Due to unfortunate circumstances, the joy of receiving the news of being pregnant may not be a part of the life of some women, who may decide not to go ahead with the pregnancy. In such cases, doctors assist them in termination of pregnancy either surgically or medically as per their choice. Every now and then, pregnancies get terminated naturally; this is referred to as miscarriage when it occurs in early pregnancy before the fetus is twenty weeks old, or as spontaneous abortion when it takes place at a later stage.
How Medical Abortion Works
In medical abortion, doctors administer the drugs commonly known as RU-486 or Mifepristone, which is a synthetic steroid hormone that terminates pregnancy. This method is safe in early pregnancy, that is, before the 8th week since the LMP (last menstrual period). The medical abortion process involves 2 drugs, namely Methotrexate and Misoprostol that work in 2 ways:
- The drug Methotrexate binds progesterone, a hormone that facilitates the thickening of lining in uterus and promotes cell growth. It also inhibits the production of folic acid which is required for the growth of embryo.
- Misoprostol forces the embryo out of uterus by causing contractions. The resulting bleeding can continue for nearly 13 days with the light bleeding lasting for weeks.
After the intake of the pills RU-486 and Misoprostol, the uterine lining breaks down due to inhibition of the hormone progesterone and woman begins to menstruate on the same day in about 80% of the cases. The combination of these drugs proves to be successful in more than 95% of cases.
In some cases, the drug Mifepristone itself proves sufficient in successfully terminating the pregnancy, in which case, the woman need not take Misoprostol, which causes side effects like pain, nausea and diarrhea. After 2 weeks, the health professional will confirm the termination through ultra sound scanning or blood sample to check the HCG (human chorionic gonadotropin) levels which go up during pregnancy, but come down to normal levels in case of successful termination of pregnancy.
When to Go for Surgical Abortion
Surgical abortion is often considered when the medical abortion does not work out properly. The other reasons to opt this can be like:
- the mother decides to go for termination of pregnancy after the 9th week
- there are serious health problems or complications for the mother or child needing immediate attention
- the amniocentesis test (that can be performed only after the 15th week) proves birth defects in the fetus
Surgical Abortion Methods
There are various methods of surgical abortion depending upon the stage of pregnancy:
Manual Aspiration: If the woman has been pregnant for less than 11 weeks, the medical practitioner may go for manual aspiration, a procedure in which the surgeon sucks the embryonic tissue from the uterus through a syringe.
Vacuum Aspiration: In vacuum aspiration, the cervix is anesthetized and expanded before inserting a hollow plastic suction tube to suck out the embryo from the uterus.
Dilation and Evacuation: For women who are in second semester of pregnancy, a procedure known as dilation and evacuation is followed. This lasts for 2 days. On day 1, a sterile fiber is inserted into the cervix to absorb moisture and expand it. Later, a suction instrument is used along with forceps to remove the embryo and clean the uterus.
Dilation and Extraction: If the woman prefers not to have the cervix dilated, then a procedure of dilation and extraction is adopted by the surgeons. In this procedure, the head of the embryo is disintegrated before being sucked out of the uterus though the small opening of the cervix.
Dilation and Curettage (D&C): This is an outdated procedure that is no longer followed. It was a harsh procedure wherein the wall of the uterus was scraped to remove placenta, uterine wall and embryo.