therapeutic abortion


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Related to therapeutic abortion: spontaneous abortion, criminal abortion, Elective Abortion

Abortion, Therapeutic

 

Definition

Therapeutic abortion is the intentional termination of a pregnancy before the fetus can live independently. Abortion has been a legal procedure in the United States since 1973.

Purpose

An abortion may be performed whenever there is some compelling reason to end a pregnancy. Women have abortions because continuing the pregnancy would cause them hardship, endanger their life or health, or because prenatal testing has shown that the fetus will be born with severe abnormalities.
Abortions are safest when performed within the first six to 10 weeks after the last menstrual period. The calculation of this date is referred to as the gestational age and is used in determining the stage of pregnancy. For example, a woman who is two weeks late having her period is said to be six weeks pregnant, because it is six weeks since she last menstruated.
About 90% of women who have abortions do so before 13 weeks and experience few complications. Abortions performed between 13-24 weeks have a higher rate of complications. Abortions after 24 weeks are extremely rare and are usually limited to situations where the life of the mother is in danger.

Precautions

Most women are able to have abortions at clinics or outpatient facilities if the procedure is performed early in pregnancy. Women who have stable diabetes, controlled epilepsy, mild to moderate high blood pressure, or who are HIV positive can often have abortions as outpatients if precautions are taken. Women with heart disease, previous endocarditis, asthma, lupus erythematosus, uterine fibroid tumors, blood clotting disorders, poorly controlled epilepsy, or some psychological disorders usually need to be hospitalized in order to receive special monitoring and medications during the procedure.

Description

Very early abortions

Between five and seven weeks, a pregnancy can be ended by a procedure called menstrual extraction. This procedure is also sometimes called menstrual regulation, mini-suction, or preemptive abortion. The contents of the uterus are suctioned out through a thin (3-4 mm) plastic tube that is inserted through the undilated cervix. Suction is applied either by a bulb syringe or a small pump.
Another method is called the "morning after" pill, or emergency contraception. Basically, it involves taking high doses of birth control pills within 24 to 48 hours of having unprotected sex. The high doses of hormones causes the uterine lining to change so that it will not support a pregnancy. Thus, if the egg has been fertilized, it is simply expelled from the body.
There are two types of emergency contraception. One type is identical to ordinary birth control pills, and uses the hormones estrogen and progestin). This type is available with a prescription under the brand name Preven. But women can even use their regular birth control pills for emergency contraception, after they check with their doctor about the proper dose. About half of women who use birth control pills for
Between 5 and 7 weeks, a pregnancy can be ended by a procedure called menstrual extraction. The contents of the uterus are suctioned out through a thin extraction tube that is inserted through the undilated cervix.
Between 5 and 7 weeks, a pregnancy can be ended by a procedure called menstrual extraction. The contents of the uterus are suctioned out through a thin extraction tube that is inserted through the undilated cervix.
(Illustration by Electronic Illustrators Group.)
emergency contraception get nauseated and 20 percent vomit. This method cuts the risk of pregnancy 75 percent.
The other type of morning-after pill contains only one hormone: progestin, and is available under the brand name Plan B. It is more effective than the first type with a lower risk of nausea and vomiting. It reduces the risk of pregnancy 89 percent.
Women should check with their physicians regarding the proper dose of pills to take, as it depends on the brand of birth control pill. Not all birth control pills will work for emergency contraception.
Menstrual extractions are safe, but because the amount of fetal material is so small at this stage of development, it is easy to miss. This results in an incomplete abortion that means the pregnancy continues.

First trimester abortions

The first trimester of pregnancy includes the first 13 weeks after the last menstrual period. In the United States, about 90% of abortions are performed during this period. It is the safest time in which to have an abortion, and the time in which women have the most choice of how the procedure is performed.

