nontherapeutic abortion, voluntary abortion, voluntary pregnancy termination
An abortion is referred to as an elective or voluntary abortion when it is performed at the request of the woman for non-medical reasons. An elective abortion represents one subtype of induced abortion, the other one being therapeutic abortion, which is performed to save the life of the pregnant woman; prevent harm to the woman's physical or mental health; terminate a pregnancy where indications are that the child will have a significantly increased chance of premature morbidity or mortality or be otherwise disabled; or to selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy.
Most abortions result from unintended pregnancies. Unintended pregnancy is a complex phenomenon, which raise to take an emergency decision. Low contraceptive prevalence and high user failure rates are the leading causes of this unexpected situation. The abortion procedure is one of the most common procedures for women in their reproductive years and by the age of 45. The number of annual abortions that take place worldwide is around 40 million.
Elective abortions may be divided into several categories, depending on the method of the procedure.
There are two types of a legal elective abortion: surgical and medical abortion.
Up to 15 weeks' gestation, suction-aspiration or vacuum aspiration (Pic. 1) are the most common surgical methods of induced abortion. Manual vacuum aspiration (MVA) consists of removing the fetus or embryo, placenta, and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) uses an electric pump. These techniques differ in the mechanism used to apply suction, in how early in pregnancy they can be used, and in whether cervical dilatation (the opening of the cervix- in this case the opening is done with medical device) is necessary.
Dilation and curettage (D&C, Pic. 2), the second most common method of surgical abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette.
From the 15th week of gestation until approximately the 26th, other techniques must be used. Dilation and evacuation (D&E) consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. After the 16th week of gestation, abortions can also be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus’s head before evacuation.
In the third trimester of pregnancy, induced abortion may be performed surgically by intact dilation and extraction or by hysterotomy. Hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anaesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy.
First-trimester procedures can generally be performed using local anaesthesia, while second-trimester methods may require deep sedation or general anaesthesia.
2. Medical abortion
Medical abortions are those induced by abortifacient pharmaceuticals.
Medical abortion regiments involving mifepristone followed by misoprostol in the cheek between 24 and 48 hours later are effective when performed before 63 days' gestation. n very early abortions, up to 7 weeks gestation, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration), especially when clinical practice does not include detailed inspection of aspirated tissue .
Women have reported that the medical abortion “feels more natural” than a surgical abortion and is done in the sanctity of their own home. Contrary to the surgical abortion, a medical abortion can only be done up until about six weeks into the pregnancy.
After the procedure, the patient may experience some common symptoms. These include:
As most elective abortions originate from unintended pregnancies, the most effective way of prevention is avoiding such a pregnancy by using methods of birth control. Local legislative status of abortion significantly affects the number of unsafe abortions.
Legal abortion is a very safe procedure and does not significantly affect the woman’s fertility and her ability to have children in the future. Abortions performed in early stages of the pregnancy carry even lower risk than later performed procedures. The risk increases with multiple abortions. Especially in women after multiple surgical abortions, there is a higher risk of damage to cervix or uterus in the process because any instrument, which is inserted inside the uterus, can potentially cause scarring in these areas, especially when it's done multiple times. However, surgical removal of the scar tissue can usually solve the problem and restore fertility.
With a legal, properly procured abortion for non-medical reasons, the fertility of the patient is usually not affected, and the patient is able to conceive naturally in the future. Especially with a medical abortion, the risk for possible adverse effects on fertility is almost zero, even with multiple abortions. The risk increases with multiple surgical abortions, where repeated damage, although minimal, to the cervix may eventually cause scarring. However even such scars may be surgically removed and fertility restored.