• Camelia Brande

What is abortion?

In support of what is currently happening in Poland and in other countries, where abortion is not legal or restrictive, we stand by them and share knowledge about what abortion is, why it is necessary to be legal and the consequences of banning it.

In November we will look closely into abortion, starting today with explaining what abortion is and the types of methods in use.


First of all, we want to remind everyone that abortion is a human right and and every individual has the right to decide on the number and timing of their children, has the right to information about abortion and contraception and has the right to receive medical care before, during and after the abortion process.


Abortion represents the voluntarily ending of a pregnancy by removal or expulsion of an embryo or fetus. Abortion can be performed based on the following reasons:

  • On request (gestational age limit is different by country): malformations, rape, incest, out of personal choice

  • To save the woman’s life

  • To preserve the woman’s mental health

  • Broad social or economic grounds


How do I prepare for an abortion?


Pre-abortion care

Before the procedure of abortion can happen the patient undergoes pre-abortion care


1. Abortion counseling: patients need to be informed about every aspect before undergoing the procedure in a caring, non-judgemental and confidential way

  • Pregnancy options: abortion, giving birth and keeping the baby, giving birth and giving the baby to adoption

  • Abortion methods: medical or surgical

  • Risks and benefits for each method and for abortion in general

  • Emotional needs, coping abilities after the procedure is finished

  • Contraceptive options

  • After the counseling the patient needs to be able to provide voluntary informed consent

2. Medical evaluation of the pregnancy

  • Confirming the presence of a pregnancy through a urine test by analyzing the levels of beta human chorionic gonadotropin (𝛽hCG). High levels of 𝛽hCG are presented when an egg is fertilized and starts developing into an embryo and later into a fetus. Curios about the developmental process of a fetus and its size can be compared to various fruits? Check our previous articles!

  • Determination of gestational age. Each country has a different upper limit of gestational age where it is safe and legal to perform an abortion. The age of pregnancy can be determined through medical history (last period), gynecological examination (a pelvic examination can be up to 98% accurate if performed by an experienced physician), ultrasound (standard measure for determining the pregnancy location and gestational age)

  • Determination of 𝛽hCG levels. Levels of 𝛽hCG<5000 IU/I mean that pregnancy is less than 6 weeks

  • In case of finding an ectopic pregnancy or molar pregnancy (abnormal pregnancy where a fertilized egg develops into a mass and not into a viable fetus), the medical abortion (MA) is contraindicated as it has higher risks. Don’t know what an ectopic pregnancy is? We have a dedicated article for this topic!


What is Medical Abortion (MA)?

  • Medical abortion (MA) represents the process of voluntarily interrupting a pregnancy through the administration of one or more medications

  • MA is irreversible and it is recommended for pregnancy termination up to 12 weeks

  • The following medication is used for inducing abortion: Misoprostol, Mifepristone and Methotrexate, both in combination and/or used alone

  • Misoprostol is a synthetic substance derived from natural Prostaglandins. Misoprostol induces uterine contractions and dilation of the cervix, therefore facilitating the expulsion of tissue

  • Mifepristone is an anti-progesterone, therefore it blocks the functions of progesterone in maintaining the pregnancy. Mifepristone modifies the healthy structure of the uterine lining and dilates the cervix, hence facilitating the expulsion of tissue

  • Methotrexate inhibits the cell multiplication process, consequently inverting the pregnancy development. Methotrexate is highly teratogen (produces birth defects in newborns) and is recommended to be used only when Misoprostol or Mifepristone are not available.

  • In case of an incomplete pregnancy termination, surgical evacuation of remaining parts of the fetus may be required

  • Medical abortion increases access in areas where surgical services are not easily accessible due to cost or availability

  • Contraindications for MA: suspected or confirmed ectopic pregnancy, having an IUD (intrauterine device for contraception), liver and kidney disease or other conditions that may be affected by the use of these drugs, uncertainty on the decision to abort, unwillingness to abstain from intercourse and alcohol until the complete termination of pregnancy. In these cases, surgical abortion is more suitable.


What are the side effects of Medical Abortion (MA)?

  • Bleeding: it starts a few hours after the administration of medication; along blood, tissue can pass as well. It is normal for the bleeding to be heavier than a regular period and can produce dizziness or a higher heart beat rate.

