Abortion - elective or therapeutic

Definition

Elective or therapeutic abortion is the deliberate termination of a pregnancy.

Alternative Names

Causes

Elective abortions are those initiated by personal choice. Roughly 20% of all pregnancies (excluding miscarriages) end in elective abortion. It has been reported that since abortion was legalized in 1973 through 2002, over 42 million legal abortions have been performed.

Symptoms

Early pregnancy symptoms include:

• Breast tenderness
• Breast swelling
• Discoloration of breast areola
• Nausea
• Light-headedness or dizziness
• Missed periods

Exams and Tests

A pelvic examination is performed to confirm pregnancy and estimate the weeks of gestation. A serum HCG blood test may be performed to confirm pregnancy. A vaginal or abdominal ultrasound may be used to determine gestational age and location.

Treatment

Elective abortions that take place between 8 and 12 weeks of gestation involve dilating the cervix and removing the contents of the uterus by suctioning the inner walls of the uterus.

In 2000, the FDA approved the medication mifepristone as an alternative to surgical abortion in the United States. Other medications that have been available to terminate an early pregnancy include methotrexate, misoprostol, or a combination of these medications. Most women who use medication do so because of a desire to avoid anesthesia and surgery.

Side effects of medication may include nausea, vomiting, diarrhea, warmth or chills, headache, more visits to the doctor's office, prolonged vaginal bleeding, and more aware of cramping than with surgical abortion. With medication, passage of the products of conception most likely will occur at home, but some women may still require a surgical procedure to complete the abortion.

Prior to an elective abortion, your provider will assess your blood type. After this test, if your blood is Rh negative, you may receive Rh-immune globulin (RhoGAM) to avoid Rh incompatibility in future pregnancies.

Outlook (Prognosis)

Legally performed abortions are relatively safe. Complications rarely occur.

Possible Complications

Excessive loss of blood, uterine perforation and infection, and an incomplete abortion are the most frequent complications. These complications are rare when the procedure is performed by a competent provider in an adequate facility.

Teenagers may not be aware that they are pregnant until the second trimester and could increase the danger to their own lives with second trimester abortions. Infection resulting from the procedure occurs most commonly in women who have a preexisting gonorrheal or chlamydial infection.

When to Contact a Medical Professional

Call for an appointment with your health care provider if an unplanned pregnancy occurs and you want information about the choice of elective abortion.

Call your health care provider if an elective or therapeutic abortion has been performed and vaginal bleeding continues beyond what was predicted, or if you continue to have symptoms of pregnancy or severe pain. Excessive bleeding can cause shock. Continued pain or pregnancy symptoms may indicate a possible ectopic or tubal pregnancy.

Call your health care provider if signs of infection develop, including persistent fever, foul odor to vaginal drainage, vaginal drainage that looks like pus, or abdominal pain or tenderness.

Prevention

Improved methods of contraception can help prevent many unplanned pregnancies. This includes education related to abstinence, or, in the case of chosen sexual activity, contraception education.

Contraceptive methods do not always prevent pregnancy -- unplanned pregnancies occur even when couples practice adequate methods of contraception to the best of their abilities.

Sometimes, a woman chooses to terminate a pregnancy that results from a sexual assault, one that endangers her health, or one in which the fetus is abnormal.

Finer LB, Henshaw SK. Disparities in rates of unintended pregnancy in the United States, 1994 and 2001. Perspect Sex Reprod Health. 2006 Jun;38(2):90-6.