There are many methods that are used to
terminate a pregnancy.
The cost and type of an abortion procedure is often determined by
how many weeks a woman is into the pregnancy. Each one has risks
and possible complications. The following information is made available
by the Pennsylvania Department of Health and the U.S. Food &
Medical Abortions (1st trimester only)
What is MIFEPREX (mifepristone)
and how does it work?
Mifepristone is a drug that blocks
a hormone called progesterone that is needed for pregnancy to continue.
Mifepristone, when used together with another medicine called misoprostol,
is used to end an early pregnancy by inducing an abortion.
In Pennsylvania, the administration of mifepristone
for the purpose of inducing an abortion is regulated under the Abortion
About 5-8 out of 100 women taking mifepristone
will need a surgical procedure to complete the abortion or to stop
too much bleeding.
expect. This treatment causes cramping and bleeding. Usually,
these symptoms mean that the treatment is working to induce an abortion.
But sometimes women can get cramping and bleeding and still be pregnant.
This is why a woman who chooses an
abortion by this method must return to her provider on Day 3 and
about Day 14.
is a need for 2 follow-up visits with the health
care clinic providing this drug and access to a medical care
facility in case of an emergency.
If a woman is not already bleeding after
taking Mifeprex, she probably will begin to bleed once she takes
misoprostol. Bleeding or spotting can be expected for an average
of 9-16 days and may last for up to 30 days. The bleeding may be
similar to, or greater than, a normal heavy period. The woman may
see blood clots and tissue that come from her uterus. This is an
expected part of ending the pregnancy. Misoprostol may cause cramps,
nausea, diarrhea, and other symptoms. Other side effects of this
method include vomiting, headache, dizziness, back pain and tiredness.
and the need for surgery. In about 1 out of 100 women, bleeding
can be so heavy that it requires a surgical procedure (curettage)
to stop it.
Before a woman receives mifepristone, she
must be given a Medication Guide and sign a statement (Patient Agreement)
certifying that she has decided to end her pregnancy this way. Not
all women should take mifepristone, including those taking certain
other medications, those more than 49 days (7 weeks) past their
last menstrual period, and those who cannot easily get emergency
medical help in the 2 weeks after taking it.
For more information about medical abortions, visit:
FDA - Mifeprex (mifepristone) Information www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/
The First Trimester
use a vacuum aspiration method during the first trimester (the first
three months of pregnancy). The doctor must first check the size
of your uterus. Your doctor will ask you to lie on your back and
bend your knees. He or she will place one hand in your vagina and
the other on your abdomen (belly). The doctor will look at the opening
of your uterus (the cervix) using a speculum (a special instrument).
Next, the doctor will spray or inject medicine on your cervix. This
prevents you from feeling any pain. Then the doctor will put a catheter
(a soft, clear tube similar to a long straw) into your cervix. The
catheter is connected to a machine that acts like a vacuum cleaner.
The fetus is sucked out of the womb through the catheter.
If more than six weeks have passed since
your last normal period, the doctor must first gently open (dilate)
the cervix. He or she will use a larger, firmer plastic tube (a
curette) to remove (evacuate) the fetus.
click here for photos of the unborn child at 7 weeks, 8 weeks, 11 weeks,
12 weeks, and 14 weeks. Use your browser's back button to return
to this page after viewing the photos.
The Second Trimester
during a second trimester (the fourth, fifth, and sixth months of
pregnancy), to perform an abortion, the doctor opens (dilates) the
cervix and empties (evacuates) the uterus. This method is known
as dilation and evacuation (D & E).
When this abortion method is used in the
second trimester, the doctor may insert a sponge-like material into
the cervix. As the sponge gets wet it becomes larger, opening the
mouth of the cervix. The doctor will remove the sponge two to sixteen
hours later. The doctor uses forceps to remove the fetus or fetal
parts; the doctor may also suction the fetus or fetal parts by vacuum
aspiration using a larger catheter than described for the first
trimester. The afterbirth is most commonly removed by vacuum aspiration.
Before the doctor will perform this procedure,
he or she needs to feel the size of the uterus to determine the
gestational age of the fetus. If the age is determined to be late
in the second trimester, the doctor may elect to perform the abortion
by labor induction.
