Patient Information

Abortion (pregnancy termination)

Abortion (pregnancy termination)
Author
Katherine Simmonds, MS, MPH, WHNP-BC
Section Editor
Mimi Zieman, MD
Deputy Editor
Sandy J Falk, MD
Last literature review version 19.3: Fri Sep 30 00:00:00 GMT 2011 |This topic last updated: Thu Oct 15 00:00:00 GMT 2009 (More)

ABORTION OVERVIEW — Abortion, also known as pregnancy termination, is a procedure that is performed to end a pregnancy. In the United States, abortion is a safe and legal option for women who cannot or choose not to continue with a pregnancy.

Deciding to have an abortion is a very personal decision. Any woman considering abortion should understand the risks and benefits of the various types of abortion, as well as the alternatives to abortion, including parenting and adoption.

This article will help to explain these issues and will briefly discuss legal abortion procedures, including the recommended follow up. If you have questions or concerns about abortion after reading this article, find a supportive healthcare provider or clinic that provides abortion services. (See 'Where to get more information' below.)

IS ABORTION RIGHT FOR ME? — In the United States, almost 50 percent of pregnancies are unintended, and almost one-half of these are terminated [1] .

Women have many reasons for considering abortion. Some of the most common reasons include the following:

  • Having a baby would interfere with family, work, school, or other responsibilities
  • Unable to afford raising a child
  • Do not want to be a single parent
  • Having problems with husband or partner
  • Find out that something is wrong with her unborn baby
  • Have health problems that make pregnancy a problem

If you are not sure if abortion is the right decision for you, talk to a supportive healthcare provider or a clinic that provides abortion services. You may also want to talk to a friend, family member, or your partner. It is important to share your thoughts and feelings about this decision with people who you can trust and who will support you, no matter what you decide. (See 'Where to get more information' below.)

If you are under age 17 or 18 and live in the United States, you may need one or both of your parents' permission to have an abortion (see www.guttmacher.org/statecenter/sfaa.html for a description of specific state laws). In most states, if it is not possible to get your parents' permission, you can speak with a judge to get permission for an abortion without your parents' or guardian's approval. Healthcare providers who provide abortions can help you with this process, if needed. (See 'Where to get more information' below.)

TYPES OF ABORTION PROCEDURES — There are two basic ways abortions are performed:

  • One is called "medical" or "medication abortion", meaning that you take medicine to end the pregnancy.
  • The other is called "surgical" abortion, meaning that a doctor does a procedure to remove the pregnancy.

Medication or surgical abortion? — The type of abortion procedure you have depends on a number of factors, including how far along you are in your pregnancy, what type of abortions are available in your area, and your personal preferences. Medication abortion is most effective if you are less than 8 to 9 weeks pregnant.

Reasons that you might prefer medication abortion:

  • You would prefer to be in the privacy of your home when you pass the pregnancy tissue
  • You would prefer to avoid having anesthesia
  • You would prefer to avoid medical instruments being inserted into your uterus to remove the pregnancy. In 2 percent of cases, medication abortion does not end or completely remove the pregnancy tissue from inside the uterus and a surgical procedure is needed. (See 'How effective is medication abortion?' below.)

Reasons that you might prefer surgical abortion:

  • You are 8 to 9 or more weeks pregnant
  • You prefer to have the abortion completed in one visit
  • You are not comfortable with the idea of heavy vaginal bleeding and passing pregnancy tissue at home
  • You would prefer to have anesthesia to minimize pain

Initial evaluation — With both medication and surgical abortion, you will need the following before the procedure.

  • A pregnancy test or ultrasound to confirm the pregnancy and determine how far along your pregnancy is. To determine how far along you are, you can use this calculator (calculator 1).
  • A blood test to determine your blood count (to make sure you do not have anemia) and blood type. If you have a negative blood type (eg, A negative), you will be given an injection of a medication called Rh immune globulin (Rhogam®) after the abortion. This helps to prevent your immune system from causing complications in future pregnancies.
  • You may be offered testing for sexually transmitted infections. Commonly performed tests include gonorrhea, chlamydia, and HIV. Testing for syphilis and hepatitis A, B, and C may also be recommended.
  • You will discuss the risks and benefits of abortion, the available procedures (medication and surgical), and alternatives to abortion (parenting, adoption) with a counselor, doctor, or nurse. This is an important step; if you have any questions or concerns, this is the time to ask.
  • In some states in the United States, women must wait for a certain amount of time (usually 24 hours) between having the counseling, described above, and having the abortion. In other states, the abortion can be performed on the same day as the counseling. For information about your state, see www.guttmacher.org/statecenter/spibs/spib_MWPA.pdf
  • You will discuss options for birth control. After medication or surgical abortion, you can become pregnant again quickly, even before your next menstrual period. You can start using most methods (pill, patch, vaginal ring, injection) on the day of an aspiration abortion.
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With medication abortion, you can start birth control after your pregnancy has ended, usually within a few days after your first visit. (See "Patient information: Birth control; which method is right for me?".)

