RU 486 also known at the Abortion Pill is only approved by the Food & Drug Administration for use in women up to the 49th day after their last menstrual period. This pill however is commonly used “off label” up to 63 days. This procedures usually requires 3 office visits. On the first visit, the woman is given pills to cause the death of the fetus. Two days later, if the fetus has not been expelled from her body, the woman is given a second drug (misoprostol) to accomplish this. One to two weeks later, an evaluation is done to determine if the procedure has been completed. [11,12]
RU 486 will NOT work in the case of an ectopic pregnancy. Ectopic pregnancy is a potentially life-threatening condition in which the embryo lodges outside the uterus, usually in the fallopian tube. [13,14] If an ectopic pregnancy is not diagnosed early, the tube may burst, causing internal bleeding and in some cases, the death of the woman.
11. Mifeprex (mifepreistone) Information. Center for Drug Evaluation and Research, U.S. Food and Drug Administration, http://ww.fda.gov/cder/drug/infopage/mifepristone/ (accessed June 16, 2008).
12. Mifeprex Package Insert (U.S. Food and Drug Administration-approved label), July 2005.
13. Gary M, Harrison D. Analysis of severe adverse events related to the use of Mifepristone as an abortifacient. The Annals of PHarmacology 2006; 40.
14. Medical Management of Abortion. ACOG Practice Bulletin No. 67 American College of Obstetricians and Gynecologists October 2005.
Dilation and evacuation (D&E) is done in the second 12 weeks (second trimester) of pregnancy. It usually includes a combination of vacuum aspiration, dilation and curettage (D&C), and the use of surgical instruments (such as forceps).
An ultrasound is done before a D&E to determine the size of the uterus and the number of weeks of the pregnancy.
A device called a cervical (osmotic) dilator is often inserted in the cervix 24 hours before the procedure to help slowly open (dilate) the cervix. Dilating the cervix reduces the risk of any injury to the cervix during the procedure. Misoprostol may also be given several hours before surgery. This medicine can help soften the cervix.
D&E usually takes 30 minutes. It is usually done in a hospital but does not require an overnight stay. It can also be done at a clinic where doctors are specially trained to perform abortion. During a D&E procedure, your doctor will:
- Give you a first dose of antibiotic to prevent infection.
- Position you on the exam table in the same position used for a pelvic exam, with your feet on stirrups while lying on your back.
- Insert a speculum into the vagina.
- Clean the vagina and cervix with an antiseptic solution.
- Give you a pain medicine injection in the cervical area (paracervical block) along with a sedative. If the procedure is done in an operating room, you could receive a spinal anesthesia injection into the fluid around the spinal cord. This numbs the area between your legs. Or your doctor may use general anesthesia, which makes you unconscious.
- Grasp the cervix with an instrument to hold the uterus in place.
- Dilate the cervical canal with probes of increasing size. An abortion in the second 12 weeks will need the cervix to be dilated more than required for a vacuum aspiration.
- Pass a hollow tube (cannula) into the uterus. The cannula is attached by tubing to a bottle and a pump that provides a gentle vacuum to remove tissue in the uterus. Some cramping is felt during the rest of the procedure.
- Pass a grasping instrument (forceps) into the uterus to grasp larger pieces of tissue. This is more likely in pregnancies of 16 weeks or more and is done before the uterine lining is scraped with a curette.
- Use a curved instrument (curette) to gently scrape the lining of the uterus and remove tissue in the uterus.
- Use suction. This may be done as a final step to make sure the uterine contents are completely removed.
- Give you a medicine to reduce the amount of bleeding from the procedure.
Possible complications and signs:
Call your doctor immediately if you have any of these symptoms after an abortion:
- Severe bleeding. Both medical and surgical abortions usually cause bleeding that is different from a normal menstrual period. Severe bleeding can mean:
- Passing clots that are bigger than a golf ball, lasting 2 or more hours.
- Soaking more than 2 large pads in an hour, for 2 hours in a row.
- Bleeding heavily for 12 hours in a row.
- Signs of infection in your whole body, such as headache, muscle aches, dizziness, or a general feeling of illness. Severe infection is possible without fever.
- Severe pain in the belly that is not relieved by pain medicine, rest, or heat
- Hot flushes or a fever of 100.4°F (38°C) or higher that lasts longer than 4 hours
- Vomiting lasting more than 4 to 6 hours
- Sudden Abdominal swelling or rapid heart rate
- Vaginal discharge that has increased in amount or smells bad
- pain, swelling or redness in the genital area
The above was taken from: www.webmd.com.women/dilation-and-evacuation-de-for-abortion
First Trimester Aspiration Abortion is done through the first trimester (13 weeks or less). Depending upon the provider and the cost, varying degrees of pain control are offered ranging from local anesthetic to full general anesthesia. For very early pregnancies (4-7 weeks LMP) local anesthesia is usually given. Then a long thin tube is inserted into the uterus. A large syringe is attached to the tube and the embryo is suctioned out.
Toward the end of the first trimester, the cervix needs to be opened wider to complete the procedure because the fetus is larger. This may require a two day process where medications are placed in the vagina, or a thin rod made of seaweed is inserted into the cervix to gradually soften and open the cervix overnight. The day of the procedure, the doctor may need to further stretch open the cervix using metal rods. This is usually painful so local or general anesthesia is typically needed. Next, the doctor inserts a plastic tube into the uterus and then applies suction. Either electric or manual suction machines are used. Manual Vacuum Aspirators (MVA) are becoming more popular in the U.S. The suction pulls the fetus’ body a part and out of the uterus. The doctor may refer to the fetus and fetal parts as the “products of conception.” [1,2,3,4]
1. Paul M, Lichtenberg E S, Borgatta L, Grimes DA, Stubblefield PG, Creinin MD, Management of Unintended and Abnormal Pregnancy, Comprehensive Abortion Care; 2009 Wiley-Blackwell
2. Induced Abortion. ACOG Patient Education Pamphlet, American College of Obstetricians and Gynecologists. June 2007.
3. Rock J, Thompson J. TeLinde’s Operative Gynecology, 8th edition, Lippincott-Raven, 1997.
4. Stenchever M, et al. Comprehensive Gynecology, 4th edition, Mosby, Inc., 2001.
CONSIDERING ABORTION: Explore ALL Your Options. We are available to discuss your options, listen to your concerns and answer your questions. Contact us to share your thoughts, concerns and feelings about what you are going through. Abortion is not just a simple procedure, but a life-changing event. There are many different reasons to choose abortion, but many times it is the feeling that you have no other choice. Our goal is to provide you with accurate information and offer you a free ultrasound to determine pregnancy age and viability; two things that are important before having an abortion. Knowing more about fetal development and pregnancy may assist you in making your decision. You may also be interested in knowing the risks of abortion, what are your rights with abortion providers, and what are your short term or long term risks to consider.
NOTE: Our center offers consultations, ultrasounds and accurate information about all pregnancy options; however, we do not offer or refer for abortion services. The information presented on this website is intended for general education purposes only and should not be relied upon as a substitute for professional and/or medical advice.