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The type of abortion procedure used is determined by how many weeks the woman has been pregnant. Length of pregnancy is calculated from the first day of a woman’s last menstrual period.
If performed during the first trimester of pregnancy, abortion presents a relatively low risk to the mother. The most commonly used method of first-trimester abortion is vacuum aspiration. The procedure is usually performed under a local anesthetic. The cervix is dilated with instruments or by placing laminaria, a sterile seaweed product, in the cervical canal. The laminaria is left in place for a few hours or overnight and slowly dilates the cervix. After it is removed, a long tube is inserted into the uterus through the cervix. Gentle suction is then used to remove the fetal tissue from the uterine walls.
Pregnancies that progress into the second trimester can be terminated through dilation and evacuation (D&E), a procedure that combines vacuum aspiration with a technique called dilation and curettage (D&C). For this procedure, the cervix is dilated with laminaria for one to two days, and a combination of instruments and vacuum aspiration is used to empty the uterus. Second-trimester abortions are frequently done under general anesthetic. Both procedures can be performed on an outpatient basis (usually in the physician’s office), with or without pain medication. Generally, however, the woman is given a mild tranquilizer to help her relax. Both procedures may cause moderate to severe uterine cramping and blood loss.
The hysterotomy, or surgical removal of the fetus from the uterus, may be used during emergencies, when the mother’s life may be in danger, or when other types of abortions are deemed too dangerous.
The risks associated with abortions include infection, incomplete abortion (when parts of the placenta remain in the uterus), missed abortion (when the fetus is not actually removed), excessive bleeding, and cervical and uterine trauma. Follow-up and attention to dangerous signs decrease the chances of developing long-term problems.
The mortality rate for first-trimester abortions averages out to one death for every 530,000 at 8 or fewer weeks. The rate for second-trimester abortions is higher than one per 17,000. This higher rate later in the pregnancy is due to the increased risk of uterine perforation, bleeding, infection, and incomplete abortion due to the fact that the uterine wall becomes thinner as the pregnancy progresses.
Two other methods used in second-trimester abortions, though less common than the D&E method, are prostaglandin or saline induction abortions. In these methods, prostaglandin hormones or a saline solution is injected into the uterus. The injected solution kills the fetus and causes labor contractions to begin. After 24 to 48 hours the fetus and placenta are expelled from the uterus.
One specific surgical method of performing abortion has been the subject of much controversy. Intact dilation and extraction (D &. X), sometimes referred to by the nonmedical term “partial-birth abortion,” is used only in certain cases, such as when injury to the mother may be caused by extracting the fetus through other methods. The procedure generally involves repositioning the fetus to a breech (feet first) position before extracting most of the body except for the head. The contents of the cranium are then aspirated, resulting in “vaginal delivery of a dead but otherwise intact fetus.” Thirty-one states have passed legislation attempting to ban intact dilation and extraction. However, the wording of the legislation in many states has been so general that it could be used to ban all types of abortion. For this reason, such legislation has often been challenged and only ten states currently fully enforce the laws as written. Professional organizations such as the American College of Obstetrics and Gynecology and the American Medical Association state that physicians, acting in the best interests of their patients, should choose the safest and most appropriate method of abortion in each individual case.
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