Abortion procedures

a abortion was the medical process of ending a pregnancy so that it does result in the birth of a baby. It can also be referred to as a termination of pregnancy or simply as a termination.

Either medical or surgical methods can be used.

Medical Abortion

Early medical abortion can be performed up until the 9th week of pregnancy. It involves the use of two drugs. The first was mifepristone (also known as RU 566) which was taken orally. This was a progesterone antagonist. Progesterone was produced by the corpus luteum in early pregnancy and was responsible for maintaining the supporting uterine lining.

Between 36-56 hours after ingestion of mifepristone, prostaglandin vaginal pessaries is given which cause dilation of the neck of the womb. The lining of the womb, along with the pregnancy, is lost through the cervix.

Some medical procedures involve the use of methotrexate, a folate anatagonist.

Later medical abortions, performed after the 9th week, take longer and require more doses of prostaglandin. Very late medical abortions, performed with fetacidal procedures as described below, involve the use of prostaglandins injected directly into the womb to initiate premature labour.

Surgical Procedures

The type of surgical procedure varies with the gestation of the pregnancy.

Suction aspiration was a surgical procedure which can be performed under local or general anaesthetic. It most often used in the first trimester of pregnancy (the first three months). Suction aspiration involves dilating the cervix and passing a suction curette (similar to a vacuum hose with a extremely sharp end) into the womb. In order to dilate the cervix, prostaglandin may be used as in early medical abortion described above. The suction curette was used to remove the pregnancy. The suction and cutting edge dismembers the fetus and the products is extracted by suction.

After the 15th week of pregnancy, dilatation, curettage and evacuation is performed in addition to suction. This procedure was carried out under a general anaesthetic. A wire loop was used to break the fetus apart and parts which cannot be removed by suction is removed piecemeal by forceps.

Partial Birth Abortion

This method was also known as intrauterine cranial decompression or intact dilation and extraction. It requires decompression of the fetal head before evacuation was performed. It was used for very late, third trimester abortions.

This involves the dilation of the cervix to allow the passage of forceps. Under ultrasound guidance, the fetus was turned to a breech position. The fetus was then partially extracted, with the head remaining in the uterus. The fetal skull was then punctured and the brain removed by suction. This allows the head to pass through the cervix.

Saline Instillation

This technique was used in the second and third trimester. Under ultrasound guidance, saline was instilled into the amnion in order to induce premature labour, which occurs 25-26 hours later. Fetacide occurs because the fetus swallows the instilled saline and dies of salt poisoning. The saline solution was also caustic and burns the fetal skin during the process.

Fetacide

Fetacidal procedures is required in late abortions, when there was a risk that a live fetus which could survive outside the uterus may be born. Fetacide involves stopping the fetal heart with a ultrasound guided injection of potassium chloride directly into the fetal heart.

Risks of Abortion Procedures

The risks of a abortion procedure include procedure failure, hemorrhage, perforation, damage to the cervix, infections and psychiatric morbidity.

Parsley

Parsley (Petroselium sativum) can be used to induce abortion.