Abortion

Once you’ve got the confirmation of pregnancy and your health care provider very well knows how many weeks along the pregnancy is and you’re to terminate then the method provided typically reflects your stage of gestation. Medical/surgically early abortions can be done successfully.  Most of the facilities don’t have the established protocols/personnel with technical ability to provide medical abortions.  And hence abortions are done surgically.

Preoperative care

•    In order to undergo abortion women travel afar and finishing the preoperative preparation make them feel comfortable in a short office visit. Waiting periods are needed in some states by the law in such case it can be done in stages.
•    A targeted history, physical examination, laboratory work, and ultrasound is involved by the assessment process which is followed by a counseling session.
•    Preparation of second-trimester is quite tough. It’s not possible to prepare the cervix before 24 hours but the fundamental assessment method is alike.
•    In order to examine for apparent problems with fetus ultrasound examinations can be used.
•    Intra-amniotic injection of the drug digoxin is provided by certain center which ends up the heart activity in fetus prior to a second trimester abortion.
Medical abortion
•    First- and second-trimester medical abortion

o    Through Misoprostol alone, methotrexate-Misoprostol combination regimens or Mifeprex (RU-486) with/without Misoprostol first-trimester i.e. first three months of pregnancy terminations is achieved. In other countries other prostaglandins are used.
o    Medical abortion is indicated for those people who consent to a medical abortion but also ready for surgical abortion in case the abortion fails. Less than 42-49 days is the gestational stage but a lot of protocols may be used which also comprises 62days from menstrual period.

o    The Mifeprex/Misoprostol drugs are given as follows:

•     On the first day Mifeprex is taken as a pill (600 mg) at the doctor’s office.
•     On the third day Misoprostol is taken as pill/inserted vaginally at home and should be at observation for four hours.
•     In order to know whether abortion has been completed you got return to the office between days of 12 and 20.
•     You can go for surgical abortion or can give a repetitive dose of Misoprostol.

o    The methotrexate/Misoprostol regimen is alike, as follows:

•     On day 1 Methotrexate is injected.
•     At home Misoprostol is taken vaginally on 6-7 day and on day 8 go to office in order to find if abortion has taken place/not. By monitoring Misoprostol can be done again/surgical abortion can be finished.

•    Prostaglandin-induced second-trimester abortion- Vaginally, orally/injected into fetus medicine can be induced.
•    Saline-induced abortion: The method which consumes long time and this method was followed 20 years ago which is not performed frequently though it’s safe.

Surgical abortion

•    Cervical dilatation and preparation

o    For the first trimester termination especially the period between less than
10 weeks gestation, you do not need to have the cervix dilated. You might’ve a small sterilized stick known as laminaria japonica in case you’re in the latter part of first trimester which is been placed in your cervix. This may be placed all over the night and its useful for four hours.
o    A sterilizing solution through Betadine cervix is prepared before inserting a stick. An injection of anesthetizing can be given into the cervix and it’s the start in the method of abortion. Prior to begin the dilatation process its important to note that you understand all the risks and all those must’ve elucidated in the counseling.

•    Sedation during abortion

o    As each step is explained by the doctor most of the women get coached through an abortion. Numbing is preferred by some women in their cervix and most don’t need any IV sedation.
o    IV fluids will be used incase huge sedation is opted.

•    First-trimester surgical abortion

o    Through cervical dilatation early abortions are done and using a hand held syringe/small bore cannula, a tube which is attached to a suction machine. A manual aspiration means abortions done with syringe. Vacuum aspirator produces those which are done with suction and these are referred to as a vacuum aspiration. Both the methods consume less amount of time.
o    In order to grab the cervix tools are used after preparation with Betadine and probably insensate. Through the cervix the cannula is inserted into your uterus. By applying suction to the syringe/via the machine the actual discharge is done and in order to complete this method consumes few minutes. There will be loss of small amount of blood.
o    In order to make sure that all has been emptied, your health care provider will check the tissue.

•    Dilatation and curettage (D&C)

o    This is a treatment of incomplete abortion/ particularly it’s a term i.e. normally applied to diagnostic method.
o    Though uterus is emptied with a sharp metal curette, this method is achieved with same kind of dilatation method. Than the flexible/rigid plastic devices, curettes are more dangerous which being used in suction methods and they’re not suggested for abortion procedures.

•    Second-trimester dilatation and evacuation

o    The safest method which is very usual method of second-trimester termination is dilatation and evacuation which is used by experienced doctors. This dilation consumes more number of hours and probably even days through sticks in order to enlarge the cervix.
o    The procedure is achieved once the cervix becomes widen by using a combination of suction curettage and manual discharge of fetus and placenta. In order to guide the tools ultra sound can be used.
o    Than the first-trimester method, the method is more not comfortable and is of long duration. With local anesthesia most of the women can undergo it without any trouble.

•    Dilatation and extraction

o    By cervical preparation this method is achieved which is alike to the cases of dilatation and evacuation but the fetus is taken out in an intact condition. After the contents are discharged the fetal head is collapsed so that it passes through the cervix.
o    This method is done by only some providers and for cases of maternal medical complications/serious medical problems with fetus it’s normally reserved.
o    Intact dilatation and extraction is similar to the procedure and by abortion opponents it has also been called as partial-birth abortion.

•    Induction of labor

o    Standard drugs used to bring labor for birth are experienced with most of the doctors and in the second trimester of pregnancy these can be used.
o    For this method premature rupture of membranes is one indication.