Depending on the age of the pregnancy, there are different types of abortions:
- Medical abortion (Medical Termination of Pregnancy, done during the first trimester)
- Vacuum aspiration (Done during the first trimester)
- Dilation and evacuation (D&E) (Done during second trimester)
- Labour induction (Rare but done during third trimester)
Statistics say that, around half of abortions across the world get terminated.
Medical abortion is done with two different medicines. Mifepristone and Misoprostol. Some doctors may advise you to take mifepristone first and then within a certain period you need to take misoprostol. Some other gynaecologists may advise you to take both at the same time. Mifepristone stops the growth of the foetus and misoprostol causes ‘induced miscarriage’ by cramping the uterus. As a result, the foetus falls off and the miscarriage looks like a heavy period with big blots of blood coming out.
This is a safer procedure that doesn’t involve any surgery or anaesthesia. However, in few cases, no miscarriage can happen or the bleeding may not stop even after few hours which may be a threat to life.
Read more about Abortion pill.
Vacuum aspiration of foetus
Vacuum is a minimally invasive procedure performed under local anaesthesia. This is done as a day care procedure. In short, the procedure is performed in the following steps:
- Antiseptic cream / lotion is applied to the outer parts around the vagina.
- A speculum is inserted into the vagina. It passes through the cervix creating a tunnel like entry to the uterus.
- Local anaesthesia is administered at specific points on the cervix.
- A cannula is then inserted into the uterus through the speculum. The length or numbering of the cannula is usually the same as the number of weeks of pregnancy.
- Then, with a vacuum creating device (that looks like a large syringe), the contents of the uterus are emptied.
- Once emptied, the cannula is removed and so is the speculum.
- A sterile pad is placed on the vagina to capture any bleeding.
You will be advised to monitor the blood flow from the vagina and report any abnormalities to your doctor. Vacuum aspiration procedure is performed if the pregnancy is under 12 weeks and if MTP doesn’t work.
Dilation & Evacuation (D&E) – a surgical abortion procedure
Dilation & evacuation procedure is performed when the pregnancy is between 13 – 24 weeks. (In India, if the pregnancy is over 20 weeks, you will need approval from two registered medical practitioners as per law.) During this time, the foetus can be between 3 inches to 8 inches in size, depending on the age of pregnancy.
24 to 48 hours before the procedure, a seaweed called laminaria is placed inside the cervix. Laminaria absorbs the moisture in the cervix and swells so that the cervix opens up to facilitate the removal of larger foetus. At the time of the procedure, a speculum is used to open up the vagina further and then metal dilators are used to further open the cervix.
A suction tube is then inserted into the cervix to remove the amniotic fluids first. Then a sopher clamp is used to remove the foetus. The sopher clamp holds the foetus and the foetus is removed in parts. Then a curette is used to scrape the lining of the uterus to remove the placenta.
Risks involved with D&E procedure
- Uterine perforation
- Cervical Laceration
- Infection of cervix and uterus
- Haemorrhage (and death in worst case)
Labour induction abortion
Less than 1% of the cases need this type of abortion. Labour induction abortion is performed in either 2nd or 3rd trimester of pregnancy. This type of abortion is done only when the doctor determines that your life is in danger.
This is like induced labour. Medicines to contract the uterus will be given, usually by mouth. Another option is to place the medicines into the vagina or inject them into the uterus. As the foetus would have grown considerably large in size, cramping is usually very severe and pain medication will be needed. This is not an out-patient procedure. You will have to get admitted to the hospital and stay for a couple of days.
Complications of labour induction abortion
- Cervical Injury
- Rupture of the uterus
- Incomplete abortion
If you plan to abort your pregnancy, don’t wait until it’s too late. Surgical procedures are often riskier than non-surgical methods. It’s ok if you take a week to decide but I would suggest you get the abortion done before the 12th week.