During labor induction, labor can be started
(induced) by injecting medicines or salt water into the fetal bag
of waters (amniotic sac). The medicine can be injected into the
bag of waters by cleaning the belly (abdomen) to kill germs on the
skin; putting numbing medicine (anesthetic) into the skin; and pushing
a needle through the skin into the bag of waters. Medicine may also
be injected into the woman's bloodstream through her vein to induce
labor. Labor will usually begin in two to four hours.
Generally, labor induction requires a longer
stay and is not performed in a clinic setting. If the afterbirth
is not removed with the fetus during labor induction, the doctor
must open the cervix and suction the uterus as described in the
vacuum aspiration method.
When an abortion is performed by the D &
E method, there is virtually no chance that the fetus will live
through the procedure. When an abortion is performed late in the
second trimester, the doctor may elect to inject medicine into the
fetus to terminate it before doing the vacuum aspiration. If the
labor induction method is used, there is minimal chance that a baby
could live for a short period of time. The chance of living outside
the uterus increases as gestational age increases. In the event
the baby removed is alive, a physician or other medical personnel
attending the baby is required by law to provide the type and degree
of care and treatment which in the good faith judgment of the physician
is commonly provided to any other person under similar conditions
click here for photos of the unborn child at 16 weeks and 20 weeks.
You can return to this page by using your browser's back button.
The Third Trimester
physician may advise you to end your pregnancy early between 24
and 38 weeks gestation (weeks menstrual). Should this advice call
for the use of any means to end your pregnancy with knowledge that
the termination by those means will, with reasonable likelihood,
cause the death of the unborn child, then the termination of pregnancy
using such means is an abortion. An abortion at this stage of your
pregnancy may only be done if your physician reasonably believes
that it is necessary to prevent either your death or a substantial
and irreversible impairment of one of your major bodily functions.
When a pregnancy is ended at this stage,
one of two procedures is performed: labor induction or cesarean
If pregnancy is ended by labor induction
during the third trimester it is quite different from the description
above. In the third trimester, labor can be started by injecting
medicine directly into the bloodstream (vein) of the pregnant woman.
Labor and delivery of the fetus during the third trimester are similar
to childbirth. The duration of labor depends on the size of the
baby and the "readiness" of the womb.
As with childbirth, the complications of
labor induction during the third trimester include: infection, heavy
bleeding, stroke, and high blood pressure. When medicines are used
to start labor, there is a greater risk of rupture of the womb than
during normal childbirth.
If labor cannot be started by injecting
medicine into the pregnant woman, or if the pregnant woman is too
sick to undergo labor, a cesarean section may be done. A cesarean
section is surgery to remove the baby from the womb. Generally,
the woman is made numb and sleepy and/or by a combination of medicines
injected into the vein or spine and/or medicine inhaled into the
lungs. Then the belly is prepared by washing with a soapy solution
(antiseptic) to kill germs. The belly and womb are then surgically
cut open and the baby removed.
The likelihood that your baby will live
after it is delivered during this stage of your pregnancy depends
on the baby's gestational age and health at the time of delivery.
When an abortion is performed during the third trimester the following
steps must be taken:
- The physician who terminated the pregnancy must certify in writing that based upon the physician's medical examination and medical judgment, the abortion is necessary to prevent either your death or substantial and irreversible impairment to one of your major bodily functions.
- A second physician must also examine you and certify in writing that based upon that physician's medical examination and medical judgment, the abortion is necessary to prevent either your death or substantial and irreversible impairment of one of your major bodily functions.
- The abortion must take place in a hospital.
- The physician must select a procedure that is most likely to allow the unborn baby to live.
- A second physician must also be present in the room in which the abortion is performed. That physician will take charge of medical care for the baby immediately after it is delivered and must take all reasonable steps necessary to preserve the baby's life and health.
The physician is not required to use the
abortion method that would provide the best opportunity for the
baby to live if the physician determines in his or her good faith
medical judgment that use of that method poses a significantly greater
risk to your life or to the substantial and irreversible impairment
of one of your major bodily functions than would another method.
In the case of a medical emergency, a physician
is also not required to comply with any condition listed above which,
in the physician's medical judgment, he or she is prevented from
satisfying because of the medical emergency.