Key terms

Endocarditis — An infection of the inner membrane lining of the heart.
Fibroid tumors — Fibroid tumors are non-cancerous (benign) growths in the uterus. They occur in 30-40% of women over age 40, and do not need to be removed unless they are causing symptoms that interfere with a woman's normal activities.
Lupus erythematosus — A chronic inflammatory disease in which inappropriate immune system reactions cause abnormalities in the blood vessels and connective tissue.
Prostaglandin — Oxygenated unsaturated cyclic fatty acids responsible for various hormonal reactions such as muscle contraction.
Rh negative — Lacking the Rh factor, genetically determined antigens in red blood cells that produce immune responses. If an Rh negative woman is pregnant with an Rh positive fetus, her body will produce antibodies against the fetus's blood, causing a disease known as Rh disease. Sensitization to the disease occurs when the women's blood is exposed to the fetus's blood. Rh immune globulin (RhoGAM) is a vaccine that must be given to a woman after an abortion, miscarriage, or prenatal tests in order to prevent sensitization to Rh disease.
MEDICAL ABORTIONS. Medical abortions are brought about by taking medications that end the pregnancy. The advantages of a first trimester medical abortion are:
  • The procedure is non-invasive; no surgical instruments are used.
  • Anesthesia is not required.
  • Drugs are administered either orally or by injection.
  • The procedure resembles a natural miscarriage.
Disadvantages of a medical abortion are:
  • The effectiveness decreases after the seventh week.
  • The procedure may require multiple visits to the doctor.
  • Bleeding after the abortion lasts longer than after a surgical abortion.
  • The woman may see the contents of her womb as it is expelled.
Two different medications can be used to bring about an abortion. Methotrexate (Rheumatrex) works by stopping fetal cells from dividing which causes the fetus to die.
On the first visit to the doctor, the woman receives an injection of methotrexate. On the second visit, about a week later, she is given misoprostol (Cytotec), an oxygenated unsaturated cyclic fatty acid responsible for various hormonal reactions such as muscle contraction (prostaglandin), that stimulates contractions of the uterus. Within two weeks, the woman will expel the contents of her uterus, ending the pregnancy. A follow-up visit to the doctor is necessary to assure that the abortion is complete.
With this procedure, a woman will feel cramping and may feel nauseated from the misoprostol. This combination of drugs is 90-96% effective in ending pregnancy.
Mifepristone (RU-486), which goes by the brand name Mifeprex, works by blocking the action of progesterone, a hormone needed for pregnancy to continue, then stimulates ulerine contractions thus ending the pregnancy. It can be taken as much as 49 days after the first day of a woman's last period. On the first visit to the doctor, a woman takes a mifepristone pill. Two days later she returns and, if the miscarriage has not occurred, takes two misoprostol pills, which causes the uterus to contract. Five percent of women won't need to take misoprostol. After an observation period, she returns home.
Within four days, 90% of women have expelled the contents of their uterus and completed the abortion. Within 14 days, 95-97% of women have completed the abortion. A third follow-up visit to the doctor is necessary to confirm through observation or ultrasound that the procedure is complete. In the event that it is not, a surgical abortion is performed. Studies show that 4.5 to 8 percent of women need surgery or a blood transfusion after taking mifepristone, and the pregnancy persists in about 1 percent of women. In this case, surgical abortion is recommended because the fetus may be damanged. Side effects include nausea, vaginal bleeding and heavy cramping. The bleeding is typically heavier than a normal period and may last up to 16 days.
Mifepristone is not recommended for women with ectopic pregnancy, an IUD, who have been taking long-term steroidal therapy, have bleeding abnormalities or on blood-thinners such as Coumadin.