MEDICATION ABORTION — Medication abortion usually involves taking two different medications to end an early pregnancy. In the United States, medication abortion may be an option if you are 7 weeks or less (49 days) pregnant (policies on dates can vary by clinic). To determine if you can have a medication abortion, use this calculator (calculator 1).

Medication abortion is available in some medical offices and hospitals and in most clinics that provide abortion services. The following steps are involved in most cases:

  • A healthcare provider will confirm how many days pregnant you are, either by using a calculator or by using ultrasound measurements of the pregnancy.
  • You will be given two medications, mifepristone and misoprostol. Information about these medications is available online (see www.earlyoptionpill.com or www.prochoice.org/about_abortion/facts/medical_abortion.html).
  • You will take the mifepristone at the clinic or medical office. You will take the misoprostol several hours or days later, usually at home.

Expected side effects — Abdominal pain, cramps, and vaginal bleeding are expected side effects with medication abortion. Some women also have fever, nausea, vomiting, or diarrhea.

Pain and cramps — Most women will have abdominal pain and cramps after taking the second medication (misoprostol). These cramps may be mild or strong. The pain usually improves after the pregnancy has passed out of your uterus, within 4 to 6 hours after taking the misoprostol.

You can take 600 to 800 mg of ibuprofen (Advil, Motrin) every 6 to 8 hours for pain, if needed. Some doctors and nurses also give a prescription for a stronger pain medication to use if needed. You can also use a heating pad on your abdomen. If you have severe pain that is not relieved by these treatments, call your clinic immediately.

Vaginal bleeding — It is normal to experience vaginal bleeding with a medication abortion. The bleeding may be heavy, especially in the first few hours after you take the misoprostol. The bleeding usually decreases after you pass the pregnancy tissue out of your uterus, and then continues for several weeks. It should be lighter than a menstrual period after the first few days.

If you are bleeding so heavily that you soak through one menstrual pad per hour for two hours in a row and you are still bleeding, you should call your healthcare provider or clinic immediately. If you do not have bleeding at all after you take the medications, you should also call your doctor or nurse.

Fever, nausea, vomiting, diarrhea — Some women experience a mild fever, nausea, vomiting, or diarrhea after taking the second medication (misoprostol). This usually resolves on its own, without treatment. If you develop a fever greater than 100.4ºF (38ºC) or if you have chills, vomiting, or diarrhea that does not go away within a day of taking the medications, call your doctor or nurse.

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How effective is medication abortion? — Medication abortion is very effective in ending pregnancies that are up to 49 days (less than 7 weeks). It is nearly as effective in ending pregnancies up to 56 or 63 days (8 or 9 weeks).

If medication abortion is not effective in ending your pregnancy, you will need to have a surgical abortion. Continuing a pregnancy after taking mifepristone or misoprostol is not safe due to the risk of birth defects from the medications. For signs that your abortion was not effective, (see 'When to seek help after abortion' below).

SURGICAL ABORTION — Surgical abortion is a procedure that is done in a clinic or hospital to end a pregnancy. The procedure is done by removing the pregnancy tissue from the uterus through the opening, called the cervix. (See "Surgical termination of pregnancy: First trimester".)

In most cases, you can choose to have a surgical abortion while you are awake, using only local anesthesia, or while you are sedated. Some providers also offer other medicines to reduce pain and anxiety, including medicines you take by mouth. If you are more than 14 weeks pregnant, you will probably require sedation. To determine how far along your pregnancy is, use this calculator (calculator 1). (See "Termination of pregnancy: Second trimester".)

A doctor gives local anesthesia by injecting your cervix with anesthetic medication. This usually causes some mild pain that passes quickly. You will not require an IV line if you have only local anesthesia.

If you have sedation, you will have an IV line placed in a vein, and medication will be given to make you feel sleepy. Most people do not remember anything after the sedative medication is given. You will also be given local anesthesia, after the sedative. General anesthesia (where you are completely unconscious) is not recommended for abortion in most cases.

The procedure usually takes between 5 and 20 minutes. You will be monitored in a recovery area for about an hour after the procedure (longer if you are given a sedative).

Expected side effects — Vaginal bleeding, abdominal pain, and cramping are expected side effects after a surgical abortion.

Abdominal pain and cramping — Most women have some abdominal pain and cramping after a surgical abortion. You can take 600 to 800 mg ibuprofen (Advil, Motrin) every 6 to 8 hours for pain, if needed. Some doctors give a prescription for a stronger pain medication that you can take if needed.

The pain usually lasts several hours. If you have severe pain that does not get better with these treatments or if your pain continues for more than a few days after the procedure, call your doctor or nurse.

Vaginal bleeding — It is normal to have some vaginal bleeding after a surgical abortion. Usually the bleeding is less than what you have with a normal menstrual period. The bleeding usually lasts a few days to two weeks, and should become lighter after the first few days. You may pass also pieces of tissue or blood clots.

