Pregnancy and Termination

Pregnancy and Termination
PCL 07 – Sharon’s dilemma
Amber Hartley

Termination, or abortion, of pregnancy, may be deliberate or spontaneous. Deliberate termination of pregnancy can be performed at different stages of the pregnancy and in different ways.

The two main types of deliberate termination are surgical and medical. Terminations are generally not performed prior to 6 weeks gestation, due to the danger of incomplete abortion. Ideally, terminations should be performed before 12 weeks, and week 7 or 8 is generally considered the best time. Terminations can be performed between 12 and 16 weeks, although with more difficulty after 16 weeks. Terminations after 18 weeks are very rarely performed.

Surgical methods

Suction curettage
§ May be used up to 15 weeks gestation
§ Procedure involves dilating the cervix and then inserting a small flexible tube attached to a suction pump. The suction pump is then used to remove the products of conception and a curette is used to ensure that no products of conception remain. The procedure takes about 10 minutes.
§ Requires local or general anaesthesia
§ Failure rate is 2-3 per 1000 (this rate is higher prior to 7 weeks gestation)
§ Side effects include mild pain and bleeding, infections (up to 10% of suction curettage abortions result in infection), Cervical trauma (<10>

Manual vacuum aspiration

• May be used prior to 7 weeks
• Not really used much in Australia
• Lower failure rate for early abortion than suction curettage

Dilation and Evacuation (D & E)

• Used after 14 weeks
• Mild pain and bleeding may result, which are more prolonged than at earlier gestation
• Complication rates rise with gestation (ie. the later the termination, the greater chance of complications). Complications include cervical trauma (8-22 in 1000), Uterine perforation (2-4 in 1000), Haemorrhage requiring transfusion (2-4 in 1000).

Medical methods

Involves use of drugs: mifepristone (RU486) plus misoprostal.
Mifepristone not available in Australia (in 2005)
Can be used throughout first and second trimesters
Women are usually aware of the passage of products of conception. This may be accompanied by some pain.
Side effects:

• Bleeding
• Diarrhoea
• Nausea and vomiting
• Dizziness, hot flushes, chills
• Headache

Long term risks associated with Termination

• Some increased risk of later miscarriage, preterm birth, and placenta praevia
• No association with infertility, ectopic pregnancy or breast cancer.

Under Medicare, costs of having a termination range from $180 to $350.

Figure 1: Suction Curettage

References

http://www.whg.org.au/PDFs/Pregnancy%20termination%20brochure%20January%202007.pdf

http://www.ranzcog.edu.au/womenshealth/pdfs/Termination-of-pregnancy.pdf

http://survivors.la/images/sa-9-weeks.jpg

http://archives.cnn.com/2000/HEALTH/11/21/abortion.pill/ap.abortion.pill.uterus.gif