Table of Contents
What is abortion?
Abortion refers to the spontaneous loss of a pregnancy or its termination by medical or surgical methods before it reaches its stage of viability (20 weeks of gestation). The term Abortion is generally used for abortions induced by a doctor and the term miscarriage is popularly used for spontaneous abortions.
Abortions are extremely safe and free of complications when the correct abortion procedure appropriate for the stage of pregnancy, is carried out by a qualified and skilled healthcare professional. However, abortions can get complicated when they are self-induced or done by unqualified people. Such unsafe abortions are a significant cause of maternal morbidity and mortality and are easily preventable by seeking proper medical help.
Why is abortion done?
An abortion may be done for the following reasons:
- Unwanted or unplanned pregnancy: An unwanted pregnancy can happen due to:
- unprotected intercourse without contraceptive use
- accidental pregnancy due to contraceptive failure or nonconsensual sex.
- Wanted or Planned pregnancy: When the pregnancy is planned, but the woman does not want to carry on with the pregnancy due to pressing situations like financial crisis, death of husband, divorce, lack of family support system, career opportunities, poor maternal health etc.
- Congenital anomalies: Sometimes, the fetus does not develop normally and is found to have severe congenital anomalies or developmental defects. In that case, an abortion may be done which is called the Medical Termination of Pregnancy.
- Spontaneous abortion: When an early pregnancy stops developing and gets expelled from the uterus on its own, it is called spontaneous abortion. It is indicated by spontaneous vaginal bleeding with or without pain, during the early weeks of pregnancy.
What are the types of abortion?
- SPONTANEOUS ABORTION: An abortion that occurs on its own without the pregnant woman’s intent and without any medical intervention is called spontaneous abortion. It is also called miscarriage. Miscarriages are common & about one-third of all pregnancies end up as miscarriages. If you have a miscarriage, visit your doctor to get assessed and to ensure that the abortion was complete. If certain products of conception are found to be left behind, your doctor might do a procedure called Dilatation and Evacuation (D & E) to clean up the uterus. Your doctor may also order some tests to find out the reason for your abortion to prevent such an incident in your future pregnancies.
- INDUCED ABORTION: An abortion caused by the intervention of a medical professional at the request of a pregnant woman is called Induced abortion. Induced abortion can be medicinal or procedural. The type of abortion depends on your pregnancy stage, your general health, any medical conditions, and the local laws and regulations in your country or region.
- First trimester abortion (Pregnancy up to 12 weeks) can be terminated as a Medicinal abortion. In this, certain medicines are prescribed by your doctor to induce an abortion. These pills are mifepristone and misoprostol.
- Second trimester abortion (Pregnancies 12 weeks to 20 weeks) are usually done as Procedural abortion. The most commonly performed procedure is called Dilatation and Evacuation (D & E). It is done by your doctor as a daycare procedure and you will be discharged on the same day.
First trimester abortion (Medicinal abortion)
What is a first trimester abortion?
The first trimester of pregnancy lasts up to 12 weeks of pregnancy. During this period, your doctor will prescribe you certain pills to induce an abortion. This is called a first trimester abortion or medical abortion or medicinal abortion.
How is a first trimester abortion done?
On the first day, you will be given a drug called mifepristone. Taking this drug will stop your pregnancy from growing further. After 24 to 48 hours, you will be given another drug called misoprostol. This drug causes the uterus to contract and expel the pregnancy, in the form of bleeding.
Can I stay at home for my medicinal abortion?
Yes, you can stay at home for your medical abortion. Your doctor will prescribe you the medicines and explain the procedure for taking them. These medicines can be taken at home but you have to get your follow-up as per your doctor’s advice. You should also have some close family at home to watch over you so that in the rare event of any major bleeding or nay other problem, you have someone to support you.
What are the side effects of medical abortion?
Medicinal abortion is safe and effective in early pregnancy (< 12 weeks) with a very low rate of complications. The side effects are usually mild and may include heavy bleeding, pain, nausea, vomiting, severe cramps in your tummy etc. These can be easily managed with simple painkillers and over-the-counter medications. Some fever or chills may also be there, but these are due to the medicine and not due to any infection. So don’t worry and take paracetamol for the fever.
When can I resume sexual intercourse after medical abortion?
It is very important to know that you should wait for about 2 to 3 weeks before resuming sexual intercourse. This is to prevent the chances of any vaginal infections after the abortion and let your body heal. You should also avoid douching and inserting anything in the vagina like tampons, diaphragms, cervical caps etc.
Does medical abortion affect my chances of getting pregnant in the future?
No, Medicinal abortion does not affect your fertility or your chances of getting pregnant in the future. These medicines just help to terminate your current pregnancy.
What happens after a medical abortion?
Within 24 to 48 hours of taking your first medicine (mifepristone), you have to take your second medicine (misoprostol). You will start having cramping sensations and bleeding for the next 2 to 10 hours. After this, should report to your doctor for follow-up as per the instructions given by your doctor. Your doctor will do a recheck ultrasound to confirm that the abortion was complete and that no products of conception are left behind.
What happens if medical abortion does not work?
If a medical abortion is not feasible or ineffective for some reason, surgical procedures like Suction evacuation or Dilatation and Evacuation (D and E) may be done to abort the pregnancy. These procedures are done on a daycare basis and you are allowed to go back home after 2 to 4 hours of observation.
How long does it take to feel normal after a medical abortion?