Surgical abortions

First trimester surgical abortions are performed using vacuum aspiration. The procedure is also called dilation and evacuation (D & E), suction dilation, vacuum curettage, or suction curettage.
Advantages of a vacuum aspiration abortion are:
  • It is usually done as a one-day outpatient procedure.
  • The procedure takes only 10-15 minutes.
  • Bleeding after the abortion lasts five days or less.
  • The woman does not see the products of her womb being removed.
Disadvantages include:
  • The procedure is invasive; surgical instruments are used.
  • Infection may occur.
During a vacuum aspiration, the woman's cervix is gradually dilated by expanding rods inserted into the cervical opening. Once dilated, a tube attached to a suction pump is inserted through the cervix and the contents of the uterus are suctioned out. The procedure is 97-99% effective. The amount of discomfort a woman feels varies considerably. Local anesthesia is often given to numb the cervix, but it does not mask uterine cramping. After a few hours of rest, the woman may return home.

Second trimester abortions

Although it is better to have an abortion during the first trimester, some second trimester abortions may be inevitable. The results of genetic testing are often not available until 16 weeks. In addition, women, especially teens, may not have recognized the pregnancy or come to terms with it emotionally soon enough to have a first trimester abortion. Teens make up the largest group having second trimester abortions.
Some second trimester abortions are performed as a D & E. The procedures are similar to those used in the first trimester, but a larger suction tube must be used because more material must be removed. This increases the amount of cervical dilation necessary and increases the risk of the procedure. Many physicians are reluctant to perform a D & E this late in pregnancy, and for some women is it not a medically safe option.
The alternative to a D & E in the second trimester is an abortion by induced labor. Induced labor may require an overnight stay in a hospital. The day before the procedure, the woman visits the doctor for tests, and to either have rods inserted in her cervix to help dilate it or to receive medication that will soften the cervix and speed up labor.
On the day of the abortion, drugs, usually prostaglandins to induce contractions, and a salt water solution, are injected into the uterus. Contractions begin, and within eight to 72 hours the woman delivers the fetus.
Side effects of this procedure include nausea, vomiting, and diarrhea from the prostaglandins, and pain from uterine cramps. Anesthesia of the sort used in childbirth can be given to mask the pain. Many women are able to go home a few hours after the procedure.
Very early abortions cost between $200-$400. Later abortions cost more. The cost increases about $100 per week between the thirteenth and sixteenth week. Second trimester abortions are much more costly because they often involve more risk, more services, anesthesia, and sometimes a hospital stay. Insurance carriers and HMOs may or may not cover the procedure. Federal law prohibits federal funds including Medicaid funds, from being used to pay for an elective abortion.

Preparation

The doctor must know accurately the stage of a woman's pregnancy before an abortion is performed. The doctor will ask the woman questions about her menstrual cycle and also do a physical examination to confirm the stage of pregnancy. This may be done at an office visit before the abortion or on the day of the abortion. Some states require a waiting period before an abortion can be performed. Others require parental or court consent for a child under age 18 to receive an abortion.
Despite the fact that almost half of all women in the United States have had at least one abortion by the time they reach age 45, abortion is surrounded by controversy. Women often find themselves in emotional turmoil when deciding if an abortion is a procedure they wish to undergo. Pre-abortion counseling is important in helping a woman resolve any questions she may have about having the procedure.

Aftercare

Regardless of the method used to perform the abortion, a woman will be observed for a period of time to make sure her blood pressure is stable and that bleeding is controlled. The doctor may prescribe antibiotics to reduce the chance of infection. Women who are Rh negative (lacking genetically determined antigens in their red blood cells that produce immune responses) should be given a human Rh immune globulin (RhoGAM) after the procedure unless the father of the fetus is also Rh negative. This prevents blood incompatibility complications in future pregnancies.
Bleeding will continue for about five days in a surgical abortion and longer in a medical abortion. To decrease the risk of infection, a woman should avoid intercourse and not use tampons and douches for two weeks after the abortion.
A follow-up visit is a necessary part of the woman's aftercare. Contraception will be offered to women who wish to avoid future pregnancies, because menstrual periods normally resume within a few weeks.

