BODYTypes
A 10-week-old fetus removed via a therapeutic abortion from a 44-year-old woman diagnosedwith early-stageuterine cancer . The uterus (womb), included the fetus.
Spontaneous
Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus due toaccidental trauma or natural causes before approximately the 22ndweek of gestation; thedefinition by gestational age varies by country. Most miscarriages are due to incorrect replicationof chromosomes; they can also be caused by environmental factors. A pregnancy that ends before 37 weeks of gestation resulting in a live-borninfant is known as a " premature birth".
When a fetus diesin uteroafter about 22 weeks, or during delivery, it is usually termed
"stillborn". Premature births and stillbirths are generally not considered to be miscarriagesalthough usage of these terms can sometimes overlap.Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending uponthe age and health of the pregnant woman. Most miscarriages occur very early in pregnancy, inmost cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulationand pregnancy found that 61.9% of conceptuseswere lost prior to 12 weeks, and 91.7% of these losses occurred subclinically,without the knowledge of the once pregnant woman.The risk of spontaneous abortion decreases sharply after the 10th week from the last menstrual period(LMP). One study of 232 pregnant women showed "virtually complete [pregnancy loss] by the end of the embryonic period" (10 weeks LMP) with a pregnancy loss rate of only 2 percent after 8.5 weeks LMP.The most common cause of spontaneous abortion during the first trimester is chromosomalabnormalities of the embryo/fetus,
accounting for at least 50% of sampled early pregnancylosses Other causes include vascular disease (such aslupus),diabetes, other hormonal problems,
infection, and abnormalities of the uterus.
Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion. A spontaneous abortion can also be caused by accidentaltrauma;
intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.
Induced
A pregnancy can be intentionally aborted in many ways. The manner selected depends chieflyupon thegestational age of the embryo or fetus, which increases in size as the pregnancy
progresses. Specific procedures may also be selected due to legality, regional availability, anddoctor-patient preference. Reasons for procuring induced abortions are typically characterized aseither therapeutic or elective. An abortion is medically referred to as a therapeutic abortionwhen
it is performed to:
•
save the life of the pregnant woman;
•
preserve the woman's physical or mental health;
•
terminate pregnancy that would result in a child born with acongenital disorder thatwould be fatal or associated with significantmorbidity; or
•
selectively reducethe number of fetuses to lessen health risks associated withmultiple pregnancy.An abortion is referred to as
elective
when it is performed at the request of the woman "for reasons other than maternal health or fetal disease."
Methods
Medical
"Medical abortions" are non-surgical abortions that use pharmaceutical drugs. As of 2005,medical abortions constitute 13% of all abortions in the United States. Combined regimensincludemethotrexateor mifepristone, followed by a prostaglandin(either misoprostolor
gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) Whenused within 49 days gestation, approximately 92% of women undergoing medical abortion with acombined regimen completed it without surgical intervention. Misoprostol can be used alone, but
has a lower efficacy rate than combined regimens. In cases of failure of medical abortion,vacuum or manual aspiration is used to complete the abortion surgically.
Surgical
A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).
1:
Amniotic sac
2:
Embryo
3:
Uterine lining
4:
Speculum
5:
Vacurette
6:
Attached to a suction pumpIn the first 12 weeks,suction-aspirationor vacuum abortion is the most common method.
Manual vacuum aspiration
(MVA) abortion consists of removing thefetusor embryo, placenta
and membranes by suction using a manual syringe, while
electricvacuum aspiration
(EVA)abortion uses an electric pump. These techniques are comparable, and differ in the mechanismused to apply suction, how early in pregnancy they can be used, and whether cervical dilation isnecessary. MVA, also known as "mini-suction" and "menstrual extraction", can be used in veryearly pregnancy, and does not require cervical dilation. Surgical techniques are sometimesreferred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th,dilation and evacuation (D&E) is used. D&E consists of opening
thecervixof the uterus and emptying it using surgical instruments and suction.
(D&C), the second most common method of surgical abortion, is astandard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion.
refers to cleaning the walls of theuterus with acurette. TheWorld Health
Organizationrecommends this procedure, also called
sharp curettage,
only when MVA isunavailable.Other techniques must be used to induce abortion in the secondtrimester . Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with
hypertonic solutions containingsaline or urea. After the 16th week of gestation, abortions can be
induced byintact dilation and extraction(IDX) (also called intrauterine cranial decompression),which requires surgical decompression of the fetus's head before evacuation. IDX is sometimescalled " partial-birth abortion," which has beenfederally bannedin the United States. A
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