Elective Medical Abortion

Overview & Description

When a woman chooses to end apregnancy,the procedure is called an elective abortion. The fetus may be removed from theuterus by means of an elective surgical abortionor an elective medical abortion. A medical abortion is done by giving the womanmedicines that will end the pregnancy.

Who is a candidate for the procedure?

Any woman who chooses to end a pregnancy for health orpersonal reasons is a candidate for an elective abortion. Abortions arelegal in the United States during the first 12 weeks of pregnancy. After that,abortion is regulated by each state.

How is the procedure performed?

Before an abortion is done, a doctor will confirm that a woman ispregnant. The length of a pregnancy will be measured by noting the numberof days that have passed since the first day of her last menstrual period, known as theLMP. A medical abortion can be done as soon as the pregnancy is confirmed.Medical abortions do not work as well later in pregnancy, so they are notgenerally used past 7 weeks after LMP. After 7 weeks, anelective surgical abortioncan be used.

To prepare for an abortion, a pelvic exammight be done to confirm the size of the uterus. Lab studies will rule outanemia,determine the woman’s Rh factor,and screen for sexually transmitted diseases.The woman should be taught what to expect during and after the procedure,and psychological supportshould be given as needed. Medicines used for a medical abortion include:

  • methotrexate, a medicine approved by the Food and Drug Administration,called the FDA, for cancertreatment. Methotrexate is most often given as a shot, but it also can betaken by mouth. Methotrexate stops the fertilized egg from implanting inthe uterine lining during the first few weeks after conception.
  • mifepristone, known as RU-486, which was recently approved by the FDA formedical abortions. Mifepristone works by blocking the female hormoneprogesterone. As a result, the lining of the uterus breaks down and ispassed out of the uterus, along with the fetus, through the cervix.
  • misoprostol, which is taken a few days after the woman takes eithermethotrexate or mifepristone. Misoprostol is given by tablets that areeither swallowed or inserted into the vagina. It causes the uterus tocontract and expel the fetus through the vagina.
  • Preparation & Expectations

    What happens right after the procedure?

    A medical abortion can take from 3 days to 3 to 4 weeks.After the first medicine (methotrexate or mifepristone) is given for a medicalabortion, the woman can go home. Some women will have vaginal bleedingafter the first medicine. The bleeding can range from light to heavy.

    The woman will return to the doctor for a second visit to take themisoprostol. The uterine cramping caused by this medicine might result inthe embryo being expelled right away while at the doctor’s office. In othercases, the tissue is assed later at home. Many women will have crampsfor several hoursand pass blood clots as they are aborting. Most of these symptoms shouldstart to taper off after the embryo has been passed. Bleeding canlast for 1 or 2 weeks more. Headache, nausea, vomiting,and diarrheacan also be caused by misoprostol.

    Finally, a third visit will be made so that the doctor cancheck to be sure that the abortion was complete. Of the women who takemethotrexate, 80% to 85% will abort within 2 weeks. A woman who takeslonger may need more misoprostol. With mifepristone, 95% to 97% of thewomen will expel the uterine contents within 2 weeks. About 5% of thewomen who choose to have an elective medical abortion require a surgicalabortion because the medicine does not work.

    After any abortion, a woman with Rh negativeblood should be given an injection of Rh immune globulin unless the fatheris also known to have Rh negative blood. Pain medicinesmay also be prescribed. Sometimes antibiotics are needed to help preventinfection.

    Home Care and Complications

    What happens later at home?

    Once she’s home, a woman should:

  • call the doctor if there are any new or worsening symptoms, such asfever,severe or lasting abdominal distress,or heavy vaginal bleeding
  • be aware of the possible emotional effects of abortion.Some women have depressionsimilar to postpartum depressionafter an abortion.
  • avoid using tampons or having sex for at least 2 weeks
  • slowly resume daily activity as she is able
  • If a woman has no problems after the abortion, it is likely thatshe will be able to get pregnant again later. A follow-up visit with a doctorshould include a pelvic examto be sure the uterus shrinks in size. This office visit is also a good timefor a woman and her doctor to discuss birth control,so she can choose a method that will work well for her.

    What are the potential complications after the procedure?

    Any type of abortion can cause heavy bleeding that might requirea D&Cor blood transfusion.Long-term complications have not been linked with the medicines usedfor medical abortion.

    Article type: xmedgeneral