Abortion is the interruption of the normal process of pregnancy, by the death of the foetus before the twenty-eighth week. This can happen spontaneously; in everyday language a spontaneousis usually called a . Abortion here is used to mean deliberate termination of a pregnancy.
Abortion is now legal in many countries. There are many highly dangerous methods of inducing an, but the procedures used in legal abortions are as surgically safe for the mother as possible. Legal methods are divided into medical methods and surgical methods.
Medical methods introduce a substance into the body to induce labour and thus end a pregnancy early. The most common substances used are prostaglandins, which can be introduced into the amniotic fluid or as a suppository in the vagina. Prostaglandins can lead to the delivery of a live foetus. Saline is another common abortifacient; some of the amniotic fluid is removed and replaced with saline. The salt water kills the foetus, but can cause some problems to the mother. Urea is a third substance which can be used as a medical method, but it is more effective when used in combination with prostaglandins.
Surgical methods include vacuum curettage, D and c (dilatation and curettage), D and E (dilatation and evacuation), hysterotomy, and hysterectomy. Vacuum curettage is done under a local anaesthetic. A vacuum curette (a long hollow medical instrument) is introduced into the uterus to suck out its contents, then a sharp curette removes any remaining material. This needs only a small dilatation of the cervix, and can be done up to thirteen weeks into pregnancy. A D and c abortion is an adaptation of a technique used to treat various gynaecological conditions. The contents of the uterus are scraped out with a sharp metal curette. This requires a larger dilatation than a vacuum curette, and may increase the pain and blood loss.
D and E is a combination of the first two methods, and is used especially in the 13-16 week period, although it can be done up to twenty weeks into pregnancy. The cervix needs to be dilated more than for a vacuum curettage, and because the foetus is bigger the surgeon may need a crushing instrument for the skull and a larger-bore vacuum curette. This procedure can be done with a local or a general anaesthetic.
A hysterotomy is a small caesarian section; it requires a general anaesthetic, and because it is abdominal surgery there is an increased convalescence time. This technique is rarely used. Hysterectomy is the surgical removal of the uterus; this would only be used for an abortion if there were also a vital medical condition (such as advanced cancer) which required immediate removal of the uterus as well as the foetus.
Medical complications of abortion are kept to a minimum if: the pregnancy is in the early stages; the woman is healthy; the abortionist is skilled; local anaesthesia rather than general is used; the reproductive system is normal; and complete follow-up is provided by the clinic and used by the woman. Also, the material removed from the uterus should be examined to make sure that the pregnancy is notor molar. The death rates for legal abortion vary by method, but average:
- 1 in 400,000 before 9 weeks.
- 1 in 100,000 from 9 to 12 weeks.
- 1 in 25,000 from 13 to 16 weeks.
- 1 in 10,000 after 16 weeks.
Other medical complications are mainly caused by infection, incomplete removal of the foetus and placenta, blood clots, continuing pregnancy, cervical or uterine trauma (shock), and bleeding.
Warning signs of infection include cramping, fever, pain, discharge, and pelvic discomfort. The infection may affect the endometrium, the fallopian tube(s) or the abdominal cavity, and may lead to infertility. Incomplete abortion and blood clots lead to severe cramping pains, but can be remedied by vacuum aspiration or D and c. 0.1-0.3% of women are still pregnant after the abortion. This may be because the foetus was missed, or because the pregnancy was ectopic, or because the woman was expecting twins and only one was aborted.
A woman is advised after an abortion not to use tampons, not to have sex or douche for a week, and to take her temperature twice a day for the first week to check for fever. If her temperature reaches 100°F or more, or if she experiences severe pain, a, or has very heavy bleeding for two days, or any bleeding for two weeks, she must see a doctor urgently. If she has no period for eight weeks, or if other symptoms of pregnancy persist, she may still be pregnant. In any case women are advised to go for a follow-up medical check two weeks after an abortion.
Research into long-term effects of abortion is inconclusive, but some conditions are known to be associated with abortion in some cases. These include subsequent infertil ity, and miscarriage, premature delivery or low birth weight of subsequent babies. There are also potential psychological and emotional effects, particularly (but by no means exclusively) for the Christian, including guilt, shame, remorse, and psychological disturbance.