Induced abortion is the intentional ending of a pregnancy by a procedure or medications.
A pregnancy may be ended by having a procedure to remove the contents of the uterus or by taking certain medications.
Complications are uncommon when an abortion is done by a trained health care professional in a hospital or clinic.
Induced abortion does not increase risks for the fetus or woman during subsequent pregnancies.
In the United States, about half of pregnancies are unintended. About 40% of unintended pregnancies end in a procedural or medical abortion; 93% of abortions are done prior to 13 weeks of pregnancy. After a miscarriage, the same medications or procedural techniques are used to remove all remaining pregnancy tissue from the uterus.
In the United States, both medical and procedural abortion is regulated by state-specific restrictions (for example, mandatory waiting periods, number of weeks of pregnancy). In countries where abortion is legal, abortion is safe and complications are rare. Worldwide, about 13% of deaths in pregnant women are due to unsafe abortion. Most of these deaths occur in countries where abortion is illegal.
Often, ultrasound is used to estimate the age of the fetus, but sometimes a health care professional's evaluation can estimate the age during the 1st trimester. If women have risk factors for problems related to an abortion (such as heart or lung disease, seizures, or a history of cesarean deliveries), they may require further evaluation. Before a procedural abortion at 12 or more weeks of pregnancy, women may need to use medications or small devices (dilators) to help soften and dilate the cervix. This helps to reduce risk of complications.
Contraception can be started immediately after an abortion done before 28 weeks of pregnancy.
Methods of Abortion
Abortion methods include
Procedural abortion: Removal of the contents of the uterus through the cervix
Medications to cause (induce) abortion: Use of medications to stimulate contractions of the uterus, which expel the contents of the uterus
The method used depends in part on how long a woman has been pregnant and access to care. Ultrasound is usually done to estimate the length of the pregnancy. Procedural abortion can be used for most pregnancies. Medication abortion can be used for pregnancies up to 12 weeks on an outpatient basis; before leaving the facility, women should understand the bleeding expectations and precautions to take during and after the medication abortion.
Anesthetic options should be offered according to a woman's preference. For abortions done early in the pregnancy, only a local anesthetic may be needed; pelvic cramping at the time of the procedure may still occur. Moderate sedation (medications that relieve pain and help women relax but allow women to remain conscious) or deep sedation may be used later in the pregnancy. Rarely, a general anesthetic is needed.
Before a procedural abortion, women are given antibiotics that are effective against infections in the reproductive tract.
After any abortion (procedural or medication), women with Rh-negative blood are given injection of Rh antibodies called Rho(D) immune globulin. If the fetus has Rh-positive blood, a woman who has Rh-negative blood may produce antibodies to the Rh factor. These antibodies can destroy the fetus's red blood cells. Treatment with Rho(D) immune globulin reduces the risk that the woman's immune system will make these antibodies and endanger subsequent pregnancies. Treatment with immune globulin is not needed before 12 weeks of pregnancy.
Procedural abortion
The contents of the uterus are removed through the vagina. Different techniques are used depending on the length of the pregnancy. They include:
Dilation and curettage (D and C) with suction
Dilation and evacuation (D and E)
Dilation refers to widening the cervix. Different types of dilators may be used, depending on how long the pregnancy has lasted and how many children the woman has had. To reduce the possibility of injuring the cervix during dilation, doctors may use substances that absorb fluids, such as dried seaweed stems (laminaria) or a synthetic dilator. Laminaria are inserted into the opening of the cervix and left in place for at least 4 hours, sometimes overnight. As the dilators absorb large amounts of fluid from the body, they expand and stretch the opening of the cervix. Medications such as misoprostol (a refers to widening the cervix. Different types of dilators may be used, depending on how long the pregnancy has lasted and how many children the woman has had. To reduce the possibility of injuring the cervix during dilation, doctors may use substances that absorb fluids, such as dried seaweed stems (laminaria) or a synthetic dilator. Laminaria are inserted into the opening of the cervix and left in place for at least 4 hours, sometimes overnight. As the dilators absorb large amounts of fluid from the body, they expand and stretch the opening of the cervix. Medications such as misoprostol (aprostaglandin) can also be used to dilate the cervix.
Typically for pregnancies less than 16 weeks, dilation and curettage (D and C) with a suction instrument is used. A speculum is used in the vagina to enable the clinician to see the cervix. A local anesthetic (such as lidocaine) is injected into the cervix to reduce discomfort, and the cervix is dilated. Then a flexible tube attached to a vacuum source is inserted into the uterus to remove the fetus and placenta. The suction source may be a handheld syringe or similar instrument or a suction machine. Sometimes after the suction instrument is used, a small, sharp, scoop-shaped instrument (curet) is inserted to remove any remaining tissue. This procedure should be used rarely and gently to reduce the risk of scarring and infertility.Typically for pregnancies less than 16 weeks, dilation and curettage (D and C) with a suction instrument is used. A speculum is used in the vagina to enable the clinician to see the cervix. A local anesthetic (such as lidocaine) is injected into the cervix to reduce discomfort, and the cervix is dilated. Then a flexible tube attached to a vacuum source is inserted into the uterus to remove the fetus and placenta. The suction source may be a handheld syringe or similar instrument or a suction machine. Sometimes after the suction instrument is used, a small, sharp, scoop-shaped instrument (curet) is inserted to remove any remaining tissue. This procedure should be used rarely and gently to reduce the risk of scarring and infertility.
