Abortion Procedures for Termination of Pregnancy

ABORTION PROCEDURES

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Motherhood is said to be the most beautiful part of a woman’s life. It is a thought that is integrated into women by collective historical and societal thinking, but one that is starting to be cast aside by other growing priorities, such as gaining financial stability, blossoming careers, moving to other cities/countries, and so on. Even though parenthood can be one of the most rewarding jobs in the world, some couples may choose it at a later stage, or maybe not at all.

A woman can choose to abort a pregnancy due to many reasons: maybe it was unplanned and she isn’t ready; maybe she’s too young; maybe she’s undergoing financial or marriage distress; maybe she has a health condition that is not conducive for a healthy, full-term pregnancy. Let’s a take a look at what abortion really means, and what are the different types of abortion procedures that can be adopted, depending on the stage of your pregnancy.

What is Abortion?

An abortion is the loss of pregnancy that occurs due to removal of products of conception (foetus, foetal membranes, pregnancy tissue, and placenta) from the uterus. Abortions can be induced medically or naturally. They may also occur spontaneously, which is termed as a miscarriage.

Types of Abortion Procedures

Based on the trimester of gestation (your month of pregnancy), abortion procedures may be categorized as follows:

  1. Abortion procedures during the first trimester (1 – 3 months)
  2. Abortion procedures during the second trimester (4 – 6 months)
  3. Abortion procedures during the third trimester (7 – 9 months)

Based on the technique used, these procedures can also be classified as the following:

  • Medical Abortion Procedures: Medical procedures for abortions involve the use of certain medications, either hormones or chemical substances in the form of injections or pills, to terminate the pregnancy. Mifepristone and Misoprostol are the two commonly used medications for abortions, and they are available as RU-486, Abortion Pill, or Mifeprex. These methods are usually employed for early to mid-first trimester abortions.
  • Surgical Abortion Procedures: Invasive or surgical methods like Manual Vacuum Aspiration, Dilation and Curettage, and Dilation and Evacuation may be used for second-trimester abortions or failed medical abortions.

Now, let’s look at the abortion procedures trimester-wise.

Abortion Procedures During First Trimester

First trimester abortions may be performed either by medical or surgical techniques. However, abortion methods in early stages or up to nine weeks are almost always medical.

The two most commonly used medical means of inducing abortions are:

1. Methotrexate (MTX) and Misoprostol Combination

This medical method of abortion is considered during the first 7 weeks of the pregnancy. Methotrexate is medication for cancer, meaning that it stops cancer cells from multiplying. When taken for an abortion, it will stop the embryo cells from multiplying. Misoprostol is a prostaglandin, which induces strong uterine contractions, resulting in the expulsion of the pregnancy tissue (which is the product of conception during the first 8 weeks of pregnancy).

2. Mifepristone and Misoprostol Combination

This is the most common medical method used to terminate a pregnancy in the first 10 weeks. Mifepristone is a chemical that acts as a progesterone receptor blocker. (Progesterone is a very important hormone that is required to maintain a pregnancy.) It reverses the effect of progesterone in a pregnancy by blocking its receptors, and hence makes the uterus sensitive to the effects of prostaglandin, which is provided by the misoprostol. This medicine should be taken a few hours after the mifepristone.

In the late first trimester or in case of failed medical abortions, the following surgical methods may be applied for inducing abortions:

1. Manual Aspiration

Manual Vacuum Aspiration, or MVA, is the least invasive surgical technique used for termination of a pregnancy in the second to the third month of gestation (pregnancy). The foetus is sucked out of the dilated cervix by the suction tube applied. It involves administration of local anaesthesia for pain relief.

2. Dilation And Curettage (D&C)

With the help of a curette or a spoon like instrument made of steel, the foetal products are removed from the uterine cavity, followed by detachment and removal of the placenta. The technique can be used for the termination of a 3-month pregnancy, and it involves comparatively more blood loss than an MVA.

Abortion Procedures During Second Trimester

Surgical Methods

1. Dilation And Evacuation (D&E)

The D&E procedure is similar to that of dilation and curettage (D&C) and is usually applied for second-trimester abortions up to 24 weeks. The baby is very small, so no crushing or gripping of feet etc. takes place. The cervix is dilated and the contents of the uterus, including fetus and placenta, are removed using an aspirator or forceps. Retained products of conception may necessitate a follow-up vacuum aspiration.

