What are the Types of Abortion?
Induced abortions are of two types – medical abortion and surgical abortion.
Medical abortion is done using certain medications that bring about termination of pregnancy. It is usually performed till 9 weeks from the last menstrual period. Medications used to bring about abortion include:
► Mifepristone and misoprostol: Mifepristone is a drug that acts as anti-progesterone; progesterone is a hormone that helps to maintain pregnancy. It is administered as an oral tablet of 600mg and brings about abortion in 65 to 80% cases. In order to improve the results, it is followed by 400 µg of misoprostol 48 hours later. Misoprostol is a prostaglandin, which brings about contraction of the uterus and dilates the cervix, which thus helps to evacuate the uterus. Misoprostol may also be administered vaginally as a single or two doses, or by sublingual (kept under the tongue) or buccal (absorbed through the mucus membranes of the mouth) routes. Gemeprost may be used as a vaginal pessary instead of misoprostol. It may also be used without mifepristone in some cases.
► Methotrexate and misoprostol: Methotrexate followed by misoprostol is administered in countries where mifepristone is not available, but this combination is comparatively less effective.
Surgical abortions were performed even before medical methods were available. These include:
► Vacuum aspiration: Vacuum aspiration is a common surgical procedure where a vacuum is applied in the uterus to bring about abortion. It is usually performed under local anesthesia before 12 weeks of gestation. Treatment to soften and dilate the cervix may be administered before the procedure. Very early abortions may be done manually with a syringe. These are referred to as manual aspirations or menstrual aspirations.
Chances of serious complications are low and include perforation of the uterus and incomplete abortion.
► Dilatation and evacuation: Dilatation and evacuation is the surgical procedure usually adopted for abortion during second trimester. The cervix is initially softened and dilated. This is followed by surgical evacuation of the uterus with suction curettage and manual extraction.
Up to 9 weeks of gestation, the patient may be offered either medical or surgical abortion. Studies indicate that surgical abortions are more acceptable to women. This may be due to more pain, prolonged bleeding and slightly higher failure rate with medications as compared to surgical evacuation.
Abortions after 20 weeks of pregnancy are carried out only under exceptional circumstances. The procedures used in these abortions include labor induction, saline infusion, hysterotomy, or dilatation and extraction.