therapeutic abortion

Definition

Therapeutic abortion is the intentional termination of a pregnancy before the fetus can live independently. Abortion has been a legal procedure in the United States since 1973.

Description

Between five and seven weeks, a pregnancy can be ended by a procedure called menstrual extraction. This procedure is also sometimes called menstrual regulation, mini-suction, or preemptive abortion. The contents of the uterus are suctioned out through a thin (3-4 mm) plastic tube that is inserted through the undilated cervix. Suction is applied either by a bulb syringe or a small pump.

Another method is called the "morning after" pill, or emergency contraception. Basically, it involves taking high doses of birth control pills within 24 to 48 hours of having unprotected sex. The high doses of hormones causes the uterine lining to change so that it will not support a pregnancy. Thus, if the egg has been fertilized, it is simply expelled from the body.

There are two types of emergency contraception. One type is identical to ordinary birth control pills, and uses the hormones estrogen and progestin). This type is available with a prescription under the brand name Preven. But women can even use their regular birth control pills for emergency contraception, after they check with their doctor about the proper dose. About half of women who use birth control pills for emergency contraception get nauseated and 20 percent vomit. This method cuts the risk of pregnancy 75 percent.

The other type of morning-after pill contains only one hormone: progestin, and is available under the brand name Plan B. It is more effective than the first type with a lower risk of nausea and vomiting. It reduces the risk of pregnancy 89 percent.

Women should check with their physicians regarding the proper dose of pills to take, as it depends on the

brand of birth control pill. Not all birth control pills will work for emergency contraception.

Menstrual extractions are safe, but because the amount of fetal material is so small at this stage of development, it is easy to miss. This results in an incomplete abortion that means the pregnancy continues.

The first trimester of pregnancy includes the first 13 weeks after the last menstrual period. In the United States, about 90% of abortions are performed during this period. It is the safest time in which to have an abortion, and the time in which women have the most choice of how the procedure is performed.

MEDICAL ABORTIONS. Medical abortions are brought about by taking medications that end the pregnancy. The advantages of a first trimester medical abortion are:

• The procedure is non-invasive; no surgical instruments are used.
• Anesthesia is not required.
• Drugs are administered either orally or by injection.
• The procedure resembles a natural miscarriage.

Disadvantages of a medical abortion are:

• The effectiveness decreases after the seventh week.
• The procedure may require multiple visits to the doctor.
• Bleeding after the abortion lasts longer than after a surgical abortion.
• The woman may see the contents of her womb as it is expelled.

Two different medications can be used to bring about an abortion. Methotrexate (Rheumatrex) works by stopping fetal cells from dividing which causes the fetus to die.

On the first visit to the doctor, the woman receives an injection of methotrexate. On the second visit, about a week later, she is given misoprostol (Cytotec), an oxygenated unsaturated cyclic fatty acid responsible for various hormonal reactions such as muscle contraction (prostaglandin), that stimulates contractions of the uterus. Within two weeks, the woman will expel the contents of her uterus, ending the pregnancy. A followup visit to the doctor is necessary to assure that the abortion is complete.

With this procedure, a woman will feel cramping and may feel nauseated from the misoprostol. This combination of drugs is 90-96% effective in ending pregnancy.

Mifepristone (RU-486), which goes by the brand name Mifeprex, works by blocking the action of progesterone, a hormone needed for pregnancy to continue, then stimulates uterine contractions thus ending the pregnancy. It can be taken a much as 49 days after the first day of a woman's last period. On the first visit to the doctor, a woman takes a mifepristone pill. Two days later she returns and, if the miscarriage has not occurred, takes two misoprostol pills, which causes the uterus to contract. Five percent of women won't need to take misoprostol. After an observation period, she returns home.

Within four days, 90% of women have expelled the contents of their uterus and completed the abortion. Within 14 days, 95-97% of women have completed the abortion. A third follow-up visit to the doctor is necessary to confirm through observation or ultrasound that the procedure is complete. In the event that it is not, a surgical abortion is performed. Studies show that 4.5 to 8 percent of women need surgery or a blood transfusion after taking mifepristone, and the pregnancy persists in about 1 percent of women. In this case, surgical abortion is recommended because the fetus may be damanged. Side effects include nausea, vaginal bleeding and heavy cramping. The bleeding is typically heavier than a normal period and may last up to 16 days.

Mifepristone is not recommended for women with ectopic pregnancy, an IUD, who have been taking long-term steroidal therapy, have bleeding abnormalities or on blood-thinners such as Coumadin.

First trimester surgical abortions are performed using vacuum aspiration. The procedure is also called dilation and evacuation (D & E), suction dilation, vacuum curettage, or suction curettage.

Advantages of a vacuum aspiration abortion are:

• It is usually done as a one-day outpatient procedure.
• The procedure takes only 10-15 minutes.
• Bleeding after the abortion lasts five days or less.
• The woman does not see the products of her womb being removed.

Disadvantages include:

• The procedure is invasive; surgical instruments are used.
• Infection may occur.

During a vacuum aspiration, the woman's cervix is gradually dilated by expanding rods inserted into the cervical opening. Once dilated, a tube attached to a suction pump is inserted through the cervix and the contents of the uterus are suctioned out. The procedure is 97-99% effective. The amount of discomfort a woman feels varies considerably. Local anesthesia is often given to numb the cervix, but it does not mask uterine cramping. After a few hours of rest, the woman may return home.

Although it is better to have an abortion during the first trimester, some second trimester abortions may be inevitable. The results of genetic testing are often not available until 16 weeks. In addition, women, especially teens, may not have recognized the pregnancy or come to terms with it emotionally soon enough to have a first trimester abortion. Teens make up the largest group having second trimester abortions.

Some second trimester abortions are performed as a D & E. The procedures are similar to those used in the first trimester, but a larger suction tube must be used because more material must be removed. This increases the amount of cervical dilation necessary and increases the risk of the procedure. Many physicians are reluctant to perform a D & E this late in pregnancy, and for some women is it not a medically safe option.

The alternative to a D & E in the second trimester is an abortion by induced labor. Induced labor may require an overnight stay in a hospital. The day before the procedure, the woman visits the doctor for tests, and to either have rods inserted in her cervix to help dilate it or to receive medication that will soften the cervix and speed up labor.

On the day of the abortion, drugs, usually prostaglandins to induce contractions, and a salt water solution, are injected into the uterus. Contractions begin, and within eight to 72 hours the woman delivers the fetus.

Side effects of this procedure include nausea, vomiting, and diarrhea from the prostaglandins, and pain from uterine cramps. Anesthesia of the sort used in childbirth can be given to mask the pain. Many women are able to go home a few hours after the procedure.

Very early abortions cost between $200-$400. Later abortions cost more. The cost increases about $100 per week between the thirteenth and sixteenth week. Second trimester abortions are much more costly because they often involve more risk, more services, anesthesia, and sometimes a hospital stay. Insurance carriers and HMOs may or may not cover the procedure. Federal law prohibits federal funds including Medicaid funds, from being used to pay for an elective abortion.

— Debra Gordon

1. Any of various procedures resulting in the termination of a pregnancy by a qualified physician.
2. Any of various procedures resulting in the termination of a pregnancy in order to save the life or preserve the health of the mother.

Abortion induced because of the mother's physical or mental health, or to prevent the birth of a deformed child or of a child conceived as a result of rape or incest.

The noun has one meaning:

Meaning #1: a legally induced abortion for medical reasons (as when the mother's life is threatened)