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Abortion Methods & Medical Risks
If a woman chooses to have an abortion, she and her doctor must first determine how far her pregnancy has progressed. The stage of a woman’s pregnancy will directly affect the appropriateness or method of abortion. The doctor will use a different method for women at different stages of pregnancy. In order to determine the gestational age of the embryo or fetus, the doctor will perform a pelvic exam and/or an ultrasound.

Abortion Risks

Definitions for Medical Risks of Abortion

Early Non-Surgical Abortion

Vacuum Aspiration Abortion

Dilation and Curettage Abortion

Dilatation and Evacuation (D&E)

Labor Induction (Includes Intra-Uterine Instillation)

Hysterotomy (similar to a Caesarean Section)

Dilation and Extraction

Possible Detrimental Psychological Effects of Abortion


Abortion Risks
At or prior to eight weeks after the first day of the last normal menstrual period is considered the safest time to have an abortion. The complication rate doubles with each two-week delay after that time. The risk of complications for the woman increases with advancing gestational age.

According to data from the Centers for Disease Control and Prevention (CDC), the risk of dying as a direct result of a legally induced abortion is less than one per 100,000. This risk increases with the length of pregnancy. For example:

  • Less than 1 death per 100,000 abortions at 8 or fewer weeks

  • Less than 6 deaths per 100,000 at 16-20 weeks

  • Less than 17 deaths per 100,000 at 21 or more weeks

Complications associated with an abortion may make it difficult to become pregnant in the future or carry a pregnancy to term.


Definitions for Medical Risks of Abortion

 

The risk of complications for the woman increases with advancing gestational age.

 

Pelvic Infections (Sepsis): Bacteria (germs) from the vagina may enter the cervix and uterus and cause an infection. Antibiotics are used to treat an infection. In rare cases, a repeat suction, hospitalization or surgery may be needed. Infection rates are less than 1% for dilation and suction curettage/vacuum aspiration abortion, 1.5% for dilation and evacuation (D & E), and 5% for labor induction.
 

Incomplete Abortion: Fetal parts or other products of pregnancy may not be completely emptied from the uterus, requiring further medical procedures. Incomplete abortion may result in infection and bleeding. The reported rate of such complications is less than 1% after a dilation and evacuation (D & E).

Blood Clots in the Uterus: Blood clots that cause severe cramping occur in about 1% of all abortions. The clots usually are removed by a repeat dilation and suction curettage.

Heavy Bleeding (Hemorrhage): Some amount of bleeding is common following an abortion. Heavy bleeding (hemorrhage) is not common and may be treated by repeat suction, medication, or, rarely, surgery. Ask the doctor to explain what to do if it occurs.

Cut or Torn Cervix: The opening of the uterus (cervix) may be torn while it is being stretched open to allow medical instruments to pass through and into the uterus. This happens in less than 1% of first trimester abortions.

Perforation of the Uterus Wall:  A medical instrument may go through the wall of the uterus. The reported rate is 1% out of every 1000 with early abortions and 3 out of every 1000 with dilation and evacuation (D & E). Depending on the severity, perforation can lead to infection, heavy bleeding or both. Surgery may be required to repair the uterine tissue, and in the most severe cases, hysterectomy may be required.

Anesthesia-Related Complications: As with other surgical procedures, anesthesia increases the risk of complications associated with abortion. The reported risk of anesthesia-related complications is around 1 per 5,000 abortions. Most are allergic reactions producing fever, rash and discomfort.

Breast Cancer: Studies show that women who have children before age 30 have a lower risk of breast cancer than those who have children later in life or no children at all.


Early Non-Surgical Abortion

 

A drug is given that stops the hormones needed for the fetus to grow. In addition, it causes the placenta to separate from the uterus, ending the pregnancy.

 

A second drug is given by mouth or placed in the vagina causing the uterus to contract and expel the fetus and placenta. A return visit to the doctor is required for follow-up to make sure the abortion is completed.

 

Possible Complications

 

 

  • incomplete abortion

  • allergic reaction to medications

  • nausea and/or vomiting

  • fever

  • painful cramping

  • heavy bleeding

  • diarrhea

  • infection

 


Vacuum Aspiration Abortion

 

A local anesthetic is applied or injected into or near the cervix to prevent discomfort or pain. The opening of the cervix is gradually stretched with a series of dilators. The thickest dilator used is about the width of a fountain pen. A tube is inserted into the uterus and is attached to a suction system that will remove the fetus, placenta and membranes from the woman's uterus. A follow up appointment should be made with the doctor.

