Alternative Names induced abortion, interruption of pregnancy
Definition When a woman chooses to end a pregnancy , the procedure is called an elective abortion. The fetus may be removed from the uterus by means of an elective surgical abortion or an elective medical abortion. A medical abortion is done by giving the woman medications that will end the pregnancy.
Who is a candidate for the procedure? Any woman who chooses to end a pregnancy for health or personal reasons is a candidate for an elective abortion. Abortions are legal in the United States during the first 12 weeks of pregnancy. After that amount of time, abortion is regulated by each state.
How is the procedure performed? Before an abortion is performed, a healthcare provider will confirm that a woman is pregnant. The length of a pregnancy will be determined by noting the number of days that have passed since the first day of the woman's last menstrual period, or LMP. A medical abortion can be done as soon as the pregnancy is confirmed. Medical abortions do not work as well later in pregnancy, so they are not generally used past 7 weeks after LMP. After 7 weeks, an elective surgical abortion can be used.
In preparation for an abortion, a pelvic examination might be done to confirm the size of the uterus. Laboratory studies will rule out anemia , determine the woman's Rh factor , and screen for sexually transmitted diseases . Education about the procedure should be offered, and psychological support should be given as needed. Medications used for a medical abortion include:
methotrexate, a medication approved by the Federal Drug Administration, or FDA, for cancer treatment. Methotrexate is generally given by injection, but it also can be taken orally. Methotrexate stops the fertilized egg from implanting in the uterine lining during the first few weeks after conception.
mifepristone, or RU-486, which was recently approved by the FDA for medical abortions. Mifepristone works by blocking the female hormone progesterone. As a result, the lining of the uterus breaks down and is passed out of the uterus through the cervix.
misoprostol, which is taken a few days after the woman takes either methotrexate or mifepristone. Misoprostol is given by tablets that are either swallowed or inserted into the vagina. It causes uterine contractions and expulsion of the fetus through the vagina.
What happens right after the procedure? A medical abortion can take from 3 days to 3 to 4 weeks. After the first medication (methotrexate or mifepristone) is given for a medical abortion, the woman can go home. Some women will have vaginal bleeding after the first medication. The bleeding can vary from light to heavy.
The woman will return to the healthcare provider for a second visit to take the misoprostol. The uterine cramping caused by this medication might result in the expulsion of the embryo at the medical facility, or the tissue may be passed later at home. Many women will have cramps for several hours and pass blood clots as they are aborting. These symptoms should start to taper off after the embryo has been passed, but bleeding can last for 1 to 2 weeks after medical abortion. Headache , nausea , vomiting , and diarrhea can also be caused by misoprostol.
Finally, a third visit will be scheduled so that the healthcare provider can check to be sure that the abortion was complete. Of the women who take methotrexate, 80% to 85% will abort within 2 weeks. A woman who takes longer may need more misoprostol. With mifepristone, 95% to 97% of the women will expel the uterine contents within 2 weeks. About 5% of the women who choose to have an elective medical abortion require a surgical abortion because the medication does not work.
After any abortion, a woman with Rh negative blood should be given an injection of Rh immune globulin unless the father is also known to have Rh negative blood. She may also be given a prescription for pain medications . Sometimes antibiotics are prescribed to help prevent infection.
What happens later at home? After returning home, a woman should:
call the healthcare provider if there are any new or worsening symptoms, including fever , severe or lasting abdominal distress , or heavy vaginal bleeding
avoid using tampons or having sexual intercourse for at least 2 weeks
slowly resume daily activity as tolerated
If a woman has no complications from the abortion, it is likely that she will be able to get pregnant at a later time. A follow-up visit with a healthcare provider should include a pelvic exam to be sure the uterus is shrinking in size. This office visit is also a good time for a woman and her provider to discuss birth control , so she can choose a method that will work well for her.
What are the potential complications after the procedure? Any type of abortion can cause heavy bleeding that might require a D&C or blood transfusion . Long-term complications have not been associated with the medications used for medical abortion.
Author: Eva Martin, MD Reviewer: Barbara Mallari, RN, BSN, PHN Last Updated: 11/15/00 Contributors Potential conflict of interest information for reviewers available on request
