induced abortion

abortion /abor·tion/ (ah-bor´shun)

1. expulsion from the uterus of the products of conception before the fetus is viable.

2. premature stoppage of a natural or a pathological process.

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artificial abortion  induced a.

complete abortion  one in which all the products of conception are expelled from the uterus and identified.

habitual abortion  spontaneous abortion occurring in three or more successive pregnancies, at about the same level of development.

incomplete abortion  that with retention of parts of the products of conception.

induced abortion  that brought on intentionally by medication or instrumentation.

inevitable abortion  a condition in which vaginal bleeding has been profuse and the cervix has become dilated, and abortion will invariably occur.

infected abortion  that associated with infection of the genital tract.

missed abortion  retention in the uterus of an abortus that has been dead for at least eight weeks.

septic abortion  that associated with serious infection of the uterus leading to generalized infection.

spontaneous abortion  that occurring naturally.

therapeutic abortion  that induced for medical considerations.

threatened abortion  a condition in which vaginal bleeding is less than in inevitable abortion and the cervix is not dilated, and abortion may or may not occur.

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in·duced abortion (n-dst)

n.

Abortion caused intentionally by the administration of drugs or by mechanical means.

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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 psychologic sequelae. Follow-up is routinely scheduled about 2 weeks after the procedure.

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abortion

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

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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 cattle.

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.

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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.