As stated earlier, medical abortion is associated with very few side effects and they are generally mild. You can resume your daily routine on the very next day. If you may feel cramping, soreness, or fatigue in the next few days, you can take simple over-the-counter painkillers like ibuprofen. You may also have some mild bleeding or spotting for a few days after your abortion. This is also normal and goes away in a few days. Some fever or chills may be felt for one to two days. These are mostly due to the medicines and are responsive to simple paracetamol. However, prolonged or high-grade fever or persistent heavy bleeding should be reported to your doctor.
Second trimester abortion (Procedural abortion)
What is a second trimester abortion?
The second-trimester abortions can be done for pregnancies 13 to 20 weeks. As the fetus keeps growing in the second trimester, the risks of abortion increase. So it is a good idea to get the abortion done as soon as possible after you have taken a decision.
How are second trimester abortions done?
Most second trimester abortions are done as Procedural abortions, although in early second stage (12 to 14 weeks), medicinal abortion may be done by your doctor.
The most common procedure is Dilatation and Evacuation (D & E). It is called so as the cervix needs to be dilated first before suctioning out the fetus. This is because by the second trimester, the fetus grows in size and it is easier to evacuate the uterine cavity after dilatation of cervix.
What happens on the day of the second trimester abortion?
You will be taken to an operation theatre where you will be first given either sedation, general anesthesia or local anesthesia around the cervix, as decided by you and your anesthesiologist before the procedure.
Then the cervix is dilated by the use of dilators. After this, a plastic tube is inserted in the uterus and attached to suction so that the products of conception are sucked out. Finally an instrument called curette is used to ensure that the uterus has been emptied completely. The entire procedure takes about 10-15 minutes.
What happens after the second trimester abortion?
Even after a general anesthetic, you will be awake before you leave the operation theatre. You will be kept in observation room for about 2-3 hours. When you are able to stand, walk, pass urine, drink water and other liquids, it means that you are ready for discharge and you will be discharged.
Before discharge, your doctor will give you some instructions for postoperative care at home. You will also be prescribed some antibiotics and painkillers to be taken for a couple of days.
What are the side effects or complications of second trimester abortion?
D & E is a simple procedure and in expert hands, the overall risk of complications is very low. However, the risks are greater as compared to first trimester abortions. The main complications include:
- Uterine perforation: Sometimes the uterus may get injured or perorated during the procedure. This is a dreaded complication as the uterus may keep on bleeding inside.
- Postoperative bleeding: Small amount of vaginal bleeding or spotting for a few hours or few days postop is normal. However, heavy or persistent bleeding is abnormal and you should immediately go to the emergency in such a situation.
- Risks of anesthesia: Although it is a minor procedure, the risks of drug reactions and other anesthesia risks still remain.
- Infection: Again, in good hands and at good centres, the risk of infection is very low.
- Pain: You may have some pain, cramps or fatigue for a few days which easily respond to routine painkillers.
- Nausea or vomiting: These are common side effects after any procedure and respond to routine antacids or antiemetics available over the counter.
What happens before an abortion?
Your healthcare professional will take a detailed history including the date of your last menstrual period, the normal length of your cycles, your pregnancy duration, history of any medical conditions or previous surgical procedures, and history of allergy to any medicines. The history is followed by a physical examination, blood tests and an ultrasound. An ultrasound is also done to ensure that the pregnancy is in the uterus and not at some other abnormal site (ectopic pregnancy). After completing the workup, your doctor will guide you about:
- Various abortion methods are feasible for your abortion – both medical or surgical
- Risks and benefits of the various abortion methods
- Whether there is a need for admission
- Details of anesthesia, if required
- Post-abortion care at home
What happens during an abortion?
The abortion methods are different for the first and second trimesters of pregnancy. The risks and benefits of each method are discussed separately below in the respective sections
What happens after an abortion?
Abortions are usually uncomplicated procedures, with a very low rate of infection. After an abortion, you may feel pain or cramping for a few days, for which over-the-counter painkillers are effective. You may also experience some nausea, vomiting, or loss of appetite, for which routine antacids are usually effective. Your doctor may prescribe some antibiotics for a few days.
Is abortion safe?
In the absence of any concomitant medical conditions, abortions are generally safe with a very low rate of complications.
Does abortion have any long-term effects?
Abortion is a simple medical procedure to remove an unwanted pregnancy. It does not affect your fertility and does not have any long-term ill-effects on your health.
What is the best time for abortion?
The time limit till which you can get your abortion done varies among countries and regions and depends on the local laws. However, as a general rule, if you are considering getting an abortion, you should decide as soon as possible. This is because the medical abortion with pills can only be done till 12 weeks. After 12 weeks, procedural or surgical abortion is done by your doctor. The size of the fetus also grows with increasing time of pregnancy and the risks of the procedure also increase proportionately.
Carry home message
Abortions came happen spontaneously in early pregnancy and are called miscarriages. Abortions can also be medically induced at the request of the patient. This can be done by prescribing certain medicines (Medicinal or Medical abortions) or by performing certain procedures (Procedural abortion).
For medical abortion, you can take your medicines at home and come for checkup 6 to 10 hours after the bleeding starts. Procedural abortions are done in hospital as day care procedures and you are discharged on the same day.
Abortions are very common procedures and are very safe when done by qualified and skilled professionals, in a good centre with quality care. Stay healthy!
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