Considering Abortion?
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Abortion Procedures
The Abortion Pill
This abortion procedure goes by many names, including medication- abortion, RU-486, and
Mifeprex/mifepristone. This drug is only approved by the U.S. Food and Drug Administration for use in
women up to the 70th day after her last menstrual period; but its sometimes used off-label past 70 days even
against FDA guidelines.[1]
If a doctor recommends the abortion pill even though you're more than 70 days (10 weeks) pregnant,
it might be best to look for a medical professional who cares about your health and well being and
abides by FDA regulations.
This procedure usually requires three office visits:
- On the first visit, the woman is given pills to cause the death of the embryo (human being in early
stages of development). - 24 to 48' hours later, the woman is given a second drug (misoprostol) to induce labor at a location
appropriate for the patient. - 7 to 14 days later, the woman returns for an evaluation to determine if the procedure has been
completed.
Note: The abortion pill won't work in the case of an ectopic pregnancy [2] This is a potentially life threat-
ening condition in which the embryo implants outside the uterus, usually in the fallopian tube. If an ectopic-
pregnancy is not diagnosed early, the tube may burst causing internal bleeding and, in some cases, death.
First-Trimester Aspiration Abortion-Up to Twelve or Thirteen Weeks of Pregnancy[3]
This surgical abortion is performed throughout the first trimester (though some abortion providers
may use the technique up to·16 weeks of pregnancy). Depending upon the provider and the cost, varying
methods of pain control are offered, ranging from local anesthetic to full general anesthesia. In the first
trimester, local anesthesia is most commonly used, while IV (intravenous) sedation is used far less frequently.
Before-the abortion can take place, the woman's cervix must be opened so the instruments may pass through.
The clinician does this either by inserting dilators (metal or water-absorbing) into the cervix, or by using a
drug administered orally or vaginally. The degree of dilation required depends upon the stage of the pregnancy.
Once the woman's cervix is dilated, the abortion provider may use either a manual vacuum aspirator or
an electric suction instrument to remove the contents of the uterus, including the embryo or fetus
(human being in first or second stage of development), placenta and other tissue.
The abortion provider passes the instrument through the cervix and into the uterus. Once inside, the instru-
ment will suction out the uterine contents. After the uterus has been emptied, the clinician will remove the
suction instrument and inspect the woman's cervix for bleeding.
To ensure that the abortion is complete and nothing has been left behind, the abortion provider may
choose to use sharp curettage (a loop-shaped knife) and make a final pass with the suction instrument to
ensure nothing· has been left behind.
After the procedure the woman may be ushered into a recovery room. The amount of time spent in recovery
varies. If complications from the procedure have occurred, the woman may notice immediately of up to about
two weeks after.
Dilation and Evacuation (D&E) About Thirteen Weeks and Onward[4]
This surgical abortion is done during the second trimester of pregnancy. In this procedure, the cervix
must be opened wider than a first trimester abortion because of the size of the growing fetus. This is done
by dilating the cervix about one to two days before the procedure.
On the day of the abortion procedure, the dilators are removed. If the pregnancy is early enough in the
second trimester, using suction to remove the fetus may be enough. This is sometimes called a suction
D&E, and is similar to a first-trimester aspiration abortion.
As the pregnancy progresses to a further state of development, it becomes necessary to use forceps to
remove the fetus, which becomes too large to pass through the suction instrument. Before inserting the
forceps, the clinician will find the location of the fetus through ultrasound or by feeling the outside of
the woman's abdominal area.
Once the fetus has been located, the abortion provider will insert the forceps into the uterus and
begin to extract the contents. The clinician keeps track of what fetal parts have been removed so that
none are left inside that could cause infection.
Finally, a curette and/or suction instrument is used to remove any remaining tissue or blood clots to
ensure the uterus is empty. After the procedure, the woman will most likely be taken to a recovery room.
The length of time spent in recovery varies.
Dilation and Evacuation (D&E) after Potential Viability - About Twenty-Four
Weeks and Onward
When the abortion occurs at a time when the fetus could have otherwise been delivered, injections are
given to cause fetal death. This is done in order to comply with the federal law requiring a fetus to
be dead before complete removal from his/her mother's body
The medications (digoxin and potassium chloride) are either injected into the amniotic fluid, the umbilical
cord, or directly into the fetus' heart. The remainder of the procedure is the same as the Dilation and Evacu-
ation procedure described previously.
Intact D&E (Dilation and Evacuation)
The more passes the forceps must make into the uterus, the more the potential for complications and
infections increases. The intact D&E has less potential for complications and/or infections.
Because the cervix must be opened wider, dilators are usually inserted into the woman a couple of
days in advance. Depending upon the age of the fetus, the skull may be too large to pass through the
cervix. In this case, the skull must be crushed so it can be removed. To do this, the abortion provider
uses forceps to make an opening at the base of the skull in order to suction out the contents. The fetus
can then be removed intact using the forceps.
Second-Trimester Medication Abortion
This abortion procedure terminates the pregnancy by causing the death of the fetus and expelling the
contents of the uterus.
The cervix may be softened either with the use of seaweed sticks called laminaria or medications
at the start of the procedure. Once the cervix is prepared, various combinations of medications are
administered, typically a mixture of mifepristone (taken orally) and misoprostol(either oral or
vaginal). Mifepristone causes the amniotic sac (containing the fetus, placenta and pregnancy related
tissue) to detach from the uterus, resulting in fetal death, while misoprostol induces labor to deliver
the fetus, placenta and other pregnancy related tissue.
Because some women prefer to begin the abortion with a dead fetus, a variant of this procedure
is sometimes done using digoxin or potassium chloride. This medication is injected into the amniotic
fluid, umbilical cord, the fetus, or fetal heart prior to the procedure, terminating the pregnancy.
Soon after, the woman will receive drugs, usually misoprostol to cause the uterus to contract and expel
the fetus and placenta. If the abortion has not occurred within 3 hours of the last dose of the medication,
the procedure will be restarted the next day.
Effective pain regimens for second trimester medication abortions have not been well established.
Potential complications include hemorrhage, infection, and the need for a blood transfusion, retained
placenta and uterine rupture.
Our center offers consultations and accurate information about all pregnancy options; however, we do not offer
or refer for abortion services. The information on this website is intended for general education purposes only and
should not be relied upon as a substitute for professional counseling and/or medical advice.
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[1]"Medication Guide: Mifeprex," The U.S. Food and Drug Administration. last modified April 22. 2009, http://www.fda.gov/downloads/Orugs/DrugSafety/ucm088643.pdf
[2]“Mifeprex: Prescribing Information” Danco Laboratories. last modified April 22.20()9. http://www.earlyoptionpill.com/userfiles/file/Mifeprex%20Labeling%204-22-09_Final_doc.pdf
[3]Maureen Paul et al, Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion
Care (United Kingdom: Blackwell Publishing ltd,2009), 135-156.
[4]Ibid.. 157-177.