Abortion

Abortion Procedures and Risks

It may seem like abortion will wipe away this situation and you can just move on. It’s not that simple. Abortion is not just a simple medical procedure. For many women, it is a life changing event with significant physical, emotional, and spiritual consequences. Most women who struggle with past abortions say that they wish they had been told all of the facts about abortion and its risks.

Abortion Procedures

First Trimester Aspiration Abortion between 4-13 weeks after last menstrual period (LMP)
This surgical abortion is done throughout the first trimester. Depending upon the provider and the cost, varying degrees of pain control are offered ranging from local anesthetic to full general anesthesia. For very early pregnancies (4-7 weeks LMP), local anesthesia is usually given. Then a long, thin tube is inserted into the uterus. A large syringe is attached to the tube and the embryo is suctioned out.

Towards the end of the first trimester, the cervix needs to be opened wider to complete the procedure because the fetus is larger. This may require a two day process where medications are placed in the vagina, or a thin rod made of seaweed is inserted into the cervix to gradually soften and open the cervix over night. The day of the procedure, the doctor may need to further stretch open the cervix using metal rods. This is usually painful so local or general anesthesia is typically needed. Next, the doctor inserts a plastic tube into the uterus and then applies suction. Either electric or manual suction machines are commonly used. Manual Vacuum Aspirators (MVA) are becoming more popular in the U.S. The suction pulls the fetus’ body apart and out of the uterus. The doctor may also use a loop-shaped tool called a curette to scrape the fetus and fetal parts out of the uterus. (The doctor may refer to the fetus and fetal parts as the “products of conception.”)[1, 2, 3, 4]

Dilation and Evacuation (D&E): between 13 to 24 weeks after LMP
This surgical abortion is done during the second trimester of pregnancy. In this procedure, the cervix must be opened wider than in a first trimester abortion because the fetus is larger. This is done by inserting numerous thin rods made of seaweed into the cervix a day or two before the abortion. Sometimes, other oral or vaginal medications are used to further soften the cervix. The day of the procedure, after anesthesia is given (local or general), the cervix is further stretched open using metal rods. Until about 16 weeks gestation, the procedure starts with a plastic tube inserted through the cervical opening and suction is applied. The suction pulls the fetus’ body apart and out of the uterus any remaining fetal parts are removed with a grasping tool (forceps). A sharp tool (called a curette) may also be used to remove any remaining tissue.

After 16 weeks, much of the procedure is done with forceps to pull fetal parts out through the cervical opening. The doctor keeps track of what fetal parts have been removed so that none are left inside to potentially cause infection. Lastly, a curette, and/or the suction machine is used to remove any remaining tissue or blood clot ensuring the uterus is empty.[5, 6, 7]

Dilation and Evacuation (D & E) After Potential Viability: about 24 weeks and up
When the abortion is done at a point when a live birth is possible, injections are given to cause fetal death. This is done in order to comply with the federal law which requires that the fetus be dead before complete removal from the mother’s body. The medications (digoxin and potassium chloride) are either injected into the amniotic fluid, the umbilical cord or directly into the fetus’ heart. The remainder of the procedure is the same as described above.

An alternate technique called “Intact D and E” may also be used. The goal of this procedure is to remove the fetus in one piece thus reducing the risk of leaving parts behind to cause infection, among other things. This procedure requires the cervix to be open even further by inserting the seaweed rods in the cervix two or more days prior to the abortion. Often it is necessary to crush the fetus’ skull for removal as it is difficult to dilate the cervix enough to bring the head out intact.[8, 9, 10]

Medication Abortion RU486 (Abortion Pill)
This drug is only approved by the Food & Drug Administration for use in women up to the 49th day after their last menstrual period; however, it is commonly used “off label” up to 63 days. This procedure usually requires three office visits. On the first visit, the woman is given pills to cause the death of the fetus. Two days later, if the fetus has not been expelled from her body, the woman is given a second drug (misoprostol) to accomplish this. One to two weeks later, an evaluation is done to determine if the procedure has been completed.[11, 12]

RU486 will not work in the case of an ectopic pregnancy. This is a potentially life-threatening condition in which the embryo lodges outside the uterus, usually in the fallopian tube.[13, 14]

If an ectopic pregnancy is not diagnosed early, the tube may burst, causing internal bleeding and in some cases, the death of the woman.

