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Abortion Info - Everything about abortion...

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1Generalities

An abortion is an intimate and personal procedure that can only be requested by the pregnant woman according to the local regulation conditions.
Abortion: an emotionally disturbing event

Dedicated structures, such as abortion centres (termination of pregnancy centres), family planning centres, physician offices and clinics/hospitals are available to help you, inform you and assist you in making the decision that is appropriate for your situation. Medical practitioners are obliged to follow certain procedures to ensure personal, confidential treatment. You can have a talk with a trained counsellor (marital and family counsellor, psychologist or social worker) if you wish.

If you decide to conduct a termination of pregnancy, a medical visit to confirm the gestational age is required.

The difference between week of pregnancy and week of amenorrhea calculation.

Your physician will give you all information on the different methods (depending on your country regulation):

  • The different steps of the procedures
  • What effects and side effects they are likely to be experienced (e.g. menstrual like cramps, pain, nausea, vomiting and bleeding),
  • How long the procedure will take,
  • What kinds of pain management can be made available,
  • What risks and complications are associated with the method,
  • Follow-up care,
  • Initiation or switch of contraception.

Some countries require compliance with a reflection period between the pregnancy confirmation visit and the initiation of termination of pregnancy procedure. If this is the case, this time frame must be considered when making a decision about abortion method.

Get information on surgical and medical abortion

Abortion is a medical act and so, it may entail some risks and complications. Consult your physician and make sure that you have acquired all the information you need. Only health care professionals are allowed to perform this act.


Regardless of the method chosen, abortion has no effect on your health or on your chances of conceiving should you desire to become pregnant in the future.


Fiala C et al. Early Medical Abortion, a practical guide to healthcare professionals. P 38 2012


 


2Practical information

Abortion can only be performed according to the local regulation. For this procedure, it is important to determine gestational age in order to define which method is most appropriate. Not all healthcare professionals or establishments perform abortions. Get information first from your nearest family planning centre or from your gynaecologist.

Methods

There are two abortion methods:

  • The medical method:

This method consists in taking two drugs in sequence. According to the local legislation of your country, you may take the drugs in a medical facility (hospitals, clinics, family planning and abortion centers) or may be allowed to take some of the drugs safely at home by following strictly the protocol. After the drugs intake, a follow-up visit is required to monitor the complete expulsion and provide you psychological support if necessary.

  • The surgical method:

This method consists generally in vacuum aspiration. The procedure can be performed under local or general anaesthesia. It requires a technical platform to perform the procedure, so it is only possible in health care centers.

The implementation of a suitable contraception method: a necessary step
Termination of pregnancy is in no way a method of contraception. After this procedure, fertility resumes immediately. Therefore, it is crucial that you speak about the most appropriate contraceptive method for you with the physician and initiate it the same day as the expulsion in order to avoid any new, unwanted pregnancies. You should not wait the follow-up visit for starting contraception.

Nevertheless, you are advised to wait a full menstrual cycle after the abortion before trying to become pregnant.


3Medical abortion

Medical abortion is induced by medications: successive intake of two different medications with a 36 to 48 hour interval between the two.


The intake of these medications is part of a 4 steps procedure. Depending on your country's regulations, you may be required to terminate your pregnancy in a medical office or in a healthcare facility (hospital or authorised clinic) or at home.
In the last case, make sure that you or your family and/or your friend are available to support you if needed. Moreover, you should be aware of the adverse events associated with medical abortion and whom to contact if complications occur.
Not all health facilities perform medical abortion. We suggest that you get information from your local family planning centre to find the physician or centre closest to you.

Treatment

As an indication, there are in general four key steps, none of which require anaesthesia. The steps to be done may vary according to your local regulation.

See the video detailing the different steps of the medical abortion.

THE 4 STEPS OF THE MEDICAL TERMINATION OF PREGNANCY
(the steps may vary according to your local regulation)

First step

If you choose the medical method, your physician will give you the first medication. Bleeding, heavy fatigue, nausea, vomiting and pain may occur.

During this visit, you will also speak about a contraceptive method with your physician in order to initiate the most suitable method to you.

Second step

If you choose the medical method, your physician will give you the first medication. Bleeding, heavy fatigue, nausea, vomiting and pain may occur.


If you vomit within two hours of taking this medication, you must contact your physician.


After the first drug intake, you can generally resume to your normal activities. Bleeding can start after the first medication administration. Bleeding does not in any way indicate that the pregnancy has been terminated.

 

Third step

36 to 48 hours after the first medication administration, you have to take the second medication. If you vomit within 30 minutes of taking this medication, you must contact your physician.

According to the local regulation of your country, you can take it at a medical facility or at home. In the last case, make sure that you or your family and/or your friend are available to support you if needed. Bleeding, heavy fatigue, nausea, vomiting and pain can occur after this drug intake. Bleeding and pain intensity during the expulsion depend on the gestational age.

After taking the second medication, you can drink and eat.
Feel free to take the analgesics prescribed by your physician. If the high pain persists despite taking analgesics, contact your physician and go to the prescribing centre. Your physician should inform you as to whom you should contact and where to go in the event of any problem emerging.

Bleeding can occur very soon after the second medication intake, but it also may occur a bit later:

  • In most the cases within 4 hours after the second medication intake,
  • 24 to 72 hours after second medication intake.

