissue to be sucked through it. These can be flexible, rigid, curved or straight and can be attached to a manual or electrical vacuum aspirator. After the procedure, there is an examination of the tissues to confirm a complete abortion. Depending on how far along the pregnancy is will determine what tissues should be identified. If pregnancy is less then 9 weeks appropriately sized gestational sac is sufficient all the way up to after 12 weeks body parts and placenta should be identified. If there are not sufficient products of conception noted then a repeat aspiration is performed. Post-procedure recovery time is usually 20-30 min depending on patients pain and sedation use. Most women experience mild lower abdominal cramping for 2-4 days after the procedure, similar to period cramps. There may also be light bleeding and small amounts of tissue passed over the next few days. Contraception is usually discussed on the day of the procedure. Periods usually return within 6 weeks of the procedure. Nothing should be placed in the vagina for 2 weeks after the procedure.
Induction termination: Can be used from 14 - 28 weeks of gestation. Performed by inducing labor with medication. Medication is placed in the cervix to help it dilate and thin the cervix. This medication is usually placed for 12-16 hours. The medications used include misoprostol, mifepristone, and oxytocin, usually used in combination. Medication is injected into the fetus to help facilitate the abortion and to prevent a live birth. Fetal expulsion usually occurs within 24 hours of medications. Pain control is usually the same as women going through labor (oral pain medication or epidural). The procedure is done on a labor and delivery floor of a hospital. The procedure is complete once delivery of the fetus and placenta have been complete. This type of abortion is usually long due to the unpredictability of delivery and painful. Women are going to experience bleeding, cramping, nausea and vomiting for hours while waiting for the fetus to be expelled. Occasionally a patient will have a retained placenta that does require surgery. After abortion patients may experience lactation for a short period of time. Contraception can be addressed at the time of the procedure.
Dilation and evacuation: Can be used from 14-28 weeks of gestation. Osmotic dilators are placed in the cervical canal usually 1-2 days prior to the procedure to thin and dilate the cervix. This helps reduce the chance of cervical trauma. Osmotic dilators absorb moisture and expand in the cervical canal. If the cervix is not fully dilated the day of the procedure mechanical dilation can be performed. Sometimes administration of misoprostol, mifepristone or both is also used in addition to osmotic dilators. Cervical dilation must be at least 14-19 mm to allow forceps to be passed into the uterus. Prophylactic antibiotics are usually given shortly before the procedure and after the procedure. The day of the procedure the patient is placed in the same position as a pap smear (lithotomy position), a paracervical block and IV conscious sedation is administered. A speculum is placed similar to that during a pap smear so the cervix can easily be visualized. A suction cannula is passed into the cervical opening to remove amniotic fluid prior to fetal extraction. Forceps are carefully passed through the opening to bring fetal parts and placenta through the opening. After all fetal parts and placenta tissue has been removed the uterine lining is lightly scraped with the suction cannula to remove any remaining fragments. The patient may experience some mild cramping and bleeding after the procedure that is short lived. After abortion patients may experience lactation for a short period. Contraception can be addressed at the time of the procedure. A follow-up visit after about 2 weeks is common to make sure patients are healed and no complications are present.
Ginger Todd PA-C
We understand this is a delicate topic and we want to respect that everyone has the right to choose, the right to decide what is best for them. You never know what emotions may arise before and after this decision. Please seek out therapeutic support or emotional support from people who care about you and love you. There are support groups in your area if you move forward with this process.
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