Instillation Methods

Chemical abortion methods, although less common than surgical and medical methods, might be used in the late second and third trimesters (abortion of a 5 to 6-month pregnancy). The instillation method involves the injection of certain drugs or chemicals, through the cervix, into the amniotic sac to cause foetal demise and its subsequent expulsion out of the womb.

1. Salt Poisoning (beyond 4 months)

Also known as “saline amniocentesis” or a “hypertonic saline abortion”, this method is usually used after 16 weeks of pregnancy. The amniotic fluid is replaced with a concentrated salt solution, which is toxic to the baby.

2. Urea (5 – 8 months)

If hypertonic saline is risky, then urea formulations supplemented by oxytocin or prostaglandins can facilitate a quick abortion.

3. Prostaglandins (4 – 9 months)

Prostaglandins are naturally occurring substances which are normally required for childbirth. Injecting prostaglandins will stimulate uterine contractions or labour pains, resulting in spontaneous abortion. This method is commonly used during the second trimester, as the procedure for termination of a 5 – 6 month pregnancy.

SURGICAL AND MEDICAL PROCEDURES

Abortion Procedures During Third Trimester

The third trimester of pregnancy is marked by the significant physical development of the foetus. Abortions during this stage of pregnancy are rare. However, if structural anomalies, neural or developmental problems, or genetic diseases are found and diagnosed late in the foetus, then a third-trimester abortion might be required. Only surgical methods can be implemented for this purpose.

1. Partial-Birth Abortion (5 – 8 months)

This technique is used for abortions in women who are 5 to 8 months pregnant. Under sonographic view and with the help of forceps, the baby is pulled out of the birth canal. If the baby might be larger than the gestation and gets stuck, then the brain contents may be scooped out.

2. Hysterotomy (6 – 9 months)

Hysterotomy refers to the surgical opening up of the uterine cavity and manually removing the foetus, placenta and its contents. It resembles the procedure for a caesarean section, except that it is applied in cases of stillbirths or congenitally malformed foetuses.

Natural Abortion Methods

When a pregnant woman attempts to terminate her pregnancy by using over-the-counter drugs or non-pharmacological substances without medical supervision, it is known as self-induced abortion. Medical professionals may use medical techniques for inducing abortion, and this is termed as in-clinic abortion procedure. Self-abortion methods are easier and more successful in the early months. However, if not properly administered, or if done during the later stages of pregnancy, these methods may pose a serious risk to the woman’s health and can also cause serious side effects. These also don’t work most of the time, so it is better to avoid these, and opt for a professional abortion by doctors.

Following are some common methods of naturally inducing abortion or miscarriage.

Note: These methods are illegal and should not be practised at any cost. The below content is solely informational and indicates methods that should not be tried.

1. Excessive Physical Exertion

Lifting heavy weights can increase abdominal pressure, causing a miscarriage.

2. Consumption of Abortifacient Products

Eating certain foods and products like mutton marrow, dried henna powder, carrot seed soup, papayas, foods rich in Vitamin C, etc. may cause miscarriages.

3. Abdominal Massages

Excessive abdominal massages or certain physical trauma to the abdominal region may result in an abortion.

4. Use of Sharp or Invasive Instruments

Insertion of sharp substances like needles, hooks, safety pins, etc. into the uterus through the cervix may cause trauma to the foetus. Catheters or vacuum devices can (but shouldn’t) be inserted in the uterine cavity through the cervix in order to attempt aspiration of foetal components. Keep in mind that this can be dangerous and hurtful to your body and health.

5. Use of Harmful Chemicals or Douching

Substances such as turpentine oil, essential oils, and certain vaginal pessaries are harmful for the genital tract and its flora. This may cause spontaneous abortions.

Having an abortion can have a significant impact on a woman’s life. It is essential that the procedure has valid indications, is correctly timed, and is strictly performed under medical supervision. If a woman wants to opt for natural or home remedies for inducing an abortion, she must consult with her doctor or gynaecologist before choosing and administering any procedure.

References:

Healthline
Harvard Health

Also Read:

Medical Abortion Procedures
After Abortion Care
How To Terminate Pregnancy After 1 Month