induced abortion


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Related to induced abortion: therapeutic abortion

abortion

 [ah-bor´shun]
termination of pregnancy before the fetus is viable. In the medical sense, this term and the term miscarriage both refer to the termination of pregnancy before the fetus is capable of survival outside the uterus. The term abortion is more commonly used as a synonym for induced abortion, the deliberate interruption of pregnancy, as opposed to miscarriage, which connotes a spontaneous or natural loss of the fetus. Because of this distinction made by the average layperson, care should be exercised in the use of the word abortion when speaking of a spontaneous loss of the fetus.

The technique chosen to terminate pregnancy depends on the stage of pregnancy and the policies of the institution and patient needs. It is rare for a fetus to survive if it weighs less than 500 g, or if the pregnancy is terminated before 20 weeks of gestation. These factors are, however, difficult to determine with a high degree of accuracy while the fetus is still in utero; survival of the fetus delivered near the end of the second trimester often depends to a great extent on the availability of personnel and equipment capable of supporting life until the infant develops sufficiently.

Viability of the fetus outside the uterus is frequently used as the determining factor in deciding the legality and morality of induced abortion. Whether this is a valid criterion is essentially based on whether one believes that the fetus is human from the moment of conception or that it achieves humanity at some point during physical development. Those who oppose abortion on moral grounds believe that the fetus is human or potentially human and that destruction of the fetal body is tantamount to murder. Many others have equally strong beliefs that abortion is a woman's right.

The liberalization of abortion laws has resulted in a dramatic increase in the number of abortions performed in physicians' offices, clinics, and hospitals. While this has diminished the occurrence of septic abortions performed at the hands of unscrupulous abortionists and has improved the possibility of safe and uneventful physical recovery from an induced abortion, the issue remains controversial and charged with emotion. The health care provider who strongly objects to abortion is legally and morally free to choose not to participate in the procedure and is advised to avoid situations involving responsibility for the care of patients who have chosen abortion as a means of ending an unwanted pregnancy. Women who have made a decision to have an abortion need a safe, non-judgmental environment to recover physically and emotionally from the procedure.

The patient should know that other alternatives are available and that an abortion after 20 weeks is inadvisable for medical and other reasons. Preabortion counseling in the psychological, religious, and legal aspects of abortion should be readily available, with immediate referral to the proper resources. Although delay in carrying out the procedure may increase the risk of complications, no patient should be encouraged to go through with an abortion until she has had time and sufficient counseling to reach a rational decision. During postabortion counseling there should be a discussion of various methods of contraception. The client will need information on the advantages and disadvantages of each method, her responsibilities in preventing future unwanted pregnancies, and available help in initiating and following through on a program of effective contraception. She should be informed that women who have had two or more abortions run a greatly increased risk of miscarriage or spontaneous abortion in the first six months of subsequent pregnancies.
Patient Care. The type of care required and the complications to be avoided in abortion will depend on the stage of pregnancy at the time of termination and whether the abortion is spontaneous, is induced under sterile conditions, or is performed by an unskilled abortionist or the patient herself. Many women who choose to have an abortion are anxious and confused about the physical and psychological outcomes of the procedure. Therefore both pre- and postabortion counseling are recommended.

In cases of spontaneous or habitual abortion, patient care is directed toward emotional support of the patient and acceptance of her feelings of bitterness, grief, guilt, relief, and other emotions associated with the loss of the fetus. The patient should be able to express her feelings in an open, nonjudgmental, and nonthreatening environment.
complete abortion complete expulsion of all the products of conception.
criminal abortion termination of pregnancy by illegal interference, usually undertaken when legal induced abortion is unavailable. The most frequent complications are severe hemorrhage and sepsis, and for those who delay seeking medical attention the mortality rate is high.
early abortion abortion within the first 12 weeks of pregnancy.
elective abortion induced abortion done at the request of the mother for other than therapeutic reasons.
habitual abortion spontaneous abortion in three or more consecutive pregnancies before the 20th week of gestation.
incomplete abortion abortion in which parts of the products of conception are retained in the uterus.
induced abortion abortion brought on intentionally by medication or instrumentation.
inevitable abortion a condition in which vaginal bleeding has been profuse, membranes usually show gross rupturing, the cervix has become dilated, and abortion is almost certain.
infected abortion abortion associated with infection of the genital tract from retained material, with a febrile reaction.
missed abortion retention of dead products of conception in utero for more than 8 weeks.
septic abortion abortion associated with serious infection of the products of conception and endometrial lining of the uterus, leading to generalized infection; it is usually caused by pathogenic organisms of the bowel or vagina.
spontaneous abortion termination of pregnancy before the fetus is sufficiently developed to survive; called miscarriage by laypersons. In the United States this definition is confined to the termination of pregnancy before 20 weeks' gestation (based upon the date of the first day of the last normal menses). Chromosomal abnormalities cause at least half of spontaneous abortions.
therapeutic abortion abortion induced legally by a qualified physician to safeguard the health of the mother.
threatened abortion a condition in which vaginal bleeding is less than in inevitable abortion, the cervix is not dilated, and abortion may or may not occur; this is the presumed diagnosis when any bloody vaginal discharge or vaginal bleeding occurs in the first half of pregnancy.

