Abortion

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amniotic fluid collection

Abortion Definition

From the Latin word “aboriri” which means “to perish” [1], abortion refers to discontinuation of pregnancy by withdrawing the embryo or fetus from its mother’s uterus before the age of viability (around 24 weeks of gestation).

Facts, Statistics, and Incidence Rates

  • Half of all pregnancies are unplanned. [2]
  • 4 out of 10 unwanted pregnancies are being terminated. [2]
  • Because of abortion, around 3,200 babies die everyday. [3]
  • Among women of reproductive age (15-44), 2 out of 100 undergo abortion. [2]
  • While most of us may think that abortion is more prevalent among teenagers, numbers tell us that young adults (20-24 years old) account for 33% of abortion cases versus the teenagers who account for only 19% of the cases. [2]
  • Two thirds of abortion account to single women. [2]
  • 60% of abortion cases are for those women who have already children. [2] They don’t want to raise more.
  • 8% account to women who have never tried to use any birth control method. [2]
  • 43% are Protestants and 27% are Catholics. [2]

 

abortion facts

Picture : Abortion Incidence and statistics

Image Source: johnstonsarchive.net

Abortion dataPicture : Abortion Data

Image Source: johnstonsarchive.net

Types of Abortion

  1. Threatened Abortion

    • Happens within the 20th week of gestation
    • (+) vaginal bleeding
    • (+) pain
    • (-) cervical dilatation
    • Patient should have days of bed rest and sexual abstinence should be observed for about 2 weeks or until the bleeding stops.
  1. Inevitable or Imminent Abortion

    • (+) lower abdominal cramps
    • (+) vaginal bleeding
    • (+) rupture of membranes
    • (+) cervical dilatation
    • Patient will be hospitalized. Dilatation and curettage (D&C) will be performed.
  1. Incomplete Abortion

    • Type of abortion wherein not all products of conception are expelled.
    • (+) strong uterine cramps
    • (+) vaginal bleeding
    • (+) cervical dilatation
    • Patient will be hospitalized. Dilatation and curettage (D&C) will be performed.
  1. Complete Abortion

    • All products of conception are expelled.
    • (+) uterine cramps
    • (+) bleeding
    • (-) cervical dilatation
    • Patient will be monitored.
  1. Missed Abortion

    • The patient is pregnant with a dead fetus.
    • (-) pregnancy test
    • (-) cervical dilatation
    • (+) brown vaginal discharge
    • Induced labor should be done to expel the products of conception.
  1. Recurrent or Habitual Abortion

    • This happens to mothers who have had 3 or more consecutive abortions previously.
    • The cause of abortions shall be identified in order to determine the proper intervention.
  1. Septic Abortion

    • Abortion because of blood infection
    • (+) fever
    • (+) uterine cramping
    • (+) foul smelling vaginal discharge
    • Patient will be given antibiotics. [4]

Methods and Procedure of Abortion

Medical Abortion

Abortion can happen with medications alone. This type of abortion is preferred by women in early weeks of gestation who do not want to undergo surgery. The following medications are used for medical abortion:

  1. Mifepristone

Mifepristone (Mifeprex) is a medication prescribed by the physician during early pregnancy. It is taken per orem (by mouth). On the first day, you will be asked to take three tablets at one time. Have a follow-up check-up after two days for the physician to determine whether or not the pregnancy is terminated. If not, your physician may ask you to take two tablets of Misoprostol (Cytotec). [5]

Mifepristone should not be taken without the doctor’s guidance as it may lead to more problems than you can imagine. FDA approves this drug for use until 49 days after the last menstrual period [6].

  1. Misoprostol

Misoprostol (Cytotec) is used with mifepristone if the latter can’t abort the pregnancy by itself. Misoprostol serves as an aid by inducing labor. [7]

  1. Methotrexate

This drug is typically given to cancer patients. You might be wondering how this can be used to abort pregnancy. Cancer drugs attack fast growing and fast multiplying cells, the cancer cells. In a pregnant woman, the target is not the cancer cells, rather the fast growing fetus inside the mother’s womb. Since the fetus is attacked by a highly toxic drug, it dies. Misoprostol will then be used to induce labor for the fetus’ expulsion.

  1. Prostaglandins

Prostaglandins cause muscular contractions. During second to third trimester, prostaglandins can be administered into the amniotic sac. There will be regular uterine contractions which will now induce labor.