Risks

Serious complications resulting from abortions performed before 13 weeks are rare. Of the 90% of women who have abortions in this time period, 2.5% have minor complications that can be handled without hospitalization. Less than 0.5% have complications that require a hospital stay. The rate of complications increases as the pregnancy progresses.
Complications from abortions can include:
  • uncontrolled bleeding
  • infection
  • blood clots accumulating in the uterus
  • a tear in the cervix or uterus
  • missed abortion where the pregnancy continues
  • incomplete abortion where some material from the pregnancy remains in the uterus
Women who experience any of the following symptoms of post-abortion complications should call the clinic or doctor who performed the abortion immediately.
  • severe pain
  • fever over 100.4°F (38.2°C)
  • heavy bleeding that soaks through more than one sanitary pad per hour
  • foul-smelling discharge from the vagina
  • continuing symptoms of pregnancy

Normal results

Usually the pregnancy is ended without complication and without altering future fertility.

Resources

Books

Carlson, Karen J., Stephanie A. Eisenstat, and Terra Ziporyn. "Abortion." In The Harvard Guide to Women's Health. Cambridge, MA: Harvard University Press, 1996.

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.

ther·a·peu·tic a·bor·tion

abortion induced for the sake of the mother's physical or mental health or to prevent the birth of a congenitally compromised child or of a child conceived as a result of nonconsensual sexual intercourse.

therapeutic abortion

n.
1. Any of various procedures resulting in the termination of a pregnancy by a physician.
2. Any of various procedures resulting in the termination of a pregnancy in order to save the life of the mother, preserve her health, or prevent the birth of a severely ill or deformed infant.

therapeutic abortion

1 a termination of early pregnancy deemed necessary by a physician.
2
Usage notes: (informal)
any legal induced abortion. Compare elective abortion. See also induced abortion.

therapeutic abortion

Gynecology The termination of pregnancy before fetal viability in order to preserve maternal health. In its broadest definition, therapeutic abortion can be performed to (1) save the life of the mother, (2) preserve the health of the mother, (3) terminate a pregnancy that would result in the birth of a child with defects incompatible with life or associated with significant morbidity, (4) terminate a nonviable pregnancy, or (5) selectively reduce a multifetal pregnancy. Cf Elective abortion.

ther·a·peu·tic a·bor·tion

(thār'ă-pyū'tik ă-bōr'shŭn)
Abortion induced because of the mother's physical or mental health, or to prevent birth of a deformed child or a child conceived as the result of rape or incest.

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 ?
On May 21, 2014, during the annual presidential address, President Bachelet announced her plans to introduce a bill on therapeutic abortion.
PANB, FMC, RS765, file 10-3809, "Number of Therapeutic Abortions Performed on N.
The association between therapeutic abortions and prematurity has been seen before; however, our study was different in that it tried to examine the relationship between TABs and the timing of prematurity," explained Dr.
We oversampled pregnancy episodes with less common outcomes, such as ectopic pregnancies, stillbirths, and therapeutic abortions.
One obstetrician warned that the dangers of drinking during pregnancy are so serious, therapeutic abortion for alcoholic women may be advised.
It is, however, precisely at the point at which the limits of therapeutic abortion begin to become blurred that the tension between the doctrine of fetal nonpersonhood and rational morality begins to manifest itself.
The 1931 Health Code regulated therapeutic abortion until it was repealed in September 1989, a few months before the end of the regime of dictator Augusto Pinochet in March 1990.
The hospital denied her petition for legal therapeutic abortion.
Therapeutic abortion is permitted to save the lives of women and performed in hospitals, where complications of clandestine abortions are also treated.
In Chile, all abortion is illegal, although therapeutic abortion was allowed from 1931 to 1989, when the military dictatorship eliminated this exception.
However, if in the judgment of reputable medical authorities the continuation of pregnancy seriously endangers the physical or mental health of the mother, therapeutic abortion may be necessary.
In my view, legislation that forces women to have to stand in line in an overburdened, publicly funded health-care system and to have to wait for a therapeutic abortion, a procedure that probably must be performed in a timely manner, is a gross violation of the right of women to both liberty and security of the person," Oliphant wrote, according to the Free Press.