in·duced a·bor·tion

abortion brought on intentionally by drugs or mechanical means.

induced abortion

(ĭn-do͞ost′, -dyo͞ost′)
n.

induced abortion

an intentional termination of pregnancy before the fetus has developed enough to live if born. From 20% to 50% of pregnancies are terminated deliberately at the request of the mother or for medical indications, during the first trimester by vacuum aspiration and/or curettage or during the second trimester by dilation and evacuation, induction of labor, or hysterotomy. Termination of pregnancy by a trained person under proper conditions is safe. Compare spontaneous abortion. See also septic abortion, therapeutic abortion.
method The type of procedure depends on stage of pregnancy and may be either medical or surgical in nature. Mifepristone and misoprostol are oral medications administered within 7 weeks of the first day of the woman's last menstrual period. (Ultrasonography may be used if pregnancy duration is uncertain or ectopic pregnancy is suspected.) Mifepristone is taken first. Vaginal bleeding should occur within 1 to 2 days. Two days after mifepristone is taken, the misoprostol is taken to induce uterine cramps to speed the emptying of uterine contents. An ultrasound is then done to confirm a complete emptying of uterine contents. Menstrual extraction is usually performed in provider office or clinic up to 6 to 8 weeks into pregnancy. Equipment needed includes gloves, vaginal speculum, small sterile cannula, and a suction device (e.g., Del-Em) with one-way valve, collection jar, and syringe. The speculum is inserted in the vagina to expose the cervix. A small cannula is inserted in the uterus through an undilated cervix, and suction is applied to empty contents of the uterus. An oral pain or IV medication may be given before the procedure. An ultrasound may be done to confirm emptying of uterine contents. Vacuum curettage (suction dilation and curettage) is used up to 13 weeks from first day of LMP. Ultrasound is used to confirm pregnancy duration. This is a surgical procedure usually performed in an outpatient surgical center under either general anesthesia or local anesthesia accompanied by conscious sedation. Sterile technique is used to perform the procedure, which lasts 10 to 20 minutes. The woman is placed in the lithotomy position and prepped with a surgical scrub. The cervix is dilated with dilators, and a tube is then placed into the uterus and attached to a vacuum pump. The majority of the uterine contents are sucked out with the pump. A curette may then be used to scrape the walls of the uterus to remove any remaining tissue. The patient is then taken to recovery and observed until fully alert. An ultrasound is done postoperatively if incomplete evacuation is suspected. The patient is then released with antibiotics to prevent infection and oxytocic medications to contract the uterus. Dilation and evacuation are used between the 13th and 21st week of pregnancy. A medication, such as laminaria, is inserted into the vagina to help dilate the cervix 24 to 48 hours before this surgical procedure. When the cervix has dilated sufficiently, the woman is admitted to the operating room and placed under general anesthesia for a 30-minute procedure. The woman is placed in the lithotomy position and prepped with a surgical scrub. Sterile technique is followed as the cervix is further dilated with metal dilators. The uterine contents are then removed with suction, forceps, and curettes. IV oxytocics are administered, and the patient is taken to recovery and observed until fully alert. An ultrasound is done postoperatively if incomplete evacuation is suspected. The patient is then released with antibiotics to prevent infection and oxytocic medications to further contract the uterus.
outcome criteria Ultrasound or tissue evidence and a physical exam are used to confirm complete removal of all uterine contents. Intercourse and use of tampons are discouraged. Normal activity can be resumed within a day or two if no complications occur. Potential complications include heavy bleeding, infection, abdominal pain, incomplete removal of all uterine contents, perforation of uterus, scar tissue in uterus, trouble becoming pregnant in the future, and psychological sequelae. Follow-up is routinely scheduled about 2 weeks after the procedure.

induced abortion

Termination of pregnancy The voluntary termination of gestational products, a procedure performed by instruments–eg, dilatation and curettage, if performed in the first trimester or by saline infusion–saline abortion if performed later. See Abortion.

in·duced a·bor·tion

(in-dūst' ă-bōr'shŭn)
Abortion brought on deliberately by drugs or mechanical means.

abortion

premature expulsion from the uterus of the products of conception; termination of pregnancy before the fetus is viable.