 

Possible Complications

 

 

  • incomplete abortion

  • heavy bleeding

  • perforated uterus

  • pelvic infection
  • torn cervix
  • blood clots in uterus

Dilation and Curettage Abortion

 

A local anesthetic is applied or injected into or near the cervix to prevent discomfort or pain. The opening of the cervix is gradually stretched with a series of dilators. The thickest dilator used is about the width of a fountain pen. A spoon-like instrument (curette) is used to scrape the walls of the uterus to remove the fetus, placenta, and membranes. A follow up appointment should be made with the doctor.

 

Possible Complications

 

  • pelvic infection
  • heavy bleeding
  • incomplete abortion requiring vacuum aspiration
  • blood clots in uterus
  • perforated uterus
  • torn cervix

Dilatation and Evacuation (D&E)

 

Sponge-like tapered pieces of absorbent material are placed into the cervix. This material becomes moist and slowly opens the cervix. It will remain in place for several hours or overnight. A second or third application of the material may be necessary. Following dilation of the cervix, intravenous medications may be given to ease discomfort or pain and prevent infection. After a local or general anesthesia has been administered, the fetus and placenta are removed from the uterus with medical instruments such as forceps and suction curettage. Occasionally for removal, it may be necessary to dismember the fetus.

 

Possible Complications

 

  • blood clots in the uterus
  • cut or torn cervix
  • incomplete abortion
  • perforation of the wall of the uterus
  • heavy bleeding

  • pelvic infection

  • anesthesia-related complications


Labor Induction (Includes Intra-Uterine Instillation)

 

Labor induction may require a hospital stay. Medicine is placed in the cervix to soften and dilate it. There are three ways to start labor early: (1) medication is given directly into the bloodstream of the pregnant woman starting uterine contractions; (2) medication inserted into the vagina to start uterine contractions, and (3) medication injected directly into the amniotic sac by inserting a needle through the mother's abdomen and into the amniotic sac. This stops the pregnancy and starts uterine contractions. Labor and delivery of the fetus during this period are similar to the experiences of childbirth. The duration of labor depends on the size of the baby and the contractibility of the uterus. There is a small chance that a baby could live for a short period of time depending on the baby's gestational age and health at the time of delivery.

 

Possible Complications

 

If the placenta is not completely removed during labor induction, the doctor must open the cervix and use suction curettage (removal of uterine contents by low-pressure suction).

 

Labor induction abortion carries the highest risk for problems, such as infection and heavy bleeding. When medicines are used to start labor, there is a risk of rupture of the uterus. Possible complications of labor induction include infection, heavy bleeding, stroke and high blood pressure. Other medical risks may include blood clots in the uterus, heavy bleeding, cut or torn cervix, perforation of the wall of the uterus, pelvic infection, incomplete abortion, anesthesia-related complications.

 


Hysterotomy (similar to a Caesarean Section)

 

This method requires that the woman be admitted into a hospital. A hysterotomy may be performed if labor cannot be started by induction, or if the woman or her fetus is too sick to undergo labor. A hysterotomy is the removal of the fetus by surgically cutting open the abdomen and uterus. Anesthetic medication, given into the woman’s vein or back, or inhaled into the lungs, is administered so the woman will not feel the surgery.

Possible Complications

  • severe infection (sepsis)

  • blood clots to the heart and brain (emboli)

  • stomach contents breathed into lungs (aspiration pneumonia)

  • severe bleeding (hemorrhage)

  • blood clots in the uterus

  • pelvic infection

  • anesthesia-related complications

  • injury to the urinary tract

  • heavy bleeding

  • retention of pieces of the placenta


Dilation and Extraction

 

This method may be performed between 20 and 32 weeks gestation. Sponge-like tapered pieces of absorbent material are placed into the cervix. This material becomes moist and slowly opens in the cervix. It will remain in place for one to two days. A second or third application of the material may be necessary. After a local or general anesthesia has been administered, the fetus and placenta are removed from the uterus with medical instruments such as forceps, suction and curette (a spoon-like instrument). It may be necessary to dismember the fetus.
 

Possible Complications

  • uterine infection

  • blood clot, stroke or anesthesia-related death

  • high blood pressure

  • heavy bleeding


Possible Detrimental Psychological Effects of Abortion

 

Many women suffer from Post-Traumatic Stress Disorder following abortion. PTSD is a psychological dysfunction resulting from a traumatic experience. Symptoms of PTSD include:

 

  • guilt

  • depression

  • nightmares

  • fear and anxiety

  • alcohol and drug abuse

  • flashbacks

  • grief

  • suicidal thoughts or acts

  • sexual dysfunction

  • eating disorders

  • low self-esteem

  • chronic relationship  problems

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