What is an induced abortion?

An abortion, also sometimes known as the termination of pregnancy, is when an embryo or foetus and placenta are removed from the uterus either spontaneously or done by medicine or a surgical procedure. 

What are the different types of abortion?

There are six different types of abortion, depending on the circumstances and gestation period:

1. Spontaneous abortion: when the pregnancy is lost during a gestation period less than 20 weeks, without elective medical procedures (also referred to as a miscarriage)
2. Early medical abortion: up to seven weeks. Methotrexate and Misoprostol are usually given for unplanned abortions, typically for ectopic pregnancies, which can be life threatening if left untreated.
3. Medical abortion: up to 10 weeks. Mifepristone is given in-clinic and Misoprostol is taken at home, both working together to end the pregnancy and remove it in a similar way as having a period.
4. Vacuum/suction aspiration abortion: up to 16 weeks. It may be used as the main method, or can be used after a failed previous medical abortion. 
5. Dilation and evacuation (D&E) abortion: after 14 weeks. It is normally recommended when an abortion has been delayed or there is a severe medical problem with the foetus.
6. Induction abortion: second trimester abortion: 13 to 27 weeks (second trimester of pregnancy). Labour is induced to remove the foetus and placenta. It is a rarely used method.

What is involved in the procedures?

Spontaneous abortion:

A woman will have typical symptoms such as cramping, pelvic pain, bleeding, and, eventually, the discharge of tissue. There may be vaginal bleeding anywhere from hours to days. 50 to 65 per cent of spontaneous abortions are caused by chromosomal abnormalities.

Early medical abortion:

Methotrexate is taken in-clinic either via shot or by mouth, which stops the cells from multiplying. Four to six days later, Misoprostol is taken at home either via mouth or vagina, which will cause the uterus to contract to remove the foetus and placenta. It may start one to 12 hours after taking the medicine at home. Women typically experience cramps and bleeding, which may last up to four to eight hours.

In total, it may take a few days, weeks, or, in some women, up to a month for the abortion to finish. 1 to 2 per cent of women will need a surgical abortion due to failure of the medication.

Medical abortion:

Mifepristone is taken in-clinic, which blocks the hormone progesterone and stops the embryo from implanting in the uterus. Misorpostol will then be taken every few hours up to four days later at home. Cramping and bleeding will typically happen one to four hours after taking the medication. In most women, the tissue is passed four to five hours after taking the medication, but some may take up to two days. Regular periods should resume four to six weeks after the abortion. 

Vacuum/suction aspiration abortion:

This procedure is done in a clinic or hospital. Some doctors will do it on the same day as the first appointment. It may be done with local anaesthetic, sedation, or general anaesthesia. A gentle suction is used to pull out the foetus and placenta from the uterus. The total procedure takes about 10 to 15 minutes. It isn't typically painful, but the uterus may contract when the tissue is removed and result in some cramping. Sex should be avoided for at least a week after the procedure and periods should resume four to six weeks after.

Dilation and evacuation abortion:

This procedure is done in a clinic or hospital and may take up to two days, involving a combination of suction aspiration, forceps, and dilation and curettage (D&C). The cervix will be dilated on the first day to make removal easier. On the second day, the doctor will then use the forceps to remove the foetus and placenta, followed by suction aspiration to remove the uterus. A curette (scoop-like instrument) will then be used to remove the uterine lining. This part of the procedure takes around 30 minutes, and may be painful. The doctor may also provide numbing medication to prevent the discomfort. Side effects can last up to a few weeks following the procedure. Sex can be resumed about two weeks after the procedure, and periods should resume four to eight weeks afterwards.

Induction abortion: 

This procedure is done in a hospital or specialised clinic. Medication will be given to the woman to induce labour, and the uterus will contract to release the pregnancy. The doctor may use a curette to clean out the uterus after. There will be intense cramping as the uterus contracts. but typically sedatives or an epidural will be given to alleviate the pain. Induction abortion may take anywhere from several hours to more than a day to complete. Sex should be avoided for two to six weeks after having the procedure, the doctor should advise exactly how long. Regular periods should resume one to two months later.

What are possible complications and side effects?

Depending on the procedure, complications and side effects may vary. The most common ones are: 

• pain
• bleeding or spotting
• cramping
• nausea and vomiting
• diarrhoea
• chills
• headache
• sweating
• dizziness
• low-grade fever
• tiredness

None of the procedure types should cause infertility in women. Always speak with your medical practitioner about your medical history to determine possible side effects.