Vacuum Aspiration (Suction Curettage)
Vacuum aspiration, sometimes referred to as suction curettage, is an abortion that is performed during the first trimester (first three months of pregnancy). An ultrasound is done before the procedure to determine the exact location of the embryo. In a vacuum aspiration abortion, the cervix, or opening of the uterus, is dilated or stretched. This allows the physician to insert a small plastic tube, called a cannula, into the uterus. The cannula is attached to a suction tube and machine or, occasionally, in early pregnancy to a large special syringe that is used to apply manual suction. As the suction cannula is moved throughout the uterus, it scrapes and removes by suction the soft and flexible fetus along with the placenta and other tissues and fluids of pregnancy. Vacuum aspiration is generally performed in a clinic under local anesthesia.
Medical Abortion (Mifepristone and Misoprostol)
A non-surgical abortion procedure using the drugs, Mifepristone and Misoprostol, may be used by women who are in the first 10 weeks of pregnancy (by LMP). This procedure usually
allows a woman to have the abortion at home. An ultrasound is done before the procedure to determine implantation of the embryo. Then a dose of 200 mg of Mifepristone is given at the clinic. She is then given Misoprostol tablets to take anytime between 24 and 48 hours later at home. Misoprostol causes the uterus to contract, bleed, and expel the pregnancy. A follow-up examination is necessary to determine if the abortion was complete. In cases where the pregnancy continues, vacuum aspiration is recommended because of the possibility of birth defects should the woman complete her pregnancy.
Research indicates that mifepristone alone is not always effective in ending a pregnancy. You may still have a viable pregnancy after taking mifepristone. If you have taken mifepristone but have not yet taken the second drug and have questions regarding the health of your fetus or are questioning your decision to terminate your pregnancy, you should consult a physician immediately.
In 30-50% of women who take mifepristone alone, the pregnancy will continue. It has been hypothesized that women who take mifepristone, but not yet misoprostol, can reverse the effects of mifepristone by taking the medication progesterone (Delgado, et al). A systematic review of the literature yields insufficient evidence, to date, that this treatment is more effective than monitoring alone (Grossman, et al).
In every pregnancy, there is a 3-5% chance to have a baby with a birth defect, which is called the background risk. A review of published studies indicates that there is no increased risk above the background risk for birth defects with fetal exposure to mifepristone alone and no consistent pattern of birth defects have been reported.
Dilation & Evacuation (D & E)
Dilation & Evacuation procedures are the most common procedure performed in the second trimester of pregnancy (months 4-6). An ultrasound is done before the procedure to determine the exact location of the fetus and placenta. With a D & E procedure, the cervix must be dilated before the procedure. This can be done with either medications, a natural or synthetic substance
inserted into the cervix that slowly widens the cervix as it swells with moisture, or a combination of the two. Sometimes preparing the cervix must be done the day before the D & E procedure. When the opening of the cervix is sufficient, the suction tube or cannula is inserted into the uterus. The suction tube or cannula removes by suction the fluid, placenta, and possibly other pregnancy tissues. The procedure is carried out using ultrasound guidance to assure safety. Forceps are used to remove larger fetal parts and parts of the placenta. The procedure is performed under sedation, often a combination of local anesthesia as well as intravenous medication, and can be done in a clinic.
An abortion procedure that is sometimes used during the second trimester involves prostaglandin, a natural hormone and other medications that induces labor. Prostaglandin is generally placed, in suppository form, into the vagina. Typically, prostaglandin causes the woman to go into labor and deliver the fetus and other tissues of pregnancy within 24 to 36 hours. This procedure is usually performed in a hospital.