Medical Methods for Second Trimester Induced Abortion
This technique involves the termination of pregnancy by the stimulation of labor-like contractions that cause eventual expulsion of the fetus and placenta from the uterus. Like labor at full term, this procedure typically involves 10-24 hours in the hospital labor and delivery unit. Digoxin or potassium chloride is injected into the amniotic fluid, or umbilical cord or fetal heart prior to the procedure in order to avoid the delivery of a live baby. The cervix may be softened either with the use of seaweed sticks, or medications at the start of the procedure. Various combinations of oral mifepristone and oral or vaginal misoprostol are the medications of choice for midtrimester pregnancy terminations. These medications cause the pregnancy to detach from the uterus and the uterus to contract and expel the fetus and placenta, in most cases. Throughout the procedure, the patient may receive oral or intravenous pain medications. Occasionally, a scraping of the uterus is needed to remove the placenta. Potential complications include hemorrhage and the need for a blood transfusion, retained placenta and uterine rupture. The absolute risk of uterine rupture is not known.[15]

Consider the Immediate Risks of Induced Abortion

Physical Risks

Abortion carries the risk of significant complications such as bleeding, infection, and damage to organs. Serious medical complications occur infrequently in early abortions, but increase with later abortions [16, 17]. Getting complete information on the risks associated with abortion is limited due to incomplete reporting and the lack of record-keeping linking abortions to complications. The information that is available reports the following risks.

BLEEDING

Some bleeding after abortion is normal. However, if the cervix is torn or the uterus is punctured, there is a risk of severe bleeding known as hemorrhaging.[18, 19, 20] When this happens, a blood transfusion may be required. Severe bleeding is also a risk with the use of the abortion pill: one in 100 women require surgery to stop the bleeding.[21]
DAMAGE TO ORGANS

The cervix and/or uterus may be cut, torn, or damaged by abortion instruments. This may cause excessive bleeding requiring surgical repair.[28] Curettes and other abortion instruments may cause permanent scarring of the uterine lining.[29] The risk of these types of complications increases with the length of the pregnancy. If complications occur, major surgery may be required, including removal of the uterus (known as a hysterectomy).[30] If the uterus is punctured or torn, there is also a risk that damage may occur to nearby organs such as the bowel and bladder.[31]

DEATH

In extreme cases, complications from abortion (excessive bleeding, infection, organ damage from a perforated uterus, and adverse reactions to anesthesia) may lead to death.[32, 33] This complication is rare.

Consider Long Term Risks of Induced Abortion

Finding out the real risks of abortion can be difficult. Women should be given comprehensive information before going through a procedure or taking a medicine that could have lifelong effects on health. Doctors should obtain informed consent before doing a medical procedure. Consider the following as you make your decision:

Abortion and Preterm Birth

Women who undergo one or more induced abortions carry a significantly increased risk of delivering prematurely in the future. Premature delivery is associated with higher rates of cerebral palsy, as well as other complications of prematurity (brain, respiratory, bowel, and eye problems).[34, 35, 36, 37]

Abortion and Breast Cancer

Medical experts continue to debate the association between abortion and breast cancer. Did you know that carrying a pregnancy to full term gives a measure of protection against breast cancer? Terminating a pregnancy results in loss of that protection.[38, 39]

Despite the controversy around this issue, it is important for women to know what some experts say: a number of reliable studies have demonstrated connection between abortion and later development of breast cancer.[40, 41, 42, 43, 44, 45]

For more information regarding this potential risk, contact Option Line.

Emotional and Psychological Impact
Following abortion, many women experience initial relief. The perceived crisis is over and life returns to normal. For many women, however, the crisis isn’t over. Months and even years later, significant problems develop. There is evidence that abortion is associated with a decrease in both emotional and physical health, long term.[46] Many studies have shown abortion to be connected to:

•Clinical Depression [47, 48, 49]
•Drug and Alcohol Abuse [50, 51]
•Post-traumatic Stress Disorder [52, 53]
•Suicide [54, 55, 56, 57, 58]
Women who have experienced abortion may develop the following symptoms:

•Guilt, Grief, Anger, Anxiety, Depression, Suicidal Thoughts
•Difficulty Bonding with Partner or Children
•Eating Disorders

If you or someone you know is experiencing these symptoms, we offer confidential, compassionate support groups designed to help women work through these feelings. You are not alone.

Spiritual Consequences

People have different understandings of God. Whatever your present beliefs may be, there is a spiritual side to abortion that deserves to be considered. We are here to talk with you about any concerns you may have.