complete abortion
complete expulsion of all the products of conception.
early abortion
abortion within the first third of pregnancy.
epizootic bovine abortion
characterized by serious fetal disease followed by abortion. Endemic in California's coastal range and in the foothill region of the Sierra Nevada, USA. Necropsy findings in the fetus are diagnostic; they include profuse petechiation and severe granulomatous hepatitis. Cause appears to be a novel deltaproteobacterium closely related to members of the order Myxococcales. Transmitted by the tick, Ornithodoros coriaceus. Called also foothill abortion.
habitual abortion
spontaneous abortion occurring in three or more successive pregnancies.
incomplete abortion
abortion in which parts of the products of conception are retained in the uterus.
induced abortion
abortion procured by the veterinarian to eliminate a misalliance, to reduce wastage in animals in a feedlot, to encourage commencement of lactation earlier than would otherwise occur. In cattle manipulation through the rectal wall is a possible way of destroying the viability of the fetus. Induction by the administration of prostaglandins or corticosteroids is more usual. See also pregnancy termination.
infectious abortion
the common causes in the various species are:
cattle
Brucella abortus (brucellosis); Campylobacter fetus subsp. venerealis (vibriosis); Campylobacter fetus subsp. fetus; Leptospira pomona, L. hardjo (leptospirosis); Listeria monocytogenes (listeriosis); Arcanobacterium pyogenes; Aspergillus, Absidia and Mucor spp. (fungal abortion); bovine virus diarrhea virus; infectious bovine rhinotracheitis herpesvirus; Chlamydophila abortus; a deltaproteobacterium (epizootic bovine abortion); Coxiella burnetii (Q fever), Neospora caninum.
sheep and goats
Campylobacter fetus subsp. fetus (vibriosis); Campylobacter jejuni; Chlamydophila abortus (enzootic abortion of ewes); Listeria monocytogenes (listeriosis); Salmonella abortus-ovis; Brucella melitensis; Toxoplasma gondii (toxoplasmosis); Brucella ovis (limited occurrence); bluetongue virus; border disease.
horse
Streptococcus equi subsp zooepidemicus; Actinobacillus equuli, A. equisimilis; Rhodococcus equi; leptospirosis, most commonly the pomona serogroup and less frequently serovar grippotyphosa; equine herpesvirus (EHV1); equine viral arteritis (EVA); equine arteritis; Potomac horse fever; and in the USA the mare reproductive loss syndrome associated with ingestion of the Eastern tent caterpillar Malacosoma americanum.
pig
Leptospira pomona, L. grippotyphosa, L. canicola, L. icterohaemorrhagiae (leptospirosis); Erysipelothrix rhusiopathiae (erysipelas); porcine reproductive respiratory syndrome (PRRS) virus; parvovirus; porcine circovirus 2; Aujesky's disease; classical swine fever; and African swine fever.
dog and cat
Brucella canis, feline leukemia virus, feline herpesvirus.
missed abortion
retention of a dead embryo or fetus for more than 1 to 2 weeks.
pine needle abortion
a late-term abortion with retained fetal membranes in cattle caused by ingestion of isocupressic acid in the needles of Pinus spp., commonly P. ponderosa, but also P. jeffryi, P. contorta and Juniperus scopulorum and J. communis. Nutrient deficiency and tree management practices may promote ingestion off the ground as cattle graze through while eating early growing spring grass.
abortion rate
number of abortions as a percentage of the cows in the herd which were diagnosed pregnant in early pregnancy; the target is <2% but="" rates="" commonly="" approach="" 8%="" in="" dairy="" cattle="" and="" 5%="" in="" beef="">
septic abortion
abortion associated with serious infection of the uterus leading to generalized infection.
spontaneous abortion
abortion occurring naturally. See also spontaneous abortion.
abortion storm
a cluster of abortions occurring at about the same time or in rapid sequence within a group of pregnant females. See also equine viral abortion.
therapeutic abortion
abortion induced by a veterinarian for medical or other health reasons.
References in periodicals archive ?
Second, if we overestimated the proportion of postabortion care cases treated at facilities that were due to miscarriage, then the number of women treated for complications of induced abortion, and thus the abortion rate, was underestimated.
The proportion of unintended pregnancies resulting in induced abortions varied significantly among provinces.
Among the 84,620 of these subjects who had a first-trimester induced abortion, the rate of a first inpatient or outpatient psychiatric contact was 1.
Half of these women (51 percent) have had only one induced abortion, slightly fewer have had two to three abortions (44 percent), 4 percent have had four to five abortions, and less than 2 percent have had 6 or more abortions.
We reported an overall 30% increased risk of breast cancer among women who had had any induced abortions, based on worldwide data up to that point.
The review of retrospectively designed studies found no significant link between spontaneous abortion and breast cancer, but the results for induced abortion varied widely compared with women enrolled in the prospective studies, with an overall relative risk of 1.
html) concludes: "Therefore, results from epidemiological studies are reassuring in that they show no consistent effect of first trimester induced abortion upon a woman's risk of breast cancer later in life.
In many instances, the study says, induced abortions are the result of unintended pregnancies.
The relative risk of birth, spontaneous abortion, induced abortion due to fetal indications, and stillbirths (95% CI) by population fifth before the Chernobyl accident.
While there are studies that have found an increased risk of developing breast cancer after an induced abortion, some studies have found no overall risk," the booklet states.
The research found that among 300,858 Finnish mothers, 31,083 had had one induced abortion between 1996-2008, 4,417 had two, and 942 had three or more induced abortions before a first birth (excluding twins and triplets).
Having an induced abortion may increase a woman's risk for breast cancer later in life by nearly one third, according to a review and statistical analysis of 23 studies of women with breast cancer, which appeared in the October 1996 Journal of Epidemiology and Community Health, published by the British Medical Association.