If you are bleeding so heavily that you soak through one menstrual pad per hour for two hours in a row and you are still bleeding, you should call your healthcare provider or clinic immediately.

WHEN TO SEEK HELP AFTER ABORTION — Call your doctor or clinic immediately if:

  • You are bleeding so heavily that you soak through one menstrual pad per hour for two hours in a row and you are still bleeding.
  • You have severe pain that is not relieved by pain medications.
  • You have shaking chills or develop a temperature greater than 100.4ºF or 38ºC (use a thermometer to measure your temperature).
  • You have foul-smelling or pus-like vaginal discharge.

In addition, you should be aware of signs that your abortion was not complete. Call your healthcare provider if:

  • You do not have vaginal bleeding after a medication abortion.
  • Your pregnancy symptoms (breast tenderness, nausea) do not resolve within one week after your abortion. You should not do a home pregnancy test, even if you still feel pregnant, because it is likely to be positive for up to 6 weeks after having an abortion.
  • You continue to bleed for more than 2 weeks after your abortion.
  • You do not have a menstrual period within 6 weeks after your abortion.

FOLLOW UP CARE — You should not have sex or put anything in your vagina (tampons, douches) for two weeks after an abortion. Putting anything in the vagina before this time could lead to a serious infection.

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About one week after a medication abortion, you should have a follow up visit with your doctor or nurse. It is very important to go to this visit to be sure you are no longer pregnant.

Approximately two weeks after a surgical abortion, you should have a follow up visit with your doctor or nurse. At this visit, your will have a pelvic examination and can review how you are feeling.

If you have not already started using birth control, you should discuss what method is best at this follow up visit. (See "Patient information: Birth control; which method is right for me?".)

ABORTION COMPLICATIONS — Legal abortions are safe and usually cause no serious complications. However, complications do sometimes occur, as with any medical or surgical procedure. Complications can include excessive bleeding, injury to the cervix or uterus, infection, and the potential need for more surgery to remove pregnancy tissue. These complications occur in a very small number of cases [2] .

MYTHS AND FACTS ABOUT ABORTION

  • Abortion is not safe — MYTH. Legal abortions are one of the safest medical procedures available today. While abortion is not risk-free, the risk of having an abortion is far less than the risk of carrying a pregnancy and giving birth. Abortions done early in pregnancy (before 13 weeks of pregnancy) have fewer risks than abortions done later in pregnancy [2] .

Abortions that are performed by someone without training are not safe and can lead to serious complications, including bleeding, infection, infertility, and even death.

  • Abortion will make me infertile — MYTH. Legal abortions do not make it more difficult to become pregnant in the future.
  • Abortion increases my risk of breast cancer — MYTH. Several studies have conclusively proven that having an abortion does NOT increase your risk of developing breast cancer [3] .
  • Abortion increases my chance of miscarriage — PROBABLE MYTH. There have been a number of studies that have tried to determine if abortion increases the risk of miscarriage with future pregnancies. Most well-designed studies have not found that legal abortion increases the risk of miscarriage, preterm delivery, or other pregnancy complications [4-6] .

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

This article will be updated as needed every four months on our web site (www.uptodate.com/patients).

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient Level Information:

Patient information: Birth control; which method is right for me?

Professional Level Information:

Induced fetal demise
Mifepristone for the medical termination of pregnancy
Misoprostol as a single agent for medical termination of pregnancy
Overview of pregnancy termination
Postpartum and postabortion contraception
Surgical termination of pregnancy: First trimester
Termination of pregnancy: Second trimester

The following organizations also provide reliable health information.

  • National Library of Medicine

(www.nlm.nih.gov/medlineplus/abortion.html)

  • Planned Parenthood

(www.plannedparenthood.org)

  • National Abortion Federation

(www.prochoice.org)

  • Reproductive Health Technologies Project

(www.rhtp.org/abortion/default.asp)

REFERENCES

  1. Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health 2006; 38:90.
  2. Hakim-Elahi E, Tovell HM, Burnhill MS. Complications of first-trimester abortion: a report of 170,000 cases. Obstet Gynecol 1990; 76:129.
  3. Beral V, Bull D, Doll R, et al. Breast cancer and abortion: collaborative reanalysis of data from 53 epidemiological studies, including 83?000 women with breast cancer from 16 countries. Lancet 2004; 363:1007.
  4. Atrash HK, Hogue CJ. The effect of pregnancy termination on future reproduction. Baillieres Clin Obstet Gynaecol 1990; 4:391.
  5. Zhou W, Nielsen GL, Larsen H, Olsen J. Induced abortion and placenta complications in the subsequent pregnancy. Acta Obstet Gynecol Scand 2001; 80:1115.
  6. Kalish RB, Chasen ST, Rosenzweig LB, et al. Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome. Am J Obstet Gynecol 2002; 187:882.

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