Katherine Beach, CNM Maine Medical Partners Women’s Health Abortion Katherine Beach, CNM Maine Medical Partners Women’s Health

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Roe vs. Wade Abortion has been legal in the US since this famous case in 1973 No doctor is required to perform an abortion Some states have special legal requirements and waiting periods Most states require minors to get consent from their parents or gain court approval before an abortion can be performed

Relative Risk Legal abortion by qualified provider vs. illegal abortion Risk of dying from legal early abortion is 1:100,000 Risk of dying from giving birth is at least 10 times greater than that

Prevalence Each year about 1.3 million women in the US have an abortion Safest when done early and in proper setting Big decision that should be well thought out Counseling/talking with partner, family member or friend is encouraged

Types of Abortions Menstrual aspiration Medical Suction or vacuum curettage Dilation and evacuation (D & E) Labor-inducing abortion

Menstrual Aspiration Done 1-3 weeks after a missed period Syringe is used to remove the pregnancy from the lining of the uterus Carries the least risk because it’s done early, when the products of conception are small Minimal bleeding afterwards

Menstrual Aspirator (1-PAS)

Medical Abortion Must be done before 9 weeks No surgery required, but does involve several office visits 4 types: Mifepristone (RU 486) and Misoprostol oral pills Mifepristone pills and vaginal Misoprostol Methotrexate IM and vaginal Misoprostol Vaginal Misoprostol alone

Mifepristone (RU 486) and Misoprostol pills Most commonly used method of medical abortion Must be done within 49 days (7 weeks) of the first day of the LMP Requires 3 office visits RU 486 blocks the action of progesterone Misoprostol (a prostaglandin) causes the uterus to contract and expel the embryo

RU 486 and Misoprostol pills First visit—take RU 486 Second visit—take Misoprostol Third visit—2 weeks later, to make sure abortion is complete and patient has recovered Usually very effective, but if incomplete, surgical completion is necessary

RU 486 and Vaginal Misoprostol Must be performed within 63 days (9 weeks) of the first day of the LMP. Uses same drugs as first method, but in different doses The vaginal Misoprostol can be inserted at home Faster, costs less, has fewer side effects, but woman must be comfortable with placing the medication vaginally

Methotrexate and Vaginal Misoprostol Must be performed within 49 days (7 wks) of the first day of LMP Very effective, but may take up to 4 weeks for the abortion to occur Methotrexate is given IM at office Misoprostol is placed vaginally by woman at home Usually ultrasound is done to confirm abortion

Vaginal Misoprostol Alone Must be performed within 56 days (8 weeks) of the first day of the LMP Usually more severe side effects Nausea, vomiting, fever, chills Less effective than the previous 3 methods

Suction or Vacuum Curettage Most common type of abortion POC are removed by a suction device that is inserted into the uterus Can be done up to 12 weeks, but not before 7 weeks Cervix is anesthetized with lidocaine Sedative may be given/rarely general anesthesia is used Cervix is dilated at time of procedure, or can be dilated overnight with laminaria or misoprostol

Suction or Vacuum Curettage machine

Curettage Once suction procedure is complete, a sharp curettage of the endometrium is done Ensures that all POC have been removed, and that endometrium is smooth and without residual tissue Done to reduce incidence of infection Risk is uterine perforation

Dilation and Evacuation Used when abortion is desired after 12 weeks Cervix must be dilated and stronger suction/vacuum pressure is used to remove POC More cramping and bleeding Higher risk Usually done in hospital setting, with use of general anesthesia Antibiotics usually given to reduce incidence of infection

Labor-inducing Abortion If pregnancy is >16 weeks, may use agents such as Misoprostol 400 mcg every 4 hours per vagina, or oxytocin through an IV line to induce contractions and expel contents of uterus Most often used if fetus is determined to be non-compatible with life, or if intrauterine fetal demise (IUFD) has occurred