Abortion Information

DIALTION AND EVACUATION (D&E): ABOUT 13 TO 24 WEEKS AFTER LMP
The majority of second trimester abortions are performed using this method. The cervix must be opened wider than in a first trimester abortion because the fetus is larger. This is done by inserting numerous thin rods made of seaweed a day or two before the abortion and/or giving other oral or vaginal medications to further soften the cervix. Up to about 16 weeks gestation, the procedure is identical to the first trimester one. After the cervix is stretched open and the uterine contents suctioned out, any remaining fetal parts are removed with a grasping tool (forceps). A curette (a loop-shaped tool) may also be used to scrape out any remaining tissue.

After 16 weeks, much of the procedure is done with the forceps to pull fetal parts out through the cervical opening, as suction alone will not work due to the fetus' size. The doctor keeps track of what fetal parts have been removed so that none are left inside as this can potentially cause infection. Lastly, a curette, and/or the suction machine are used to remove any remaining tissue or blood clots, which if left behind cause infection and bleeding.

MEDICATION METHODS FOR SECOND TRIMESTER INDUCED ABORTION
This technique induces abortion by using medicines to cause labor and eventual delivery of the fetus and placenta. Like labor at term, this procedure typically involves 10-24 hours in the hospital's labor and delivery unit. Dogoxin or potassium chloride is injected into the amniotic fluid, umbilical cord or fetal heart prior to labor to avoid the delivery of a live fetus. The cervix is softened with the use of seaweed sticks and/or medications. Next, oral mifepristone and oral or vaginal misoprostol are used to induce labor. In most cases, thes drugs result in the delivery of the dead fetus and placenta. The patient may receive oral or intravenous pain medications. Occasionally, scraping of the uterus is needed to remove the placenta.

Potential complications include hemorrhage and the need for a blood transfusion, retained placenta and possible uterine rupture (splits open).

D&E WHEN LIVE BIRTH IS POSSIBLE (FROM ABOUT 24 WEEKS AND UP)
This procedure typically takes 2-3 days and is associated with increased risk to the life and health of the mother. Because a live birth is possible, injections are given to cause fetal death. This is done in order to comply with the federal Partial-Birth Abortion Ban Act of 2003 which requires that the fetus be dead before complete removal from the mother's body. The medications (digoxin and potassium chloride) are either injected into the amniotic fluid, the umbilical cord or directly into the fetus' heart. The remainder of the procedure is the same as the second trimester D&E. Fetal parts are reassembled after removal from the uterus to make sure nothing was left behind to cause infection.

An alternate technique, called "Intact D E" is also used. The goal is to remove the fetus in one piece, thus reducing the risk of leaving parts behind or causing damage to the woman's body. This procedure requires the cervix be opened wider; however, it is still often necessary to crush the fetus' skull for removal as it is difficult to dilate the cervix wide enough to bring the head out intact.

Abortion carries the risk of significant complications such as bleeding, infection and damage to organs. Serious medical complications occur infrequently in early abortions, but increase with later abortions.  There is evidence that induced abortion can be associated with significant loss of both emotional and physical health long term.

Getting complete information on the risks associated with abortion is limited due to incomplete reporting and the lack of record-keeping linking abortions to complications. The information that is available reports the following risks:

HEAVY BLEEDING: Some bleeding after abortion is normal. However, if the cervix is torn or the uterus is punctured, there is a risk of severe bleeding known as hemorrhaging. When this happens, a blood transfusion may be required.

INFECTION: Infection can develop from the insertion of medical instruments into the uterus or from fetal parts that are mistakenly left inside (known as an incomplete abortion). This may cause bleeding and/or a pelvic infection requiring antibiotics, and may result in the need for a surgical procedure to fully empty the uterus. Infection may cause scarring of the pelvic organs.

ANESTHESIA: Complications from general anesthesia used during abortion surgery may result in convulsions, heart complications and death, in extreme cases.

DAMAGE TO THE ORGANS: The cervix and/or uterus may be cut, torn or punctured by abortion instruments. This may cause excessive bleeding requiring surgical repair. Curettes and other abortion instruments may cause permanent scarring of the uterine lining. The risk of these types of complications increases with the length of the pregnancy. If complications occur, major surgery may be required, including removal of the uterus (known as a hysterectomy). If the uterus is punctured or torn, there is also a risk that damage may occur to nearby organs such as the bowel and bladder.

RH SENSITIZATION: Every pregnant woman should receive blood type testing to learn if her blood type is "Rh postitive" or "Rh negative". Pregnant women who are Rh negative should receive Rhogam, an injection given to prevent the formation of antibodies that may harm the baby. If an Rh negative woman does not receive Rhogam with each pregnancy, she may develop antibodies which can cause serious complications with he next pregnancy. Rhogam is needed for Rh negative women who undergo abortion.

DEATH: In extreme cases, complications from abortion (excessive bleeding, infection, organ damage from a perforated uterus and adverse reations to anesthesia) may lead to death. The risk of death immediately following an induced abortion performed at or below 8 weeks is extremely low (approxiamtely 1 in a million) but increases with length of pregnancy. From 8 weeks to 16-20 weeks, the risk of death increases 30 times, and from 8 weeks to 21 weeks and over, it increases 100 times (1 in 11,000).