Parenting

Choosing to continue your pregnancy and to parent can be challenging. With the support of caring people, parenting classes, and other resources, many women find the help they need to make this choice.We offer free services designed to assist you in your parenting decision.

Adoption

Each year more than 50,000 American women lovingly place their baby in an adoptive home. This decision is often made by women who first thought abortion was their only way out. Adoption can be a loving option for birth mother, baby and adoptive family. Contact us to discuss your options.

Note: Our center offers consultations and accurate information about all pregnancy options; however, we do not offer or refer for abortion services. The information presented on this website is intended for general education purposes only and should not be relied upon as a substitute for professional and/or medical advice.

REFERENCES
1. Paul M, Lichtenberg E S, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, Management of Unintended and Abnormal Pregnancy, Comprehensive Abortion Care; 2009 Wiley-Blackwell.

2. Induced Abortion. ACOG Patient Education Pamphlet, American College of Obstetricians and Gynecologists. June 2007.

3. Rock J, Thompson J. TeLinde’s Operative Gynecology, 8th edition, Lippincott-Raven, 1997.

4. Stenchever M, et al. Comprehensive Gynecology, 4th edition, Mosby, Inc., 2001.

5. Paul M, Lichtenberg Management of Unintended and Abnormal Pregnancy, Comprehensive Abortion Care

6. Fox MC, et al. Cervical Preparation for Second Trimester Surgical Abortion Prior to 20 Weeks. Contraception 2007; 76(6):486-95

7. Rock J, Thompson J. TeLinde’s Operative Gynecology

8. Paul M, Lichtenberg Management of Unintended and Abnormal Pregnancy, Comprehensive Abortion Care

9. Boulder Abortion Clinic, P.C.; http:www.drhern.com/medicalprocedures.asp; (Accessed June 16, 2008)

10. Pasquini L, et al. Intracardiac injection of potassium chloride as method for feticide: experience from a single UK tertiary centre. British Journal of Obstetrics & Gynecology 2008; 115(4):528-31.

11. Mifeprex (mifepristone) Information. Center for Drug Evaluation and Research, U.S. Food and Drug Administration, http://www.fda.gov/cder/drug/infopage/mifepristone/ (Accessed June 16, 2008).

12. Mifeprex Package Insert (U.S. Food and Drug Administration-approved label), July 2005.

13. Gary M, Harrison D. Analysis of severe adverse events related to the use of Mifepristone as an abortifacient. The Annals of Pharmacology 2006; 40.

14. Medical Management of Abortion. ACOG Practice Bulletin No. 67. American College of Obstetricians and Gynecologists October 2005.

15. Paul M, Lichtenberg Management of Unintended and Abnormal Pregnancy, Comprehensive Abortion Care

16. Medical Management of Abortion. ACOG Practice Bulletin No. 67

17. Katz Comprehensive Gynecology, 5th Edition, 2007 Mosby-Elsevier

18. Katz Comprehensive Gynecology, 5th Edition, 2007 Mosby-Elsevier

19. Rock, J and Thompson J; TeLinde’s Operative Gynecology, 1997; 8th edition Lippincott-Raven

20. Stenchever, et al. Comprehensive Gynecology. 2001, 4th edition, Mosby, Inc

21. Mifeprex Package Insert FDA-approved label, July 2005.

22. Katz Comprehensive Gynecology, 5th Edition, 2007 Mosby-Elsevier

23. Stenchever, et al. Comprehensive Gynecology. 2001, 4th edition, Mosby, Inc

24. ACOG Practice Bulletin, Antibiotic Prohyllaxis for Gynecologic Procedures”; No. 74, July 2006

25. Dilatation and Curettage. ACOG Patient Education Pamphlet. American College of Obstetricians and Gynecologists December 2005

26. ACOG Practice Bulletin, Medical Management of Abortion; No. 67, October 2005

27. Meich R. Pathophysiology of mifepristone-induced septic shock due to Clostridium sordellii. Ann Pharmacother 2005;39:xxxx. Published online, 26 Jul 2005, www.theannals.com

28. Rock, J and Thompson J; TeLinde’s Operative Gynecology, 1997; 8th edition Lippincott-Raven.

29. ACOG Patient Education Bulletin, Dilatation and Curettage; December 2005

30. Rock, J and Thompson J; TeLinde’s Operative Gynecology, 1997; 8th edition Lippincott-Raven.

31. Ibid.

32. Ibid.

33. Katz Comprehensive Gynecology, 5th Edition, 2007 Mosby-Elsevier

34. Rooney B, Calhoun B. Induced abortion and risk of later premature births. Journal of American Physicians and Surgeons 2003; 8(2):46-49.

