The National Center for Health Statistics, the Centers for Disease Control and Prevention (CDC), and

the
World Health Organization (WHO) define abortion as pregnancy termination prior to 20 weeks' gestation
or a fetus born weighing less than 500 g. Despite this, definitions vary widely according to state laws.

Termination of Pregnancy for Medical Reasons

When faced with life-threatening complications for the fetus or mother, couples must decide whether to
terminate the pregnancy. Here’s what you need to know.

About one-fourth of women will have an abortion before they turn 45, according to the Guttmacher
Institute. These abortions are often voluntary—for example, a woman may end the pregnancy if a child
will interfere with her education plans, or if she doesn’t have the financial means to raise another
person. Occasionally, however, couples must terminate a wanted pregnancy for medical reasons, like
fetal abnormalities or maternal health issues.

Fetal Abnormalities: Doctors conduct a few tests in the second trimester of pregnancy, including blood
work and amniocentesis (testing of the amniotic fluid.) Occasionally, these tests can uncover a condition
that could negatively impact the baby’s quality of life, or that could result in fetal death before birth or
shortly after birth. Parents-to-be must decide, in these instances, whether they want to terminate the
pregnancy.

Some conditions that necessitate pregnancy termination include:

Chromosomal abnormalities that can affect the child’s well-being, like trisomy 13, trisomy 18, Down
syndrome, Turner syndrome, Tay-Sachs disease, and Potter's Syndrome

Birth defects like certain forms of spina bifida, meningocele, kidney abnormalities, heart defects, and
anencephaly (neural tube deformation that affects the brain). Babies with severe birth defects generally
don’t live long after birth.

Hydrocephalus (cerebral spinal fluid builds in the brain)

Premature rupture of the membranes (your water breaks too early)

Impending miscarriage

• Ectopic pregnancy

Maternal Health Issues: A mother might face a certain health condition that could prove fatal to herself
and/or her baby. These include placental abruption, cancer, hyperemesis gravidarium (severe morning
sickness), infection, or advanced preeclampsia. Pregnancy termination might be recommended in such
cases.

Methods for Terminating a Pregnancy

Most of the time, doctors terminate a pregnancy through standard abortion techniques. The exact
technique used will depend on several factors, including your gestational age and the baby’s condition.
Discuss these techniques with your provider.

Medication abortions (abortion pills) are often used in the first 10 weeks of gestation. A woman will take
two separate pills (mifeprex and misoprostol) to promote the body to thin the uterine lining and expel
the contents. Most women experience heavy bleeding, clots, and cramming after a medication abortion
—and other side effects like nausea, diarrhea, fatigue, and mild fever are also likely. Medication
abortions are about 95% effective.

Doctors may also a vacuum suction technique (called vacuum aspiration) until the 16th week of
gestation. A dilation and extraction (D&E) technique, which removes the fetus with suction and tools,
can also typically used between 14-24 weeks. Both minimally-invasive procedures are more than 99%
effective, but they must be conducted in a healthcare center or clinic. Side effects include bleeding and
cramping.

Late-term abortions, which happen if the pregnancy is life-threatening to the mother or complications
prevent the baby’s survival, are generally scheduled inductions. Doctors will induce labor by injecting
medication into the fetus, amniotic sac, vagina, or vein; the woman will go through natural labor and
delivery.
Finding Support After Pregnancy Termination

Before making the decision to terminate your pregnancy, confirm the diagnosis and thoroughly discuss
the possible extent of your child's disability. Your health care provider can help put you in touch with
specialists who can provide specific information, including high-risk obstetricians, genetic counselors,
therapists, pediatric surgeons, and developmental pediatricians.

Perinatal social workers or therapists may also help prepare you for the onslaught of emotions that may
accompany a pregnancy termination. After an abortion you can expect to feel weepy, angry, and
exhausted, so having such support in place is essential for surviving this ordeal. You might also rearrange
burial services with your doctor or the healthcare service.

Additional Infos

Induced abortion is the intentional ending of a pregnancy by surgery or drugs.

A pregnancy may be ended by surgically removing the contents of the uterus or by taking certain drugs.

Complications are uncommon when an abortion is done by a trained health care practitioner in a
hospital or clinic.

