First Trimester Abortion (Up to 13 weeks)

RU486, Mifepristone

Otherwise known as the “abortion pill.” RU-486 can be prescribed for women who are within 70 days of their LMP. The process of taking this medication usually requires three office visits. After the initial consultation, the RU486 or mifepristone pills are given to the woman. She returns two days later for a second medication called misoprostol. In short, the combination of these medications causes the uterus to expel the fetus.

Risks and Considerations for the Abortion Pill

  • With the pill, the abortion takes place at home under no medical supervision.
  • You will take a single oral dose (3 pills or 600 mg) of Mifepristone. This pill blocks progesterone so the lining of the uterus breaks down and the pregnancy cannot continue to grow.
  • If the abortion does not occur within 2 days, you will need to return to the clinic and take another drug called Misoprostol. This pill induces contractions causing the uterus to empty and expel the fetus. In most cases (95%), these contractions begin within 1–4 hours and the fetus, tissue, and blood will pass vaginally within 24 hours.
  • Heavy cramping and bleeding will occur after taking the second pill
    • Some women will pass really large clots (sometimes as large as the size of a lemon)
  • About half of women will abort within 4 or 5 hours after taking the second pill. For some women it may take longer, even days.
    • It is important to have a follow up exam about 12 days later to ensure that you are no longer pregnant and that there is no fetal tissue remaining that can cause a life-threatening infection
  • Spotting to heavy bleeding can last up to 4 weeks after the abortion
  • Nausea, vomiting, diarrhea, weakness or dizziness is common after taking the second pill (misoprostol). If these symptoms last longer than 24 hours, they can indicate very serious medical problems. Seek immediate medical attention by going to the nearest emergency room.
  • There is a 3-8% chance the abortion will fail.
    • A surgical abortion is usually performed to complete a failed medical abortion.

Aspiration

During the aspiration procedure, the physician dilates (opens) the cervix (the opening to the uterus) with a series of metal dilators (starting will smaller ones first and then progressing to larger ones). Or, the physician may choose to use the laminaria (a porous material which expands with moisture in order to open and soften the cervix) to dilate you. The laminaria are usually placed in the cervix 1-2 days before the abortion procedure is scheduled. During the abortion, the doctor attaches tubing to a suction machine and inserts the tubing into the uterus. The suction created by the vacuum pulls the fetus apart and detaches the placenta from the wall of the uterus. The fetal parts and placenta are collected in a suction container and then discarded.

Risks and Considerations for Aspiration Abortion

  • During the procedure your cervix is widened. The metal rods often used to manually dilate your cervix can cause damage. The cervix may be cut, torn, or damaged, which can cause excessive bleeding that requires surgical repair. Cervical damage can increase a women’s risk of miscarriages and premature deliveries in future pregnancies and risk of infertility.
  • Most women experience some pain that will require a pain-killer either by local shots in the area of the cervix or, on rare occasions, by general anesthesia.
    • Complications from general anesthesia used during abortion surgery may result in convulsions, heart attack, and in extreme cases, death. It also increases the risk of other serious complications.
  • After dilation, a small plastic tube is then inserted into the uterus through the enlarged cervix. The tube is attached to a pump which then suctions out the fetus, the placenta, and other uterine contents. After the suctioning, the physician may need to use a curette (a sharp, spoon-like instrument) to gently scrape the walls of the uterus to make sure all the fragments of the fetus and placenta have been removed from the uterus.
    • Scarring of the uterine lining can occur by the abortion instruments that may result in miscarriages in consecutive future pregnancies and possible infertility.
    • There is a risk that the uterus and nearby organs (like the bladder) may be punctured or torn by the abortion instruments. Perforation of the uterus may result in surgery that could include removal of the uterus (hysterectomy).
  • Complications resulting in a damaged cervix and perforated uterus are rare but be sure to contact your doctor if you have any of the following symptoms:
    • Heavy or prolonged bleeding or blood clots
    • Fever
    • Pain
    • Abdominal Tenderness
    • Foul-smelling discharge from the vagina

Dilation and Curettage (D&C or sharp curettage)

This method is not common since it is considered less safe than suction curettage. The cervix (the opening to the uterus or womb) is dilated and a curette, or loop-shaped tube, is inserted into the uterus to pull the fetus body apart and detach the placenta from the wall of the uterus. All body parts and membranes are then scraped out of the mother’s body.

Risks and Considerations for D&C

  • During the procedure your cervix is widened. The metal rods often used to manually dilate your cervix can cause damage. The cervix may be cut, torn, or damaged, which can cause excessive bleeding that requires surgical repair. Cervical damage can increase a women’s risk of miscarriages and premature deliveries in future pregnancies and risk of infertility.
  • After your cervix is widened your uterus is gently scraped out using a long, spoon-shaped instrument (curette). This is to make sure all the fragments of the fetus and placenta have been removed from the uterus.
    • There is a risk that the D&C results in development of scar tissue in the uterus, a rare condition known as Asherman's syndrome. Asherman's syndrome happens most often when the D&C is done after a miscarriage or delivery. This can lead to abnormal, absent or painful menstrual cycles, future miscarriages and infertility.
    • There is a risk that the uterus and nearby organs (like the bladder) may be punctured or torn by the abortion instruments. Perforation of the uterus may result in surgery that could include removal of the uterus (hysterectomy).
  • Complications resulting in a damaged cervix and perforated uterus are rare but be sure to contact your doctor if you have any of the following symptoms:
    • Heavy or prolonged bleeding or blood clots
    • Fever
    • Pain
    • Abdominal Tenderness
    • Foul-smelling discharge from the vagina

What are the risks of 1st Trimester Abortions?

  • Infection, local and systemic (sepsis).
  • Hemorrhage and shock, especially if the uterine artery is torn.
  • Retained tissue, indicated by cramping, heavy bleeding, and infection.
  • Post-abortal syndrome, referring to an enlarged, tender, and soft uterus that retains blood clots.
  • Cervical tearing and laceration from the abortion instruments.
  • Perforation of the uterus by abortion instruments. May require major surgery, including hysterectomy.
  • Scarring of the uterine lining from suction curettes, and other instruments.
  • Failure to recognize an ectopic pregnancy, as chemical and surgical abortions do not affect an ectopic pregnancy. This could lead to the rupture of a fallopian tube and heavy bleeding. An undiagnosed ectopic pregnancy can result in infertility or death, if treatment is not provided in a timely manner.
  • Complications from anesthesia, the same as undergoing anesthesia for any other procedure.