Elective Medical Abortion

Overview & Description

When a woman chooses to end a pregnancy, the procedure is called an elective abortion. The fetus may be removed from the uterus by means of an elective surgical abortion or an elective medical abortion. A medical abortion is done by giving the woman medicines that will end the pregnancy.

Who is a candidate for the procedure?

Any woman who chooses to end a pregnancy for health or personal reasons is a candidate for an elective abortion. Abortions are legal in the United States during the first 12 weeks of pregnancy. After that, abortion is regulated by each state.

How is the procedure performed?

Before an abortion is done, a doctor will confirm that a woman is pregnant. The length of a pregnancy will be measured by noting the number of days that have passed since the first day of her last menstrual period, known as the LMP. A medical abortion can be done as soon as the pregnancy is confirmed. Medical abortions do not work as well later in pregnancy, so they are not generally used past 7 weeks after LMP. After 7 weeks, an elective surgical abortion can be used.

To prepare for an abortion, a pelvic exam might be done to confirm the size of the uterus. Lab studies will rule out anemia, determine the woman's Rh factor, and screen for sexually transmitted diseases. The woman should be taught what to expect during and after the procedure, and psychological support should be given as needed. Medicines used for a medical abortion include:

methotrexate, a medicine approved by the Food and Drug Administration, called the FDA, for cancer treatment. Methotrexate is most often given as a shot, but it also can be taken by mouth. Methotrexate stops the fertilized egg from implanting in the uterine lining during the first few weeks after conception.

mifepristone, known as RU-486, which was recently approved by the FDA for medical abortions. Mifepristone works by blocking the female hormone progesterone. As a result, the lining of the uterus breaks down and is passed out of the uterus, along with the fetus, through the cervix.

misoprostol, which is taken a few days after the woman takes either methotrexate or mifepristone. Misoprostol is given by tablets that are either swallowed or inserted into the vagina. It causes the uterus to contract and expel the fetus through the vagina.

Preparation & Expectations

What happens right after the procedure?

A medical abortion can take from 3 days to 3 to 4 weeks. After the first medicine (methotrexate or mifepristone) is given for a medical abortion, the woman can go home. Some women will have vaginal bleeding after the first medicine. The bleeding can range from light to heavy.

The woman will return to the doctor for a second visit to take the misoprostol. The uterine cramping caused by this medicine might result in the embryo being expelled right away while at the doctor's office. In other cases, the tissue is assed later at home. Many women will have cramps for several hours and pass blood clots as they are aborting. Most of these symptoms should start to taper off after the embryo has been passed. Bleeding can last for 1 or 2 weeks more. Headache, nausea, vomiting, and diarrhea can also be caused by misoprostol.

Finally, a third visit will be made so that the doctor can check to be sure that the abortion was complete. Of the women who take methotrexate, 80% to 85% will abort within 2 weeks. A woman who takes longer may need more misoprostol. With mifepristone, 95% to 97% of the women will expel the uterine contents within 2 weeks. About 5% of the women who choose to have an elective medical abortion require a surgical abortion because the medicine does not work.

After any abortion, a woman with Rh negative blood should be given an injection of Rh immune globulin unless the father is also known to have Rh negative blood. Pain medicines may also be prescribed. Sometimes antibiotics are needed to help prevent infection.

Home Care and Complications

What happens later at home?

Once she's home, a woman should:

call the doctor if there are any new or worsening symptoms, such as fever, severe or lasting abdominal distress, or heavy vaginal bleeding

be aware of the possible emotional effects of abortion. Some women have depression similar to postpartum depression after an abortion.

avoid using tampons or having sex for at least 2 weeks

slowly resume daily activity as she is able

If a woman has no problems after the abortion, it is likely that she will be able to get pregnant again later. A follow-up visit with a doctor should include a pelvic exam to be sure the uterus shrinks in size. This office visit is also a good time for a woman and her doctor to discuss birth control, so she can choose a method that will work well for her.

What are the potential complications after the procedure?

Any type of abortion can cause heavy bleeding that might require a D&C or blood transfusion. Long-term complications have not been linked with the medicines used for medical abortion.