Elective abortion does not increase risks for the fetus or woman during subsequent pregnancies.

Worldwide, the status of abortion varies from being legally banned to being available on request. About
two thirds of women in the world have access to legal abortion.
In the United States, elective abortion (abortion initiated by personal choice) is legal during the 1st
trimester (up to 12 weeks). After 12 weeks, states can impose restrictions on when abortion can be
done. For example, a waiting period or counseling may be required before an abortion can be done.
These restrictions vary from state to state.

In the United States, about 50% of pregnancies are unintended, and about 40% of unintended
pregnancies are ended by elective abortion, making it one of the most common surgical procedures
done.

In countries where abortion is legal, abortion is usually safe, and complications are rare. Worldwide,
about 13% of deaths in pregnant women are due to abortion. Most of these deaths occur in countries
where abortion is illegal.

Did You Know...

Abortion is one of the most common surgical procedures done in the United States.

Contraception can be started immediately after an abortion done before 28 weeks of pregnancy.

Methods

Abortion methods include

Surgical abortion (surgical evacuation): Removal of the contents of the uterus through the cervix

Drugs to cause (induce) abortion: Use of drugs to stimulate contractions of the uterus, which expel the
contents of the uterus
The method used depends in part on how long a woman has been pregnant. Ultrasonography is usually
done to estimate the length of the pregnancy. Surgical abortion can be used for most pregnancies up to
24 weeks. Drugs can be used for pregnancies that are less than 11 weeks (often called medical abortion)
or that are more than 15 weeks (often called induction).

For abortions done early in the pregnancy, only a local anesthetic may be needed. Conscious sedation
(drugs that relieve pain and help women relax but allow women to remain conscious) may also be used.
These drugs are usually given by vein. For abortions done later, a stronger sedative is usually required.
Rarely, a general anesthetic is needed.

On the day of a surgical abortion, women are given antibiotics that are effective against microorganisms
that can cause infections in the reproductive tract.

After any abortion (surgical or medical), women with Rh-negative blood are given injection of Rh
antibodies called Rho(D) immune globulin. If the fetus has Rh-positive blood, a woman who has Rh-
negative blood may produce antibodies to the Rh factor. These antibodies can destroy the fetus's red
blood cells. Treatment with Rho(D) immune globulin reduces the risk that the woman's immune system
will make these antibodies and endanger subsequent pregnancies.

Surgical abortion

The contents of the uterus are removed through the vagina. Surgical abortion is used for more than 95%
of abortions in the United States. Different techniques are used depending on the length of the
pregnancy. They include

Dilation and curettage (D and C) with suction

Dilation and evacuation (D and E)

Dilation refers to widening the cervix. Different types of dilators may be used, depending on how long
the pregnancy has lasted and how many children the woman has had. To reduce the possibility of
injuring the cervix during dilation, doctors may use substances that absorb fluids, such as dried seaweed
stems (laminaria) or a synthetic dilator. Laminaria are inserted into the opening of the cervix and left in
place for at least 4 hours, sometimes overnight. As the dilators absorb large amounts of fluid from the
body, they expand and stretch the opening of the cervix. Drugs such as misoprostol (a prostaglandin)
can also be used to dilate the cervix.

Typically for pregnancies of less than 14 weeks, dilation and curettage (D and C) with suction is used. For
this procedure, a local anesthetic, sometimes with conscious sedation, is used, or rarely, a general
anesthetic is used. A speculum is used to spread the walls of the vagina, and the cervix is dilated. Then a
flexible tube attached to a vacuum source is inserted into the uterus to remove the fetus and placenta.
The vacuum source may be a handheld syringe or similar instrument or an electrical suction machine.
Sometimes a small, sharp, scoop-shaped instrument (curet) is inserted to remove any remaining tissue.
This procedure is done gently to reduce the risk of scarring and infertility.

For pregnancies between 14 and 24 weeks long, dilation and evacuation (D and E) is usually used. After
the cervix is dilated, suction and forceps are used to remove the fetus and placenta. Then the uterus
may be gently scraped to make sure its contents has been removed. Complications include infection,
bleeding, or tears of the cervix or uterus, but complications are rare when surgical abortions are done by
trained doctors.