Typically at 16 or more weeks of pregnancy, dilation and evacuation (D and E) is used. After the cervix is dilated, suction and forceps are used to remove the pregnancy tissue and amniotic fluid. Then a sharp curet may be used gently to make sure all products of conception have been removed.
If women wish to prevent future pregnancies, contraception, including a copper or levonorgestrel-releasing or levonorgestrel-releasingintrauterine device (IUD), can be started as soon as the abortion is completed.
Medication abortion
For a medication abortion during early pregnancy (up to 12 weeks), the abortion process can be completed at home. For an abortion later in pregnancy, the woman typically is admitted to the hospital or clinic to take the abortion medications.
In the United States in 2023, medication abortion accounted for 63% of all abortion care, an increase of 10% from 2020 to 2023.
Medications used to induce abortion include mifepristone (RU 486), followed by a prostaglandin, such as misoprostol.Medications used to induce abortion include mifepristone (RU 486), followed by a prostaglandin, such as misoprostol.
Mifepristone,Mifepristone, taken by mouth, blocks the action of the hormone progesterone, which prepares the lining of the uterus for pregnancy. Mifepristone also makes the uterus more sensitive to the second medication that is given (the prostaglandin)., which prepares the lining of the uterus for pregnancy. Mifepristone also makes the uterus more sensitive to the second medication that is given (the prostaglandin).
Prostaglandins are hormonelike substances that stimulate the uterus to contract. They may be used with mifepristone. Prostaglandins may be held in the mouth (next to the cheek or under the tongue) until they dissolve or placed in the vagina. are hormonelike substances that stimulate the uterus to contract. They may be used with mifepristone. Prostaglandins may be held in the mouth (next to the cheek or under the tongue) until they dissolve or placed in the vagina.
Mifepristone and one dose of misoprostol is about 95% effective in pregnancies of 8 to 9 weeks and slightly less effective in pregnancies of 9 or more weeks. Effectiveness after 9 weeks of pregnancy is improved with an additional dose of misoprostol; effectiveness after 11 weeks gestation is improved with 2 additional doses.Mifepristone and one dose of misoprostol is about 95% effective in pregnancies of 8 to 9 weeks and slightly less effective in pregnancies of 9 or more weeks. Effectiveness after 9 weeks of pregnancy is improved with an additional dose of misoprostol; effectiveness after 11 weeks gestation is improved with 2 additional doses.
Clinicians confirm the completion of the abortion by one of the following:
Ultrasound
A blood test to measure human chorionic gonadotropin (hCG) on the day the medication is given and 1 week later (hCG is produced early in pregnancy)
A urine pregnancy test (expected to be negative 5 weeks or more from the medication abortion)
If a medication abortion is unsuccessful, a procedural abortion may be required.
Complications of Abortion
Complications are rare with legal abortion. Complications occur much less often after an abortion than after delivery of a full-term baby. Serious complications occur in fewer than 1% of women who have an abortion, and rates are the lowest earlier in the pregnancy and in settings with safe access to care.
The risk of complications is related to the method used.
Procedural evacuation: Complications are rare when procedural abortions are done by health care professionals. The uterus or cervix is torn (perforated) by a surgical instrument in fewer than 1 of 1,000 abortions. Injury of the intestine or another organ is even rarer. Severe bleeding during or immediately after the procedure occurs in 6 of 10,000 abortions. Very rarely, the procedure or a subsequent infection causes scar tissue to form in the lining of the uterus, resulting in sterility. This disorder is called Asherman syndrome.
Medications: Mifepristone and the prostaglandin misoprostol have side effects. The most common are crampy pelvic pain, vaginal bleeding, and gastrointestinal problems such as nausea, vomiting, and diarrhea.Mifepristone and the prostaglandin misoprostol have side effects. The most common are crampy pelvic pain, vaginal bleeding, and gastrointestinal problems such as nausea, vomiting, and diarrhea.
Either method: Bleeding and infection can occur if part of the placenta is left in the uterus. If bleeding occurs or if infection is suspected, clinicians use ultrasound to determine whether part of the placenta remains in the uterus.
Did You Know...
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Later, particularly if the woman is inactive, blood clots may develop in the legs.
If the fetus has Rh-positive blood, a woman who has Rh-negative blood may produce Rh antibodies—as in any pregnancy, miscarriage, or delivery. Such antibodies may endanger subsequent pregnancies. Giving the woman injections of Rho(D) immune globulin prevents antibodies from developing. Immune globulin may be optional for pregnancies lasting less than 8 weeks.
Women should be offered mental health resources. Women with the following may require additional resources:
Psychologic symptoms before pregnancy
Significant emotional attachment to the pregnancy
Limited social support or a sense of disapproval from their support system
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