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Medical Article

Abortion

Abortion is the premature ending of a pregnancy, through this medical process birth of a baby will stop. It is also known as a ‘termination’ or ‘termination of pregnancy’.  A natural cause ends a pregnancy, a spontaneous abortion or miscarriage occurs. In other cases, the pregnancy is ended either by taking medication or surgically terminated. It has to be done before the fetus is viable. The viability of fetus is often referred to be between 23 and 24 weeks of gestation. Still abortion is a controversial topic all over the world. To prevent complications and death of women due to illegal abortions, legalization is necessary.

Induced abortions
Induced abortion is the intentional termination of pregnancy before the fetus can live independently. It is ethically unacceptable among some communities. Abortions can the pregnant mother at risk of sepsis and death.  Therefore, legalisation is necessary to carry out abortion. Most induced abortions are performed during the first trimester, it is one of the safest medical procedures. It can be done in a health care provider’s office or clinic. Sterile conditions and well-qualified staffs’ service is essential to avoid the risk.  Statistics shows that the number of abortions has decreased in developed countries and is increasing in the developing nations.

Medications for abortion
Depending on the duration of gestation abortion is carried out with medications or surgically. Medical abortion is carried out through with a combination of two drugs-RU-486 or mifepristone that initiates abortion, and prostaglandin, which causes uterus to contract and thereby expel the abortus. Instead of mifepristone, methotrexate is also used in some places, according to its availability.  This drug acts as anti progesterone, preventing to maintain pregnancy. The drug administered as an oral tablet of 600mg and brings about abortion in 65 to 80% cases. To improve the result misoprostol is taken 48 hours later. It is a prostaglandin which brings about contraction of the uterus and dilates the cervix, which this helps to evacuate the uterus.  It is administered vaginally as a single or two doses, or sublingually (kept under the tongue) or buccal (absorbed through the mucus membranes of the mouth) routes.
 
Surgical abortion
Even before medical abortions the surgical abortions were adopted.  The procedures like vacuum aspiration and dilatation and curettage are included in surgical abortion.  Early abortion help to reduce complications in woman compared to an abortion in later stages of pregnancy. The conditions like fetal abnormalities and serious illness in the mother could result in death of the mother in later pregnancy or delivery.

Vacuum aspiration :  Vacuum aspiration or suction aspiration is a common surgical procedure to remove uterine contents through the cervix. It is usually performed under local anaesthesia before 12 weeks of gestation. It is less complex than dilation and evacuation and recovery is quicker. Treatment to soften and dilate the cervix may be administered before the procedure. It takes 10 minutes to complete. Early abortions done manually with a syringe is referred to as manual aspirations’ or menstrual aspirations.

Dilation and evacuation :  This treatment is usually performed between 15 to 24 weeks of pregnancy. It is carried out under general anaesthetia in which cervix is initially softened and dilated.  It usually includes a combination of vacuum aspiration, dilation and curettage, and the use of surgical instruments such as forceps. Before Dilation and Evacuation, ultrasound is done to determine the size of the uterus and the number of weeks of pregnancy. Up to nine weeks of gestation, the patient may be offered either medical or surgical abortion.  Most women accept surgical abortion.  Studies indicate that this may lead to more pain, prolonged bleeding and slightly higher failure rate with medications as compared to surgical evacuation. Specially trained doctors perform abortion.

Complications’ related to abortion
Abortion can cause various complications like bleeding, infection, trauma to organs and incomplete evacuation.

Medical abortion related complications
If abortion performed in the first 9 weeks, it will be risk free. It is same in the case of miscarriage. If you have symptoms like heavy bleeding, nausea, vomiting, loss of appetite, diarrhea, abdominal pain and infection etc., you should go to a doctor immediately.

Complications related to surgical abortion

Some of the possible complications related to surgical abortions are:-
Retaining of Tissue in the Uterus - Thickened lining of the uterus will remain after surgical abortion. It is expected that the uterus will naturally shed these tissues and excess blood. In certain cases it will not occur naturally and that will lead to infection, hemorrhage or both.
Heavy bleeding-  it requires blood transfusion.  Bleeding is normal after an abortion, in cases of trauma to uterus or incomplete abortion, bleeding may be excessive. If you are experiencing heavy bleeding after medical abortion you have to seek immediate medical attention.
Infection - If adequate sterile precautions are not followed during surgery infection can occur.  There are chances of infection setting in due to germs from the vagina and cervix entering the uterus. The patient may complain of foul-smelling discharge and fever.
Abdominal cramps - In rare cases, the patient may complain of abdominal or back pain and cramps after the surgical procedure.
Cervical Tear : Some time during the surgery the cervix will tear and if the tear is minor the body will heals on its own.