If women wish to prevent future pregnancies, contraception, including a copper intrauterine

device (IUD), can be started as soon as the abortion is completed. Then women are less likely to become
pregnant unintentionally and to need another abortion.

Medical abortion

Drugs to induce abortions may be used for pregnancies of less than 11 weeks or more than 15 weeks.
For an abortion during early pregnancy (less than 10 weeks), a woman can begin taking the drugs at the
doctor's office and continue taking the drugs in her home. For an abortion later in pregnancy, the
woman has to be admitted to the hospital to take the drugs that will induce labor.

Drugs used include mifepristone (RU 486), followed by a prostaglandin, such as misoprostol.

Mifepristone, given by mouth, blocks the action of the hormone progesterone, which prepares the lining
of the uterus for pregnancy. Mifepristone also makes the uterus more sensitive to the second drug that
is given (the prostaglandin).

Prostaglandins are hormonelike substances that stimulate the uterus to contract. They may be used
with mifepristone. Prostaglandins may be held in the mouth (next to the cheek or under the tongue)
until they dissolve, injected, or placed in the vagina.

Medical abortion is a term often used when drugs are used to induce abortions in pregnancies that have
lasted less than 11 weeks. The most common regimen involves taking mifepristone tablets in a doctor's
office, followed by misoprostol taken 1 to 2 days later. Misoprostol is held next to the cheek until it
dissolves, or it is placed in the vagina. The woman may take misoprostol on her own or have a doctor
give it to her. This regimen causes abortion in about 92 to 95% of pregnancies that have lasted 8 to 10
weeks. If abortion does not occur, surgical abortion is done.

Induction is a term often used when drugs are used to induce abortions in pregnancies that have lasted
more than 15 weeks. Women are given the drugs in a hospital and remain in the hospital until the
abortion is complete. Mifepristone tablets can be taken, followed in 1 to 2 days by a prostaglandin, such
as misoprostol, or misoprostol can be taken alone. For example, two misoprostol tablets placed in the
vagina every 6 hours are almost 100% effective within 48 hours.

After any of these regimens, women must see a doctor for a follow-up test to confirm that the
pregnancy has ended.

Complications of Abortion

Complications from abortion are uncommon when it is done by a trained health care practitioner in a
hospital or clinic. Also, complications occur much less often after an abortion than after delivery of a full-
term baby. Serious complications occur in fewer than 1% of women who have an abortion. Death after
an abortion is very rare. About 6 out of a million women who have an abortion die, compared with
about 140 out of a million women who deliver a full-term baby.

The risk of complications is related to the method used.

Surgical evacuation: The uterus is perforated by a surgical instrument in 1 of 1,000 abortions. Less often,
the intestine or another organ is injured. Severe bleeding occurs during or immediately after the
procedure in 6 of 10,000 abortions. The instruments used can tear the cervix, especially in pregnancies
of more than 12 weeks. Later, infections may develop. Very rarely, the procedure or a subsequent
infection causes scar tissue to form in the lining of the uterus, resulting in sterility. This disorder is called
Asherman syndrome.

Drugs: Mifepristone and the prostaglandin misoprostol have side effects. The most common are crampy
pelvic pain, vaginal bleeding, and gastrointestinal problems such as nausea, vomiting, and diarrhea.

Either method: Bleeding and infection can occur if part of the placenta is left in the uterus. If bleeding
occurs or if infection is suspected, doctors use ultrasonography to determine whether part of the
placenta remains in the uterus.

Later, particularly if the woman is inactive, blood clots may develop in the legs.

If the fetus has Rh-positive blood, a woman who has Rh-negative blood may produce Rh antibodies—as
in any pregnancy, miscarriage, or delivery. Such antibodies may endanger subsequent pregnancies.
Giving the woman injections of Rho(D) immune globulin prevents antibodies from developing.

Elective abortion probably does not increase risks for the fetus or woman during subsequent
pregnancies.

Most women do not have psychologic problems after an abortion. However, problems are more likely to
occur in women who

Had psychologic symptoms before pregnancy

Were deeply attached to the fetus

Have limited social support or feel stigmatized by their support system