Abortion Procedures

What abortion procedures are used during the first trimester?

Up to 9 Weeks Gestation (Medical abortion)

RU-486 (Mifepristone (Mifeprex) and Misoprostol)

  • Mifepristone is given orally during your first office visit. Mifepristone blocks progesterone from the uterine lining, causing the fetus to die. This alone may cause contractions to expel the fetus.
  • Misoprostol tablets are given orally or inserted vaginally during the second office visit which occurs 36 to 48 hours later.
  • You will return home where the misoprostol will start contractions and expel the fetus. This may occur within a few hours or in some cases up to two weeks after taking the misoprostol.
  • A physical exam is given two weeks later to ensure the abortion was complete and that there are no immediate complications.

Risks and Side Effects:

The procedure is unsuccessful approximately 8-10% of the time, thus requiring an additional surgical abortion procedure to complete the termination.

  • Cramping
  • Nausea
  • Vomiting
  • Diarrhea
  • Heavy bleeding
  • Infection
  • Not advised for women who have anemia, bleeding disorders, liver or kidney disease, seizure disorder, acute inflammatory bowel disease, or use an intrauterine device (IUD)

Fetal Development: Week 1-11

1 week

  • The embryo is going through lots of basic growth at this time, with the beginning development of the brain, spinal cord, heart, and gastrointestinal tract.

2-3 weeks

  • Arm and leg buds are visible, but not clearly distinguishable. The heart is now beating at a steady rhythm. The placenta has begun to form and is producing some important hormones including hCG. There is movement of rudimentary blood through the main vessels. The early structures that will become the eyes and ears are forming. The embryo is ¼ inch long by the end of these weeks.

4 weeks

  • The formation of the lungs, jaw, nose, and palate begin now. The hand and feet buds have webbed structures that will become the fingers and toes. The brain is continuing to form into its complex parts. A vaginal ultrasound could possibly detect an audible heartbeat at this time. The embryo is about a ½ inch in length.

5 weeks

  • At 5 weeks fetal development, every essential organ has begun to form in the embryo’s tiny body even though it still weighs less than an aspirin. The hair and nipple follicles are forming, and the eyelids and tongue have begun formation. The elbows and toes are more visible as the trunk begins to straighten out.

6 weeks

  • The ears are continuing to form externally and internally. Everything that is present in an adult human is now present in the small embryo. The bones are beginning to form, and the muscles can contract. The facial features continue to mature, and the eyelids are now more developed. The embryo is at the end of the embryonic period and begins the fetal period. The embryo is about 1 inch long and is the size of a bean.

7 – 11 weeks

  • The fetus has grown to about 3 inches in length and weighs about an ounce. The genitalia have clearly formed into male or female, but still could not be seen clearly on an ultrasound. The eyelids close and will not reopen until the 28th week of pregnancy. The fetus can make a fist, and the buds for baby teeth appear. The head is nearly half the size of the entire fetus.

Abortion Procedures

What abortion procedures are used between 6 and 12 weeks gestation?

Suction Aspiration or Vacuum Aspiration (Surgical Abortion)

  • Patient will lie on her back with feet in stirrups and a speculum is inserted to open the vagina.
  • A local anesthetic is administered to her cervix. Then, a tenaculum [a slender sharp pointed hook attached to a handle, and used mainly in surgery for seizing and holding parts]1 is used to hold the cervix in place for the cervix to be dilated by cone shaped rods.
  • When the cervix is wide enough, a cannula, which is a long plastic tube connected to a suction device, is inserted into the uterus to suction out the fetus and placenta.
  • The procedure usually lasts 10-15 minutes, but recovery may require staying at the clinic for a few hours.

Risk and Side Effects:

  • Cramping
  • Nausea
  • Sweating
  • Feeling faint
  • Less frequent side effects include
    • Possible heavy or prolong bleeding
    • Blood clots
    • Damage to the cervix
    • Perforation of the uterus
    • Infection due to retained products of conception or infection caused by a sexually transmitted disease (STD) or bacteria being introduced to the uterus can cause fever, pain, abdominal tenderness and possibly scar.

Abortion Procedures

What abortion procedures are used  between 12 and 21 weeks gestation?

D&C: Dilation & Curettage (Within 12-15 Weeks) (Surgical Abortion)

  • Dilation and curettage is similar to suction aspiration, except that it uses a curette, a long, looped shaped knife that scrapes the lining, placenta and fetus away from the uterus.
  • A cannula may be inserted for a final suctioning.
  • This procedure usually lasts 10 minutes with a possible stay of 5 hours.

D&E: Dilation & Evacuation (Within 15-21 Weeks) (Surgical Abortion)

  • In most cases, 24 hours prior to the actual procedure, the abortion provider will insert laminaria or a synthetic dilator inside the patient’s cervix.
  • Cone-shaped rods of increasing size are used to continue the dilation process.
  • The cannula is inserted to begin removing tissue away from the lining. Then using a curette, the lining is scraped to remove any residuals.
  • If needed, forceps may be used to remove larger parts.
  • The procedure normally takes about 30 minutes and is usually performed in a hospital setting because of the greater risk for complications.

Risks and Side Effects

  • Nausea, bleeding and cramping may occur for two weeks following the procedure
  • Infection due to retained products of conception or infection caused by an STD or bacteria being introduced to the uterus can cause fever, pain, abdominal tenderness and possibly scar.
  • Although rare, the following are additional risks related to dilation and evacuation:
    • Damage to uterine lining or cervix
    • Perforation of the uterus
    • Infection
    • Blood clots.

Fetal Development

Week 12 – 14

  • The fetus’s skin is transparent and a fine hair calledlanugo begins to form on the head. The fetus begins sucking and swallows bits of amniotic fluid. Fingerprints which individualize each human being have now developed on the tiny fingers of the fetus. Meconium is made in the intestinal tract and will build up to be the baby’s first bowel movement. Flutters may be felt in the mom’s growing abdomen as the fetus begins to move around more. Sweat glands have developed, and the liver and pancreas produce fluid secretions. The fetus has reached 6 inches in length and weighs about 4 ounces.

Week 15 – 18

  • The baby has reached a point where movements are being felt more often by the mom. The eyebrows and eyelashes grow in, and tiny nails have begun to grow on the fingers and toes. The skin of the fetus is going through many changes and begins to produce vernix at the twentieth week. Vernix is a white pasty substance that covers the fetus’s skin to protect it from amniotic fluid. A fetal heartbeat could be heard by a stethoscope now. The fetus has reached a length of 8 inches and weighs about 12 ounces.

Week 19 – 21

  • Lanugo now covers the fetus’s entire body. The fetus is beginning to have the look of a newborn infant as the skin becomes less transparent while fat begins to develop. All the components of the eyes are developed. The liver and pancreas are working hard to develop completely. The fetus has reached about 10-11 inches in length and weighs about 1 – 1 ¼ pounds.

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American Pregnancy Association (2004). Medical Abortion Procedures. Retrieved from: http://www.americanpregnancy.org/unplannedpregnancy/medicalabortions.html

Retrieved on 12/18/13 from http://americanpregnancy.org/duringpregnancy/fetaldevelopment1.htm