Bleeding lasts about 12 days in average.
Bleeding does not in any way indicate that the pregnancy has been terminated.

 

Fourth step

You must attend the follow-up visit that will take place between days 14 and 21 following the intake of the first medication, your physician will verify that the pregnancy has indeed been terminated. To do this, your physician will perform clinical and medical exams (ultrasound scan, ß-hCG urine test, and or ß-HCG blood test performed in a laboratory).

In the event of failure, your physician will advise you about the possible options. After an abortion, fertility resumes immediately. During this visit, the physician will verify that your your method of contraception is appropriate and is the best suitable to you to avoid any new unwanted pregnancies. You may also request psychosocial counselling if you feel you need psychological support.

Those conditions depend on your local regulation.
Contact a family planning structure and/or your general practitioner/gynaecologist to learn what is your local regulation for an abortion. It is essential to know the age of the pregnancy for each of the methods.

Medical abortion is not recommended in women suffering from:

  • Renal failure,
  • Hepatic failure,
  • Malnutrition,
  • Any illness or treatment that negatively affects blood clotting,
  • Severe anaemia,
  • Uncontrolled epilepsy.

The site where the medical termination of pregnancy takes place is dictated by your country's practices and legislation.

Complications after a medical abortion are rare. However, as for all medical procedures, there must be vigilance regarding possible complications. In the event of fever (lasting more than 24 hours), malaise, pain that persists despite taking analgesics, and/or heavy and persistent bleeding (the use of more than two sanitary pads per hour for two hours), you must immediately contact your physician or the facility in which the abortion was performed.

Please refer to your physician/ family planning/ gynaecologist to learn about the possible side effects and or complications after a medical abortion.


4Surgical abortion

Surgical abortion is, as its name indicates, a surgical procedure that involves a vacuum aspiration. It is performed by a physician in a medical facility because it needs to be performed in an operating theatre. The procedure includes several steps.

Treatment

As an indication, the treatment is done according to the following steps. This may vary according to your local regulation.

See the video detailing the different steps of the surgical abortion.

THE 3 STEPS OF THE SURGICAL TERMINATION OF PREGNANCY
(the steps may vary according to your local regulation)

First step

The physician will confirm the pregnancy and gestational age, and verify there are no contraindications to the procedure. Depending on your country's regulations, you may be offered psychosocial counselling and asked to comply with a reflection period to confirm your choice of method.
During this visit, you will also speak about a contraceptive method with your physician in order to initiate the most suitable method to you.

Second step

If you choose the surgical method, you will have a local or general anaesthesia. If you are having general anaesthesia, you will generally meet with the anaesthetist who will be present during the procedure. The anaesthetist will check your history and make sure that you have no contraindications to anaesthesia. Patients having local anaesthesia rarely meet with the anaesthetist.

The physician could give you a drug to take before the surgical procedure in order to prepare to opening of the cervix. Abortion procedure lasts about twenty minutes. You will then be transferred to a post-anaesthesia care unit for some time, even if the abortion is performed under local anaesthesia. Depending on your country's regulations, you will get home that night.

Third step

You must attend the follow-up visit that will take place between days 14 and 21 following the post abortion, your physician will verify that the pregnancy has indeed been terminated and that there are no complications. During this visit, the physician will verify that your contraception is appropriate to avoid any new unwanted pregnancies. Depending on your country's regulations, you may be offered psychosocial counselling.

This procedure is performed in an operating theatre and, depending on the country, can be performed under local anaesthesia or under general anaesthesia. The surgical termination of pregnancy is followed by a period of monitoring that varies depending on the type of anaesthesia selected and is generally short (the average is 2 hours), but can be prolonged if necessary.

A vacuum aspiration method will be used by the physician. A medical treatment may be administered 36 to 48 hours prior to the intervention to dilate the cervix and facilitate the procedure. Post-operative bleeding lasts 8 to 10 days on average.

Post-surgical termination of pregnancy complications are rare. However, surgical abortion is an invasive procedure, so vigilance is necessary and you must immediately contact your physician if any of the following symptoms occur:

  • Fever of unknown origin (above 38° C),
  • Significant blood loss,
  • Abdominal pain,
  • Malaise.

In the days that follow a surgical termination of pregnancy, you may experience post-operative bleeding and pain. These signs are the result of the surgical procedure and do not necessarily require you to see your physician. The bleeding and pain should gradually diminish.

Post-abortion: follow-up and contraception

The follow-up after an abortion is a necessary and integral part of the recommended protocol.

It is during the follow-up visit that your physician will verify that your pregnancy has been terminated, that you are not experiencing any complications and that you have started the method of contraception which is the most appropriate for you.

Be aware that after an abortion, fertility resumes immediately. Therefore you must start your contraception as advised by your physician. Termination of pregnancy is in no way a form of contraception. It is crucial for you to carefully follow your physician's recommendations on taking your contraception to avoid any new unwanted pregnancy.

Depending on the local legislation in your country, you may be offered post-abortion psychosocial counselling.

Summary of the 2 abortion methods

Where to go? How to get information?

For information on abortion, consult your closest healthcare professional, who will give you all of the information you need. This professional will give you the contact information for an abortion center