Introduction
Induced abortion otherwise known as safe abortion refers to the deliberate termination of pregnancy.
Termination of pregnancy is requested for and done for reasons permissible by law either through a surgical procedure or by pharmacological means.
In most countries, an induced abortion may be carried out legally only under the following conditions:
- in case of rape
- defilement or incest
- threat to the physical and mental health of the mother
- presence of foetal abnormality and
- mental retardation of the mother.
Patients given a pharmacological option for abortion will need to be monitored closely for completeness of the abortion process.
They should be informed to report back immediately in cases of profuse or heavy vaginal bleeding, fever or offensive vaginal discharge.
We have different types of abortion which include:
- Complete abortion
- Septic abortion
- Safe abortion
- Missed abortion
- Inevitable abortion
- Incomplete abortion
- Threatened abortion etc.
Investigations
- FBC
- Blood group and Rhesus factor
- Special Investigations for medico-legal indications e.g. rape (DNA, HIV status etc.)
Treatment
Treatment objectives
- To ensure that legal requirements for termination are met
- To ensure safe abortion
- To provide family planning counselling and services as needed
- To prevent risk of Rhesus incompatibility in future pregnancies
Non-pharmacological treatment
- Manual Vacuum Aspiration (4-12 week gestation)
- Dilatation and curettage (4-12 week gestation)
- Cervical ripening followed by Dilatation and Evacuation (D&E) (> 12 weeks gestation)
Pharmacological treatment
A. Medication Abortion
Evidence Rating: [A]
Mifepristone
Then
Misoprostol
Dosage regimes for Mifepristone and Misoprostol for various gestational ages
[table id=13 /
Note
Uterine sensitivity to Misoprostol increases with gestational age.
Lower doses of misoprostol are therefore used for older gestations.
*Medication Abortions in second trimester should only be done by doctors
Referral Criteria
For all types of abortion, refer early for specialist care if the uterus is suspected or found to be perforated or if complications e.g. infection or
profuse bleeding are severe.