35. Ancel P, et al. History of induced abortion as a risk factor for preterm birth in European countries: results of the EUROPOP survey. Human Reproduction 2004; 19 (3)734-760.

36. Behrman, R and Stith Butler A. Preterm Birth: Causes, Consequences, and Prevention 2006. Institute of Medicine of the National Academy of Science.

37. Swingle HM, et al. Abortion and the risk of subsequent preterm birth, a systematic review with meta-analyses. J of Repro Med 2009 Feb; 54(2):95-108.

38. MacMahon, et al. Age at first birth and breast cancer risk. Bulletin of the World Health Organization 1970. 43:209-221.

39. Trichopoulos, D, et al. Age at any birth and breast cancer risk. Int J of Cancer 1983; 31:701-704.

40. Carroll, P. The breast cancer epidemic: modeling and forecasts based on abortion and other risk factors. J of Am Physicians and Surgeons. 2007; Vol 12(3).

41. Daling, J, et al. Risk of breast cancer among young women: relationship to induced abortion. J of the Natl Cancer Institute, November 1994; Vol 86(21).

42. Dolle J; Daling J; White E; Brinton L, et al. Risk factors for triple-negative breast cancer in women under the age of 45 years. Cancer Epidemiol Biomarkers Prev 2009 Apr; 18(4):1157-66.

43. Hsieh C-c, et al. Delivery of premature newborns and maternal breast-cancer risk. Lancet. 1999; 353-1239.

44. Melbye M., et al. Preterm delivery and risk of breast cancer. Bristish J of Cancer. 1999; 80:609-613.

45. Brind, J. Induced abortion as an independent risk factor for breast cancer: a comprehensive review and meta-analysis. J of Epidemiology and Community Health. 1996; 50:481-496.

46. Thorp JM, Shadigian E, et al. Long term physical and psychological health consequences of induced abortion: review of the evidence. Obstetrical & Gynecological Survey; 2003; 58(1):67-79.

47. 47. Templeton S-K, “Royal College Warns Abortion Can Lead to Mental Illness,” The Sunday Times, March 16, 2008, http://www.timesonline.co.uk/tol/life_and_style/health/article3559486.ece (Accessed June 16, 2008); “Position Statement on Women’s Mental Health in Relation to Induced Abortion,” March 14, 2008, Royal College of Psychiatrists, http://www.rcpsych.ac.uk/members/currentissues/mentalhealthandabortion.aspx (Accessed June 16, 2008).

48. Cougle JR, et al. Depression associated with abortion and childbirth: a long-term analysis of the NLSY cohort. Med Science Monitor 2003; 9(4):105-112.d

49. Fergusson DM, et al. Abortion in young women and subsequent mental health. J of Child Psychology and Psychiatry 2006; 47(1):16-24.

50. Coleman P, Reardon D, Rue V. Prior history of induced abortion in relation to substance use during subsequent pregnancies carried to term. Am J of Obstetrics and Gynecology. 2002; 187:1673-78.

51. Coleman PK, et al. Predictors and correlates of abortion in the fragile families and well-being study: paternal behavior, substance use, and partner violence. Int J Ment Health Addiction 2008.

52. Thorp JM, Shadigian E, et al. Long term physical and psychological health consequences of induced abortion: review of the evidence.

53. Rue VM, et al. Induced abortion and traumatic stress: a preliminary comparison of American and Russian women. Medical Science Monitor 2004; 10:5-16.

54. DM, et al. Reactions to abortion and subsequent mental health. Brit J Psych 2009;

55. Yang C-Y. Association between parity and risk of suicide among parous women. Can Med Assoc J Apr 2010; 182; 569-572.

56. Reardon DC, Shuping MW, et al. Deaths associated with abortion compared to childbirth: a review of old and new data and the medical and legal implications. J of Contemporary Health Law and Policy; 2004; 20(2):279-327

57. Gissler M, et al. Suicides after pregnancy in Finland: 1987-1994: register linkage study. British Medical Journal 1996; 313:1431-4.d

58. Shadigian EM et al. Pregnancy-associated death: a qualitative systematic review of homicide and suicide. Obstetrical and Gynecological Survey 2005; 60(3):183