Abortion
Katherine Beach, CNM
Maine Medical Partners
Women’s Health
Roe vs. Wade
• Abortion has been legal in the US since this
famous case in 1973
• No doctor is required to perform an abortion
• Some states have special legal requirements
and waiting periods
• Most states require minors to get consent
from their parents or gain court approval
before an abortion can be performed
Relative Risk
Legal abortion by qualified provider vs.
illegal abortion
Risk of dying from legal early abortion is
1:100,000
Risk of dying from giving birth is at least 10
times greater than that
Prevalence
• Each year about 1.3 million women in the
US have an abortion
• Safest when done early and in proper setting
• Big decision that should be well thought out
• Counseling/talking with partner, family
member or friend is encouraged
Types of Abortions
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Menstrual aspiration
Medical
Suction or vacuum curettage
Dilation and evacuation (D & E)
Labor-inducing abortion
Menstrual Aspiration
• Done 1-3 weeks after a missed period
• Syringe is used to remove the pregnancy
from the lining of the uterus
• Carries the least risk because it’s done
early, when the products of conception are
small
• Minimal bleeding afterwards
Menstrual Aspirator (1-PAS)
Medical Abortion
• Must be done before 9 weeks
• No surgery required, but does involve
several office visits
• 4 types:
– Mifepristone (RU 486) and Misoprostol oral
pills
– Mifepristone pills and vaginal Misoprostol
– Methotrexate IM and vaginal Misoprostol
– Vaginal Misoprostol alone
Mifepristone (RU 486) and
Misoprostol pills
• Most commonly used method of medical
abortion
• Must be done within 49 days (7 weeks) of
the first day of the LMP
• Requires 3 office visits
• RU 486 blocks the action of progesterone
• Misoprostol (a prostaglandin) causes the
uterus to contract and expel the embryo
RU 486 and Misoprostol pills
• First visit—take RU 486
• Second visit—take Misoprostol
• Third visit—2 weeks later, to make sure
abortion is complete and patient has
recovered
• Usually very effective, but if incomplete,
surgical completion is necessary
RU 486 and Vaginal Misoprostol
• Must be performed within 63 days (9 weeks) of
the first day of the LMP.
• Uses same drugs as first method, but in different
doses
• The vaginal Misoprostol can be inserted at home
• Faster, costs less, has fewer side effects, but
woman must be comfortable with placing the
medication vaginally
Methotrexate and Vaginal
Misoprostol
• Must be performed within 49 days (7 wks) of the
first day of LMP
• Very effective, but may take up to 4 weeks for the
abortion to occur
• Methotrexate is given IM at office
• Misoprostol is placed vaginally by woman at
home
• Usually ultrasound is done to confirm abortion
Vaginal Misoprostol Alone
• Must be performed within 56 days (8
weeks) of the first day of the LMP
• Usually more severe side effects
– Nausea, vomiting, fever, chills
• Less effective than the previous 3 methods
Suction or Vacuum Curettage
• Most common type of abortion
• POC are removed by a suction device that is
inserted into the uterus
• Can be done up to 12 weeks, but not before 7
weeks
• Cervix is anesthetized with lidocaine
• Sedative may be given/rarely general anesthesia is
used
• Cervix is dilated at time of procedure, or can be
dilated overnight with laminaria or misoprostol
Suction or Vacuum
Curettage machine
Curettage
• Once suction procedure is complete, a sharp
curettage of the endometrium is done
• Ensures that all POC have been removed,
and that endometrium is smooth and
without residual tissue
• Done to reduce incidence of infection
• Risk is uterine perforation
Dilation and Evacuation
• Used when abortion is desired after 12 weeks
• Cervix must be dilated and stronger
suction/vacuum pressure is used to remove POC
• More cramping and bleeding
• Higher risk
• Usually done in hospital setting, with use of
general anesthesia
• Antibiotics usually given to reduce incidence of
infection
Labor-inducing Abortion
• If pregnancy is >16 weeks, may use agents
such as Misoprostol 400 mcg every 4 hours
per vagina, or oxytocin through an IV line
to induce contractions and expel contents of
uterus
• Most often used if fetus is determined to be
non-compatible with life, or if intrauterine
fetal demise (IUFD) has occurred