Methods for Induced Abortion

Abstract

We describe present methods for induced abortion used in the United States. The most common procedure is first-trimester vacuum curettage. Analgesia is usually provided with a paracervical block and is not completely effective. Pretreatment with nonsteroidal analgesics and conscious sedation augment analgesia but only to a modest extent. Cervical dilation is accomplished with conventional tapered dilators, hygroscopic dilators, or misoprostol. Manual vacuum curettage is as safe and effective as the electric uterine aspirator for procedures through 10 weeks of gestation. Common complications and their management are presented. Early abortion with mifepristone/misoprostol combinations is replacing some surgical abortions. Two mifepristone/misoprostol regimens are used. The rare serious complications of medical abortion are described. Twelve percent of abortions are performed in the second trimester, the majority of these by dilation and evacuation (D&E) after laminaria dilation of the cervix. Uterine evacuation is accomplished with heavy ovum forceps augmented by 14-16 mm vacuum cannula systems. Cervical injection of dilute vasopressin reduces blood loss. Operative ultrasonography is reported to reduce perforation risk of D&E. Dilation and evacuation procedures have evolved to include intact D&E and combination methods for more advanced gestations. Vaginal misoprostol is as effective as dinoprostone for second-trimester labor-induction abortion and appears to be replacing older methods. Mifepristone/misoprostol combinations appear more effective than misoprostol alone. Uterine rupture has been reported in women with uterine scars with misoprostol abortion in the second trimester. Fetal intracardiac injection to reduce multiple pregnancies or selectively abort an anomalous twin is accepted therapy. Outcomes for the remaining pregnancy have improved with experience.

Who Seeks Abortions at or After 20 Weeks?

“…Some women had trouble finding a place to go. This was especially the case for women seeking later abortions, because later procedures are less commonly available; 38% of these women reported delay for this reason, compared with 18% of those seeking first‐trimester procedures. Women seeking later abortions called an average of 2.2 abortion facilities before they found the one that was able to perform their procedure, while women seeking a first‐trimester abortion contacted an average of 1.7 facilities (not shown).…”

Treatment of early pregnancy failure: does induced abortion training affect later practices?

“…11 Many studies demonstrated that misoprostol and office uterine evacuation can safely evacuate a uterus in the context of induced abortion. 12 Although some providers may be reluctant to apply this research to EPF, studies have demonstrated these treatment options are safe, effective, and acceptable among women experiencing EPF. 4–8 Still, EPF treatment in the United States seems to be dominated by expectant management and operating room-based uterine evacuation.…”

Concealing emotions: nurses' experiences with induced abortion care

“…The methods for late‐term abortion (i.e., during the second and third trimesters) include dilation and evacuation (D & E), systemic medication, intra‐ or extra‐amniotic abortifacients and hysterectomy (Stubblefield et al . , Lin et al . , , Lipp ).…”