The Facts of Life: Examining Reproductive Health

Abortion

Aspiration Abortion
Aspiration is the most common abortion technique used today. It poses the least risk of complications. This type of operation is safer for the woman than a tonsillectomy.

1.) Preemptive Abortion, Endometrial Aspiration, or Menstrual Regulation
This aspiration procedure is performed before five to six weeks after the last normal menstrual period, before pregnancy can be verified. A tube, called a cannula,is inserted through the cervix and into the uterus. Because this type of abortion is performed at such an early stage in the possible pregnancy, a very small, 4-5mm, plastic cannula is used. On the other end of the cannula is a syringe which creates a vacuum. The lining of the uterus is suctioned out along with any placental and embryonic tissue that may exist.

2.) Early Uterine Evacuation (EUE) or Menstrual Extraction (ME)
EUE's are only performed after a pelvic exam or urine test confirms pregnancy. This procedure is identical to a preemptive abortion except that the cannula, or tube, inserted into the uterus is 5-6mm in diameter. This is because the pregnancy is slightly more advanced, six to eight weeks.

3.) Vacuum Aspiration or Suction Curettage
Performed when the pregnancy is in its sixth to fourteenth week. Because the pregnancy is more advanced, a larger cannula is used. The cervical opening is slowly stretched open with dilatorsand the cannula is inserted. An electrically powered aspirator provides gentle suction. Occasionally, a process known as curettageis also performed. This involves scraping the inside of the uterus with a small metal loop in order to loosen and remove tissue. The safest and least traumatic vacuum aspiration procedures use as little dilation of the cervix as possible, small, flexible cannulas, and little or no curettage.

Dilation Abortion
4.) Dilation and Curettage (D and C)
This procedure is usually done in a hospital where the woman is put under a general anesthesia. It can be performed when the pregnancy is in its sixth to sixteenth week although it has largely been replaced by the easier and safer aspiration techniques. During a D and C abortion, the cervix is slowly dilated and a curette is used to scrape the lining and all placental and fetal tissue from the uterus. No suction or aspiration is used.

5.) Dilation and Evacuation (D and E)
This method combines D and C and vacuum aspiration techniques for abortions performed later than the twelfth week after the last normal menstrual period. They can be performed up to the sixteenth week and occasionally the twenty-fourth. The cervix is dilated more than with a first trimester abortion. This is done with synthetic devices called osmotic dilators, or sticks made of sterilized seaweed called Iaminaria, which absorb moisture and expand over a 24 hour period. They are removed at the time of the abortion. Dilators are then used to further enlarge the cervical opening if necessary. The doctor uses forceps, a curette and vacuum suction to loosen and remove the contents of the uterus. Sometimes a drug is given that slows down the bleeding by helping the uterus to contract.

Instillation and Surgical Abortions
6.) Induction or Instillation Abortion
This technique is used when the pregnancy is in its sixteenth to twenty-fourth week. It involves a hospital stay of twelve to forty-eight hours. An abortion-causing solution is injected through the abdomen into the amniotic sac surrounding the fetus. After several hours, contractions cause the cervix to dilate and the fetus and placenta are expelled. Often a D and C is performed as well to remove any tissue remaining.

The solution injected is usually either a saline (salt) solution or a prostaglandin. The saline solution is generally safer and more likely to work without having a second injection, although it brings a small risk of serious emergency if salt enters a blood vessel. A prostaglandin solution works more quickly but has more negative side effects such as nausea, vomiting and diarrhea, and a higher rate of failure with the first injection.

7.) Prostaglandin Suppositories
This is a relatively new technique. It is often used when a woman has miscarried and is not going into labor to expel the fetus. The suppository is placed in the vagina and causes strong uterine contractions which result in miscarriage. It is not always successful.

8.) Hysterotomy
In this technique the surgeon removes the fetus and placenta through an incision into the abdomen and uterus. There is a higher chance of serious complications for this type of abortion because it involves major surgery. It is used when induction methods have been unsuccessful or cannot be used for medical reasons.

RU-486 plus Prostaglandin
RU-486 is a steroid drug (mifepristone) that causes abortions when combined with a prostaglandin. It is sometimes called the abortion pill. The drug blocks the normal action of progesterone in the uterus. This prevents the implantation of a fertilized egg in the uterine lining or can cause shedding of the lining if implantation has already occurred. RU-486 is most effective when used within nine weeks of the last menstrual period and when followed two days later by a dose of prostaglandin.

While this is a fairly new drug, so far it appears to be relatively safe. Some side effects include cramps, dizziness, diarrhea and vomiting. About one in a thousand women loses enough blood to require a transfusion. RU-486 plus prostaglandin is successful in aborting a pregnancy 96% of the time when used properly.