Abortion

The word abortion derives from the Latin aboriri, meaning to miscarry. Abortion is
defined as the spontaneous or induced termination of pregnancy before fetal
viability.

According to WHO, abortion is also defined as pregnancy termination before 20

weeks of gestation or with a fetus born weighing less than 500 grams.

Abortion Terms
1. Spontaneous Abortion This category includes threatened, inevitable,
incomplete, complete, and missed abortion
2. Septic Abortion Spontaneous abortion further complicated by infection
3. Recurrent Abortion Women with repetitive spontaneous abortion so that an
underlying factor can be treated to achieve a viable newborn.
4. Induced Abortion Surgical or medical termination of a live fetus that has
not reached viability

Induced abortion are further classified to

a. Therapeutic Abortion
Several medical and surgical disorders that are indication for
termination of pregnancy. e.g persistent cardiac decompensation,
hypertension, malignancy, et cetera.
Rape or Incest
Prevent fetus birth with a significant anatomical, metabolical, or
mental deformity.

b. Elective or Voluntary Abortion

Termination or Interruption of pregnancy before viability at the request
of the woman, but not for medical reasons.

Procedures
FIRST TRIMESTER
1. Surgical
Dilatation and curettage
Vacuum aspiration
Menstrual aspiration

2. Medical
Prostaglandins E2
, F2, E1, andanalogues
Vaginal insertion
Parenteral injection
Oral ingestion
Sublingual
AntiprogesteronesRU-486 (mifepristone) and epostane
Methotrexateintramuscular and oral
Various combinations of the above

1. Surgical Abortion
Surgical pregnancy termination includes a transvaginal approach through an
appropriately dilated cervix or, rarely, laparotomy with either hysterotomy or
hysterectomy.

2. Dilatation and Curretage

Transcervical approaches to surgical abortion require first dilating the cervix
andthen evacuating the pregnancy by mechanically scraping out the contents
sharp curettage, by suctioning out the contentssuction curettage, or both.

Curettageeither sharp or suctionis recommended for gestations 15 weeks.

Complication rates increase after the first trimester. Perforation, cervical laceration,
hemorrhage, incomplete removal of the fetus or placenta, and postoperative
infections are among these.

3. Dilatation and Evacuation

Beginning at 16 weeks, fetal size and structure dictate use of this technique. Wide
mechanical cervical dilatation, achieved with metal or hygroscopic dilators,
precedes mechanical destruction and evacuation of fetal parts. With complete
removal of the Fetus, a large-bore vacuum curette is used to remove the placenta
and remaining tissue. This is better accomplished using intraoperative sonographic
imaging.

4. Dilatation and Extraction

This is similar to dilatation and evacuation except that a suction cannula is used to
evacuate the intracranial contents after delivery of the fetal body through the
dilated cervix.

5. Menstrual Aspiration
This is done within 1 to 3 weeks after a missed menstrual period and with a positive
serum or urine pregnancy test result.

6. Manual Vacuum Aspiration

This procedure is similar to menstrual aspiration but is used for early pregnancy
failures or elective termination up to 12 weeks.

Medical Abortion
According to the American College of Obstetricians and Gynecologists (2011c),
outpatient medical abortion is an acceptable alternative to surgical pregnancy
termination in appropriately selected pregnant women less than 49 days menstrual
age
Antiprogestin Mifepristone
Antimetabolite Methotrexate
Prostaglandin Misoprostol
Mifepristone and methotrexate increase uterine contractility by reversing
progesterone induced inhibition, whereas misoprostol directly stimulates the
myometrium.

SECOND TRIMESTER

Consequences of Elective Abortion

Maternal Mortality
Because they are common, regulated, and reportable, most abortion statistics are
for elective procedures. Even so, abor tion-related deaths are likely under reported
(Horon, 2005). With this caveat in mind, legally induced abortion, performed by
trained gynecologists during the first 2 months of pregnancy, has a mortality rate of
less than 1 per 100,000 procedures (Pazol, 2011). In a report from Finland
comprising nearly 43,000 abortions performed before 63 days, only one procedurerelated death was documented (Niinimaki, 2009). Early abortions are even safer,
and the relative mortality risk of abortion approximately doubles for each 2 weeks
after 8 weeks gestation. The Centers for Disease Control and Prevention identified
12 abortion-related deaths in the United States in 2008 (Pazol, 2012). As
emphasized by Raymond and Grimes (2012), mortality rates are 14-fold greater for
pregnancies that are continued.
Health and Future Pregnancies

Data relating abortion to overall maternal health and to subsequent pregnancy

outcome are limited. From studies, there is no evidence for excessive mental
disorders (Munk-Olsen, 2011; Steinberg, 2014). There are few data regarding
subsequent reproductive health, although the rates of infertility or ectopic
pregnancy are not increased. There may be exceptions if there are postabortal
infections, especially those caused by chlamydiae. Also, other data suggest that
some adverse pregnancy outcomes are more common in women who have had an
induced abortion (Maconochie, 2007). Specifically, several studies note an
approximate 1.5-fold increased incidence of preterm delivery22 to 32 weeks
(Hardy, 2013; Moreau, 2005; Swingle, 2009). Multiple sharp curettage procedures
may increase the subsequent risk of placenta previa, whereas vacuum aspiration
procedures likely do not (Johnson, 2003). It appears that subsequent pregnancy
outcomes are similar regardless of whether a prior induced abortion was completed
medically or surgically. In a report of 30,349 procedures from the Danish Abortion
Registry, there were 16,883 women who had subsequent pregnancy (Virk, 2007).
Rates of ectopic pregnancy, miscarriage, and preterm delivery were not significantly
different in those with prior surgical abortion or previous medical termination.