The Women's Health Centre: Therapeutic Abortion

Medical Abortion

What is a medical abortion?

A medical abortion is an abortion, which is caused by injection of a drug rather than by a surgical suction procedure. Methotrexate has been found to be over 90% successful in causing an abortion when it is used in combination with a second drug called misoprostol. The misoprostol is given 5 to 7 days after the Methotrexate. Most methotrexate/misoprostol abortions happen within 1 week of receiving the misoprostol, but sometimes the passage of the pregnancy tissue can take weeks. To have this type of abortion you must be very early in your pregnancy (less than 49 days), generally healthy and be prepared to come to the clinic for at least 3 and up to 5 visits to the clinic.

Who is suitable to have a medical abortion?

It should be no more than 49 days since your last menstrual period, on the date of injection. You must be comfortable with your decision to terminate the pregnancy, in good general health, be able to fully understand the informed consent and be able to tolerate possible heavy bleeding, cramping and seeing the products of conception. You must be willing and able to avoid sex until the abortion is complete and must be willing to have a surgical abortion if the medical abortion is unsuccessful. You must have a telephone, be able to be contacted and have access to transportation in case of emergency.

Advantages and Disadvantages of medical abortion

Advantages

1. There is a greater than 90% chance of avoiding a surgical abortion.
2. The pregnancy can be terminated as soon as there is a positive pregnancy test. This is earlier than the usual surgical abortion.
3. Aborting the pregnancy at home provides more privacy in some cases.
4. Medical abortion does not use instruments inside the uterus so if it is successful, there is no chance of causing damage to the uterus.

Disadvantages

1. There is a 5-10% chance the treatment will not be effective or complete and a surgical procedure will be needed.
2. The abortion will take at least 1 week and may (very rarely) take as long as 5 weeks to complete.
3. Vaginal bleeding may be prolonged and heavy, rarely (less than 1%) requiring a surgical procedure (D&C) to completely empty the uterus.
4. Medication side effects (less than 10%) such as headaches, nausea, vomiting, sore mouth, dizziness or rash may occur.
5. The need for several clinic visits, blood tests and possibly ultrasounds.
6. Uncertainty about when the abortion will occur.

Surgical Abortion

A surgical abortion is provided after 8 weeks gestation due to the increased risk of missing the pregnancy were it done earlier. The procedure is done in two parts and, depending on the gestation, in one day. If the gestation period has been more than 13 weeks 6 days the procedure is done in two days.

Part 1

You will meet with the physician who will discuss your decision and have you sign the consent form. The doctor will also discuss birth control options and help you get established on the birth control you choose.

Following this discussion, the doctor will take your medical history and do a physical exam. During the physical exam, a pelvic exam will be done to confirm how long you have been pregnant and the position of your uterus. If you decide to proceed, a laminaria (a small stick of compressed seaweed) will be inserted into your cervix. Laminaria absorbs fluid from around it, which causes it to swell. This swelling softens the cervix and begins to open it. This makes the second part of the procedure easier to perform and reduces the risk of damage to the cervix.

Part 2

The pregnancy is removed by suction D&C (dilitation and curettage) which means removal of the uterine lining. It is done under local anesthetic (freezing in the cervix) with medications to make you feel relaxed and comfortable.

The physician freezes the cervix then dilates it to the diameter of the suction curette, which is only mms wide. Once the suction curette will fit through the cervix the suction is turned on. The physician will gently rotate it removing the tissue from the wall. The suction curette is removed and a metal curette is then used to ensure all tissue has been removed from the uterine wall. The uterus is then suctioned one more time. This part of the process takes 6 - 10 minutes, however you will be in the procedure room for about 15 minutes.

You will need to stay in the recovery room for one hour after the last dose of medication. As soon as you can walked unassisted, and are having no more than period like bleeding and cramping you will be discharged to go home.

Aftercare

You should experience period-like or no bleeding. If you are soaking a pad an hour, you need to contact your physician.

Watch for signs of infection such as a foul smelling discharge or high fever. If you experience this you need to contact your physician.