Abortion - medical

Definition

A medical abortion is the use of certain medications to end a pregnancy. The drugs help remove the fetus and placenta from the mother's womb (uterus).

There are different types of medical abortion.

Sometimes the woman has one for a health reason. This is called a therapeutic medical abortion.

Other times, she chooses (elects) to end the pregnancy. This is called an elective medical abortion.

See also:

• Miscarriage
• Surgical abortion

Alternative Names

Therapeutic medical abortion; Elective medical abortion; Induced abortion

Description

A medical, or nonsurgical, abortion can be done within 7 weeks from the first day of the woman's last menstrual period. A combination of prescription hormone medicines are used to help the body remove the fetus and placenta tissue. The doctor may give you the medicines after performing a physical exam and asking questions about your medical history.

Medications used to end an early pregnancy include mifepristone, methotrexate, misoprostol, prostaglandins, or a combination of these medications. Most women who use medication do so because of a desire to avoid anesthesia and surgery.

Why the Procedure Is Performed

There are several reasons a medical abortion might be considered:

• The developing baby has a birth defect or genetic problem
• The pregnancy is harmful to the woman's health (therapeutic abortion)
• The pregnancy resulted after a traumatic event such as rape or incest
• The woman may not wish to be pregnant (elective abortion)

The decision to end a pregnancy is very personal. Most health care providers recommend careful counseling before making such a decision.

Abortion is a controversial issue. A woman who chooses to end a pregnancy may feel she cannot share her decision with others. Therefore, it is important for her to identify those who may help her through what may be a difficult time.

Women who are trying to make this difficult decision should find a safe place in which they can obtain counseling regarding all options for pregnancy resolution.

If a woman chooses to have an abortion, she should find a safe place to have the procedure performed and obtain the proper support and follow-up care afterwards.

Risks

Risks of medical (nonsurgical) abortion include:

• Continued bleeding
• Diarrhea
• Fetus not passing completely from body, making surgery necessary
• Nausea
• Pain
• Vomiting

Before the Procedure

A pelvic examination is performed to confirm the pregnancy and estimate how many weeks pregnant you are.

A HCG blood test may be done to confirm the pregnancy.

A vaginal or abdominal ultrasound may be done to determine the exact age of the fetus and its location in the womb.

After the Procedure

Physical recovery usually occurs within a few days, depending on the stage of the pregnancy. A small amount of vaginal bleeding and mild uterine cramping should be expected for a few days.

A hot bath or use of a heating pad or hot water bottle on the abdomen may help relieve discomfort. Strenuous activity should be avoided for a few days. Tampons may be used after 3 days. Sexual intercourse should be avoided for 2 to 3 weeks. A normal menstrual period should occur in about 4 to 6 weeks.

It's important to begin using birth control immediately after the abortion procedure. It is possible to get pregnant again even before having a normal menstrual period. Improved methods of contraception can help prevent many unplanned pregnancies. However, unplanned pregnancies occur even when couples use birth control.

Outlook (Prognosis)

Complications rarely occur.

Women who have a medical abortion have cramping and bleeding, and pass the pregnancy-related tissue as though they were having a miscarriage.

Some women feel ambivalent about ending a pregnancy, and may need psychological and emotional support. It's important to seek counseling before making this very difficult decision.

References

ACOG. Clinical management guidelines of obstetrician-gynecologists. Medical management of abortion. Obstet Gynecol. 2005 Oct;106(4):871-82.

Mischell DR. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 14.

Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 24.

Annas GJ, Elias S. Legal and ethical issues in obstetric practice. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 51.