Method of abortion
In general, there are two procedures to choose from, surgical-instrumental and drug treatment, which are used depending on the indication and progress of the pregnancy. (1) AbortionA scraping (curettage) is suitable up to the 12th week of pregnancy after conception.The cervix is first pre-stretched to minimize the risk of injury. Under general or local anesthesia, the instruments are inserted through the vagina and cervix and the contents of the uterus are scraped out.
(2) Vacuum aspirationThis procedure is basically a vacuum aspiration – and should therefore only be performed until the 12th week of pregnancy. Here, too, the cervix is pre-expanded and the contents of the uterus are aspirated with a blunt instrument. Both scraping and vacuum aspiration can be performed on an outpatient basis, as they have a low risk profile.
Slight cramps in the lower abdomen may be expected afterwards. (3) Hysterectomy/Hysterotomy If there are also benign tumors of the uterus (e.g. myoma) or cervical cancer, the uterus is usually removed via an abdominal incision or through the vagina (hysterectomy). (1) In early pregnancy: Up to the 35th day or up to the 5th week of pregnancy after conception, there is the possibility of administering antihormones, more precisely antigestagens (Mifegyne= RU 486 = “abortion pill”).
The pregnant woman receives an administration of mifepristone, which leads to an opening of the cervix. Approximately 48 hours later, progestins in the form of misoprostol should be taken, which cause the uterus to contract and subsequently expel the fruit. The therapy is always performed under medical supervision.
A follow-up examination should take place about 1 to 2 weeks after ejection. (2) In late pregnancy: If the pregnancy is already so advanced that a scraping or hormone therapy is no longer suitable, a miscarriage (abortion) should be initiated. As already described, it is mandatory to kill the fetus beforehand with a fetocide.
This is usually achieved by injecting potassium chloride, which leads to cardiac arrest in the fetus. Another method is to cut off the blood supply via the umbilical cord. Afterwards, prostaglandins are used to induce birth or labour.
The prior administration of the antigestagen Mifegyne facilitates the process of expulsion by opening the cervix. The medication can be administered as an infusion, intramuscularly or directly into the cervix. The use of the “morning after pill” is not considered to be an abortion, as its effects occur before implantation.
It is a progestogen-only preparation and should preferably be taken 24 to 48, at most 72 hours after unprotected intercourse. By administering the drug twice, at intervals of 12 hours, a hormone withdrawal bleeding is induced and the implantation of the fetus is prevented.
- Operative-Instrumental:
- Medicinal:
As described above, dangerous complications occur especially in those countries where strict regulations force women to have illegal abortions.
The risk is particularly high because the personnel involved are often unskilled and the methods used are dubious. Of course, complications can also occur under perfect conditions. In general, the more advanced the pregnancy, the higher the risk.
Main complications are: The probability of premature birth is increased by about 10% in women who have had one abortion and by up to 30% in women who have had several abortions (it is assumed that the cause is injuries and thus reduced resistance of the cervix and uterus). Contrary to all rumors, fertility is not affected by an abortion. As far as psychological problems are concerned, it should be remembered that carrying an unwanted pregnancy can also lead to massive problems and a conflicted mother-child relationship.
- Mucous membrane and uterus injuries during scraping
- Secondary bleeding and infections
- Persistent lower abdominal pain
- Psychological problems (feelings of guilt, depressions)
