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Category: Gynecology | Obstetrics

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Abortion overview

Published: July 16, 2009. Updated: August 09, 2009

Abortion, in its most common usage, refers to the deliberate early termination of a pregnancy, resulting in the death of the embryo or fetus. Medically, the term also refers to the early termination of a pregnancy by natural causes ("spontaneous abortion" or miscarriage, which ends 1 in 5 of all pregnancies, usually within the first 13 weeks) or to the cessation of normal growth of a body part or organ. What follows is a discussion of the issues related to deliberately induced abortion.

"Morning after" or "emergency" contraceptive drugs that are taken within 72 hours of sex interfere with the release of eggs from the ovary or with fertilization, and so are not generally considered to be forms of abortion, though some groups (notably the Roman Catholic Church) consider them to be abortions, because they interfere with implantation of a zygote when taken later. (The medical definition of pregnancy requires that implantation has already occurred so, technically, emergency contraceptives do not interfere with pregnancy. The controversy arises when one considers that conception occurs before implantation. Some believe the zygote is a human being with the same moral standing of an implanted embryo before pregnancy technically starts.)

Methods of abortion

Depending on the stage of pregnancy, an abortion is performed by a number of different methods. Chemical abortion is the usual method when it is induced before the first nine weeks. The procedure consists of administering either methotrexate or mifepristone (RU-486) followed by administration of misoprostol. Approximately 8% of these abortions require surgical followup.

In the first fifteen weeks, suction-aspiration or vacuum abortion is one of the most common methods, replacing the more risky dilation and curettage (D & C). Manual vacuum aspiration (MVE) consists of emptying the uterus by suction using a manual syringe. From the fifteenth week up until around the eighteenth week a surgical dilation and extraction (D & E) is used. D & E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.

Dilation and suction curettage consists of emptying the uterus by suction using a special apparatus. Curettage is cleaning the walls of uterus with a curette. Dilation and curettage (D & C) is a standard gynaecological procedure performed for a variety of reasons, such as examination.

As the fetus size increases, other techniques must be used to secure abortion in the third trimester. Premature expulsion of the fetus can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with saline or urea solution. Very late abortions can be brought about by the controversial intact dilation and extraction (D & X) or a hysterotomy abortion, similar to a caesarian section, and requiring the surgical decompression of the fetus's head before evacuation. (This is the procedure controversially termed "partial-birth abortion").

Possible side effects

Postabortion psychological problems

Abortion may increase a woman's risk of depression. According to a study of 1,884 women conducted by the National Longitudinal Survey of Youth, women who did not carry their first pregnancies to term are 65% more likely to be diagnosed with clinical depression around eight years later. However, other studies did not support that depression may be caused by abortion. For example, a study of 2.525 women revealed that women who had an abortion were more likely to report depression or lower satisfaction with their lives. However, they also often reported rape, childhood physical and sexual abuse, and violent partners. After controlling for the history of abuse, partner characteristics, and background variables, abortion was not related to poorer mental health (Denious, J. & Russo, N. F. (2000). The Socio-Political Context of Abortion and its Relationship to Women's Mental Health. In J. Ussher (Ed.). Women's Health: Contemporary International Perspectives (pp. 431-439). London: British Psychological Society.).

Postabortion physical problems

Physical complications: studies found that the risk of serious physical complications of an abortion is less than 1%. The only viable alternative - birth - is several times riskier than abortion. The exact risk and type of complications depend on the abortion method. Breast cancer: an analysis of 53 epidemological studies undertaken in 16 countries did not find evidence of a relationship between abortion and breast cancer.

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