From the Guidelines
Abortion procedures should be performed in a hospital setting, with the safest method being dilatation and evacuation in both the first and second trimesters, as it minimizes risks to the mother and fetus. When considering abortion, it's crucial to prioritize methods that reduce morbidity, mortality, and improve quality of life. According to the European Society of Cardiology guidelines 1, pregnancy termination should be discussed with women in whom gestation represents a major maternal or fetal risk, and the first trimester is the safest time for elective pregnancy termination.
The method of abortion can vary depending on the stage of pregnancy. For example, up to 7 weeks gestation, mifepristone is an alternative to surgery, while in the second trimester, prostaglandins E1 or E2, or misoprostol, can be administered to evacuate the uterus 1. However, it's essential to note that prostaglandin F compounds should be avoided because they can significantly increase pulmonary arterial pressure (PAP) and may decrease coronary perfusion 1.
Key considerations for abortion procedures include:
- The need for anesthesia, which should be considered on an individual basis 1
- The use of antibiotic prophylaxis to prevent post-abortal endometritis, which occurs in 5–20% of women not given antibiotics 1
- Monitoring of systemic arterial oxygen saturation and blood pressure when administering prostaglandin E compounds 1
- Avoiding saline abortion due to the risk of expansion of the intravascular volume, heart failure, and clotting abnormalities 1
By prioritizing the safest and most effective methods, such as dilatation and evacuation, and considering individual patient needs and medical history, abortion procedures can be performed with minimal risks to the mother and fetus, ultimately improving morbidity, mortality, and quality of life outcomes.
From the FDA Drug Label
WARNING: TERMINATION OF PREGNANCY Mifepristone is a potent antagonist of progesterone and cortisol via the progesterone and glucocorticoid (GR-II) receptors, respectively. The antiprogestational effects will result in the termination of pregnancy. WARNING: TERMINATION OF PREGNANCY See full prescribing information for complete boxed warning. Mifepristone has potent antiprogestational effects and will result in the termination of pregnancy.
An abortion with mifepristone works by blocking progesterone, a hormone necessary for pregnancy to continue. The antiprogestational effects of mifepristone will result in the termination of pregnancy 2 2.
- Mifepristone is a potent antagonist of progesterone and cortisol via the progesterone and glucocorticoid receptors.
- The termination of pregnancy is a result of the antiprogestational effects of mifepristone.
From the Research
Abortion Methods
There are two main methods of abortion: medical and surgical.
- Medical abortion involves the use of medications to terminate a pregnancy, typically up to 9 weeks of gestation 3, 4.
- Surgical abortion involves a procedure to remove the pregnancy from the uterus, which can be performed at various gestational ages 5, 6, 7.
Medical Abortion
Medical abortion typically involves a combination of two medications: mifepristone and misoprostol.
- Mifepristone is taken first to block the hormone progesterone, which is necessary for pregnancy to continue.
- Misoprostol is taken 24-48 hours later to cause the uterus to contract and expel the pregnancy 3, 4.
- The effectiveness of medical abortion can depend on the dose and route of administration of the medications, as well as the gestational age of the pregnancy 3.
Surgical Abortion
Surgical abortion involves the use of vacuum aspiration or dilation and evacuation (D&E) to remove the pregnancy from the uterus.
- Vacuum aspiration is typically used up to 12-14 weeks of gestation, while D&E is used for later gestations 5, 6.
- The procedure can be performed under local or general anesthesia, and may involve the use of cervical preparation and pain management medications 5, 6.
Safety and Efficacy
Both medical and surgical abortion methods are safe and effective when performed by trained healthcare providers.