  • Pain: cramps and pain are expected to happen, especially in the moment of pregnancy expulsion. Studies show that older women or ones that had previous deliveries experience less pain. Pain relieving drugs such as ibuprofen of naproxen can be used. If the pain is severe, the patient can ask for a consultation, as it may be a sign of infection or the pregnancy is not fully expelled.

  • Prostaglandin effects: Prostaglandins are substances released during menstruation, resulting from the e uterine lining being destroyed. In case of an abortion the same process happens, and these prostaglandings can cause nausea, vomiting, diarrhea, dizziness, chills or fever.

  • When having the option of choice, more than 80% of women prefer MA as it offers privacy and commodity (it can be done at home), while also avoiding surgery and anesthesia side effects and pain.

  • Some women do not choose the MA method because of the higher number of check up visits, the idea of swallowing pills and the possible side effects of the medication.


What is Surgical Abortion (SA)?

  • Termination of pregnancy through surgery by vacuum aspiration was the standard method of abortion in the 1960s. After discovering the role of mifepristone in abortion in the 1980s, the MA has become a more accessible method for ending pregnancies.

  • SA is a very safe procedure, especially when performed in the first trimester, up to 12-14 weeks

  • It can be performed under local or total anesthesia, local anesthesia is preferred as the patient recovers faster and may have less complications

  • SA can be done through multiple methods: vacuum aspiration or dilation and curettage (D&C)

  • Vacuum aspiration SA has less complications than the curettage SA

  • Before starting any of the surgical methods mentioned, the patient receives medication, such as Misoprostol in order to dilate the cervix

  • Vacuum aspiration: after the cervix is dilated, a thin tube is inserted through the vagina and cervix into the uterus. The tube is connected to a sources of suction on the exterior, either an electric pump (electric vacuum aspiration) or a handheld syringe (manual vacuum aspiration)

  • Dilation and curettage: this procedure involves the dilation of the cervix and introducing a curette into the cervix, an instrument that the physician uses for removing uterine tissue

  • This methods can be used as a stand alone abortion method, or after an incomplete medical abortion


What are the Side effects of Surgical Abortion (SA)?

  • Side effects of anesthesia: nausea, vomiting, dizziness, sleepiness

  • Bleeding: less than in MA

  • Cramps and pain

  • Cervical tears or uterine perforation

Which is better: medical or surgical abortion? Here you can see better the main differences between them.


I had an abortion. What's next? Post-abortion care.


Post-abortion care for MA and SA

  • After the procedure is done, patients must go to the clinic for a follow up after one week or two. This is necessary in order to confirm the complete termination of the pregnancy through clinical history, gynecological consult, ultrasound and determination of 𝛽hCG levels

  • In case of an incomplete termination, where products of conception are still retained in the uterus, the physician can recommend another round of MA or surgical abortion (SA) through aspiration

  • Post-abortion infections can happen, such as endometritis (inflammation of the uterine inner lining) or genital tract infections

  • Toxic shock syndrome can sometimes occur but is more associated with MA than with SA. Toxic shock syndrome is not common only in MA. It can appear due to internal tampons, vaginal delivery or caesarean section. Curious to learn more about Toxic Shock syndrome? Check our previous article about TTS!

  • After the MA is complete the ovulation is restored very soon, therefore it is important to think about the suitable contraceptive method. After an abortion, if there are no contraindications, all types of hormonal contraceptives methods can be used. (Curious about hormonal contraceptives? We have an article for that!)

  • Some women may need emotional counseling after an abortion. Physicians can support patients by offering a safe and non-judgemental environment, coping advice and normalizing common reactions to abortion


Remember that abortion is a human right and the woman in question has the right to decide for her future. When deciding to have an abortion, always go to the doctor and make a decision after you have all the information. It is very important to reach out to healthcare facilities in order to have a safe abortion.


Be smart. Be (c)LIT. Fly with us!🌺🐝


Sources:

https://www.jogc.com/article/S1701-2163(16)00043-8/pdf

https://www.sciencedirect.com/science/article/pii/S1521693410000210

https://www.ourbodiesourselves.org/book-excerpts/health-article/vacuum-aspiration-abortion/

https://reproductiverights.org/worldabortionlaws

https://www.who.int/health-topics/abortion#tab=tab_1



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