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Abortion (cont.)

Types of Abortion

Surgical

Home pregnancy tests available at a drug store can indicate pregnancy early after conception. Terminations performed in this very early time frame have sometimes been termed menstrual extractions.

Abortions performed prior to nine weeks from the last menstrual period (seven weeks from conception) are performed either surgically (a procedure) or medically (with drugs).
From nine weeks until 14 weeks, an abortion is performed by a dilatation and suction curettage procedure.
After 14 weeks, surgical abortions are performed by a dilatation and evacuation procedure.
After 20 weeks of gestation, abortions can be performed by labor induction, prostaglandin labor induction, saline infusion, hysterotomy, or dilatation and extraction.

Most abortions are performed in an outpatient office setting (doctor's office, ambulatory clinic) under local anesthesia with or without sedation.

Medical

Medical abortion is a term applied to an abortion brought about by medication taken to induce it. This can be accomplished with a variety of medications given either as a single pill or a series of pills. Medical abortion has a success rate that ranges from 75-95%, with about 2-4% of failed abortions requiring surgical abortion and about 5-10% of incomplete abortions (not all tissue is expelled and it must be taken out by surgery), depending on the stage of gestation and the medical products used.

Women who select a medical abortion express a slightly greater satisfaction with their route of abortion and, in the majority of cases, express a wish to choose this method again should they have another abortion. Research needs to be performed to more clearly establish which method is best, which medications are preferable, and how successfully women and adolescents can diagnose a complete versus an incomplete abortion.

Medical abortions can provide some measure of safety in that they eliminate the risk of injury to a woman's cervix or uterus from surgical instruments. Some women require an emergency surgical abortion, and, for safety concerns, women undergoing medical abortions need access to providers willing to perform a surgical abortion should it be necessary.

In September 2000, the FDA approved the drug mifepristone (known as RU-486) for use in a specific medical plan that includes giving another drug, misoprostol, for those who do not abort with mifepristone alone. Methotrexate and misoprostol are drugs approved for other conditions that can also be used for medical termination of pregnancy. Additional research will determine exactly which drug or combination is ideal for medical abortions.

The process of a medical abortion involves bleeding, often like a heavy menstrual period, which must be differentiated from hemorrhage (a serious problem). Regardless of the amount of tissue passed, the woman must see a doctor for evaluation to make sure the process is complete (and not an incomplete abortion). A rare and serious infection by the bacteria Clostridium sordellii is related to medical abortions. There have been reports of four deaths associated with this infection since 2001. Fatal infections are rare, occurring in fewer than 1 in 100,000 uses of mifepristone medical abortions, which is far less than the number of cases of fatal penicillin-induced anaphylaxis (1 in 50,000 uses).