What are the different types of abortion?

Types of Abortion

The two main types of abortion are medical abortion and surgical abortion, with specific methods determined by gestational age and patient factors. 1

Medical Abortion

Medical abortion involves using medications to terminate a pregnancy without surgical intervention:

• Mifepristone and Misoprostol Combination - The most widely researched and effective medical abortion regimen 2

  • Mifepristone (200-600mg orally) followed 36-48 hours later by misoprostol 2
  • Effective up to 63 days (9 weeks) gestation, with approximately 95% effectiveness 3
  • Vaginal administration of misoprostol is more effective than oral administration 2

• Misoprostol Alone - Less effective than combination therapy but used when mifepristone is unavailable 2

  • Can cause uterine contractions, uterine bleeding, and expulsion of products of conception 4
  • Higher failure rates compared to combination therapy (1.4 to 3.75 times more likely to fail) 2

• Methotrexate with Misoprostol - Alternative regimen where mifepristone is unavailable 2

  • No significant difference between intramuscular and oral administration of methotrexate 2
  • No significant difference between early (day 3) and late (day 5) administration of prostaglandin 2

Surgical Abortion

Surgical methods involve physically removing pregnancy tissue from the uterus:

• Vacuum Aspiration - Most common surgical method for first trimester 5, 6

  • Manual or electric vacuum aspiration
  • Appropriate for women between 7 and 14 weeks gestation 5
  • Shorter duration of bleeding compared to medical methods 7

• Dilation and Evacuation (D&E) - Used for second trimester abortions 5, 6

  • Involves dilating the cervix and removing fetal tissue with specialized instruments
  • Requires more cervical preparation as gestational age advances 6

• Dilation and Curettage (D&C) - Less commonly used now but still performed in some settings 2

  • Involves scraping the uterine lining with a curette after dilating the cervix

Classification by Timing

• First Trimester Abortion (up to 12-14 weeks) 8

  • Can be performed using either medical or surgical methods
  • Medical abortion is most effective earlier in the first trimester 2
  • Surgical methods (vacuum aspiration) are highly effective throughout the first trimester 6

• Second Trimester Abortion (>12-14 weeks to 24 weeks) 8

  • Primarily performed using D&E or medical methods
  • Medical methods require higher doses and may take longer 5

Spontaneous Abortion (Miscarriage)

• Natural pregnancy loss without intervention 8
• May require medical or surgical intervention if incomplete 8

Clinical Considerations

• Safety Profile: Both medical and surgical methods are generally safe when performed by trained providers 5

  • One major complication (uterine perforation) was reported in surgical group in comparative studies 7
  • Medical abortion may have more prolonged bleeding 7

• Cost Implications: Medical abortions are typically less costly than surgical procedures 1

  • Abortions performed at earlier gestational ages cost less than those performed later 1

• Patient Preference: Some women prefer medical abortion to avoid a surgical procedure 3

  • However, surgical abortion provides more immediate completion 7

• Contraindications: Medical abortion is contraindicated in cases of:

  • Confirmed or suspected ectopic pregnancy 9, 4
  • Chronic adrenal failure or long-term corticosteroid therapy 9
  • Known coagulopathy or anticoagulant therapy 4

Potential Complications

• Medical Abortion:

  • Incomplete abortion requiring surgical intervention 2
  • Prolonged bleeding 7
  • Gastrointestinal side effects (nausea, vomiting, diarrhea) 2

• Surgical Abortion:

  • Uterine perforation (rare) 7
  • Cervical injury 6
  • Infection 6

Access Considerations

• Timely access to abortion services is critical as earlier procedures offer more options and improved safety 1
• Delays in accessing services may limit choice between medical and surgical methods 1
• Streamlined services and centralized referral systems improve access 1