Methods of Termination

Generally, there are 2 kinds of abortion:
- Surgical abortion: abortion where the fetus is actually physically removed
- Medical abortion: abortion induced through the use of medicines

Medical Abortion

Pros:- Procedure is less invasive
- No anesthetics required
- Faster than surgical abortion

Cons:- Usually require 2 visits
- 95% success rate

Medical abortion requires 2 stages. The 1st stage requires the use of a drug to stop the development of the embryo and the 2nd stage requires the use of a drug to help expel the embryo from the mother's body.

2 drugs can be used to stop the development of the embryo.

Methotrexate: Can be used effectively up to 5 weeks of gestation.
- Methotrexate (cytotoxic) is given by injection.
- Works by preventing cells in the embryo from dividing, thereby not allowing the embryo to develop into a fetus.
- Side effects are: Diarrhea, Hot flushes, Mouth sores, Nausea, Abdominal pain.

RU-486 (Also known as Mifepristone): can be used effectively up to 7 weeks of gestation.
- Mifepristone (anti-progesterone) is given by injection.
- Binds to wall of uterus, blocking progesterone hormone. Progesterone works by widening the uterus so that the embryo is not pushed & provides a nutrition source to the embryo. Therefore, the embryo is pushed out of place by the tightening uterus & isn't nourished. The uterine wall is shed.
- Side effects are: Wide variety of mild symptoms.

After the use of either of the above said drugs, another drug is used to help release the dead embryo.

Misoprostol: Taken after 5-7 days after Methotrexate or 1-2 days after Mifepristone.
- Misoprostol (prostagladin) is inserted into the vagina.
- Causes the cervix to widen, allowing the embryo to be released more easily.
- Side effects are: Vomitting, Abdominal pain, Diarrhea, Nausea, Fever & Chills, Dizziness.

Medical abortions have a 95% success rate (i.e. 1 in 20 attempt fails). Failed attempted are re-attempted and if it is still unsuccessful, then a surgical abortion (Dilation & Curettage) is performed.

If the mother refuses to go through with the surgical abortion & decides to go through with the pregnancy, the delivered baby will almost certainly be born deformed because of the effects of the drugs.

Surgical Abortion

There are different options of surgical abortions which are dependant on the stage of pregnancy.

1st Trimester

Manual Vacuum Aspiration (3-6 weeks)
- The earliest form of surgical abortion.
- Vagina & cervix are cleaned with an antiseptic solution.
- Local or general anesthetic is applied.
- A small instrument is used to dilate the cervix.
- A handheld syringe is inserted into the uterus & uterine tissue including the embryo is sucked out into the syringe. Cramping may occur.
- A spatula-like tool is used to scrape the inside of the uterus to ensure that the entire embryo is removed.

Machine Vacuum Aspiration (3-6 weeks)
- It is basically the same procedure as the manual vacuum aspiration but is done with a machine instead of a syringe.

Side effects are: Irregular bleeding, Cramps.

Risks are: 0.5% rate of infection, Bleeding, Loss of muscle use of the cervix.

2nd Trimester

Dilation & Extraction (13-22 weeks)
- A clamp or forceps is inserted into the vagina & into the uterus.
- The fetus is flipped upside down & into the breech position.
- Clamps are used to pluck out the fetus' body, leaving the head behind.
- The brain is sucked out with a tube, thus crushed the skull which is then removed.
- Any remains are sucked out with a tube.

Risks are: Blood clots, Heavy bleeding, Infection, Cut/Torn uterus, Incomplete abortion (Not all remains were removed).

Dilation & Evacuation (13-22 weeks)
- It is basically the same procedure as the Dilation & Extration except that the fetus is not flipped into the breech position.
- The clamps are used to rip out random parts of the fetus's body.
- The head is crushed and removed with the clamps, instead of being sucked out.

3rd Trimester

Hysterotomy
- Similar to a Caesarean section.
- An incision in the abdomen & uterus to removed to fetus.

Risks are: Blood clots, Much more dangerous, Baby able to feel pain.

Saline (18-30 weeks)
- Salt-water mixture is placed in a needle & inserted through the women's abdomen.
- The liquid surrounds the fetus and the fetus swallows the liquid which results in the burning of their skin.
- The mother delivers the dead or dying baby.

Risks are: Uterus blood clot, Infection, Heavy bleeding.