  1. Salt Poisoning

The baby normally swallows the amniotic fluid in which it floats. In the second to third trimester, a poisoned saline or salt solution is introduced into the amniotic fluid. When the baby swallows the amniotic fluid with this saline solution, it will poison his/her body, causing dehydration, convulsions, and brain hemorrhage. This is a torture for the baby and this lasts for about an hour. Induced labor then follows after a day or two. [8]

One problem that can occur when taking these medications is incomplete abortion. This is the incidence wherein the products of conception are not expelled completely. Some parts might stay on the uterus. This is dangerous. It can cause hemorrhage on the mother’s part. Furthermore, it could poison the mother’s body. If there is proven to be an incomplete abortion, the woman should undergo surgery to remove all the fetal parts.

Surgical Abortion

Surgical abortion is done when medical abortion has failed or if the patient does not like the side effects of the drugs. Since medical abortion requires the patient for many follow-up check-ups, surgical abortion is preferred by patients who want a time-conserving method. Because surgical abortion methods are mostly in an outpatient basis, and one follow-up check-up may be enough, this is for women who want a quick way of terminating their pregnancy. The following are the methods of surgical abortion:

  1. Suction Aspiration

amniotic fluid collection

Picture : Suction Aspiration

Image Source: hisbranches.org

Suction aspiration is the most common surgical abortion performed during the first trimester. Once the cervix is dilated, a suction tube is inserted into the uterus and the vacuum’s power will empty the uterine contents into a collection jar or bottle. [9]

  1. Dilatation and Curettage (D&C)

dilatation and curettage

Picture : Dilatation and Curettage (D&C)

Image Source: beltina.org

D&C is similar with suction aspiration, but instead of using a vacuum, it requires the mechanical use of hand’s control with a curette. The cervix will be dilated. Curette will be inserted into the uterus and it will be used to cut the fetal parts. Products of conception will then be scraped from the mother’s womb. [10]

  1. Dilation and Evacuation (D&E)

Abortion dilation and evacuation of fetus

Picture : Dilation and Evacuation (D&E)

Image Source: clinicquotes.com

D&E is an abortion method performed during the second trimester. The cervix will be dilated. A grasping forceps is used to remove the fetal body piece by piece. The head will not be able to pass through the cervix as a whole so it has to be crushed. All products of conception must be removed. [9]

  1. Dilation and Extraction (D&X) or Partial Birth Abortion

D&X is performed during third trimester of pregnancy. Like the other methods, the cervix will be dilated. Forceps will be inserted into the mother’s womb to grasp the baby’s feet. The body will be pulled out except for the head. The physician will insert scissors into the skull to widen it and a suction tube will suck out the baby’s brain. This will crush the head. Then all of the products of conception will be removed. [8]

  1. Hysterectomy

Like D&X, hysterectomy is also done during the third trimester. This is the abortion method that does not require cervical dilatation. An incision is made on the mother’s abdomen instead. The umbilical cord is cut inside the mother’s abdomen, thereby also cutting the baby’s access to oxygen. [9] Since the baby is not yet mature to breathe on its own, the baby dies of asphyxia (lack of oxygen). And then the baby is taken out.

The fact that in abortion, a human life is being purposely terminated and these methods of killing the baby are the reasons why abortion is too controversial. It’s been such a long time since the topic has become a very huge issue. This will continue to be a debatable issue in over the generations to come.

Normal and Abnormal Post-Abortion

  • Vaginal spotting or bleeding for up to two weeks
  • Red, brown, or black colored vaginal discharge
  • Uterine or abdominal cramps
  • Slight fever
  • Mood swings
  • Feelings of guilt and sadness
  • Breast discharge
  • Vaginal bleeding for more than three weeks
  • Profuse bleeding soaking 2 pads every hour
  • Passing of green, gray, or white tissue
  • High fever (with temperature reading of 40C or 100.4F and above)
  • Too much abdominal pain or tenderness
  • Severe depression and emotional distress to the point that it interferes with your daily functions
  • Continuation of pregnancy symptoms 2 weeks post-abortion
  • No menstrual period for more than 3 months [11][12]

What To Do and Not To Do After Abortion

  • Use sanitary towels for bleeding.
  • Take paracetamol or ibuprofen for pain.
  • Eat iron-rich foods and increase fluid intake.
  • Support system is very important.
  • Continue activities of daily living, except for strenuous exercises.
  • Sexual intercourse is prohibited for 2 weeks.
  • Do not use tampons to reduce possibility of infection.
  • Do not swim to prevent infection.
  • No to alcohol and drugs. [11][12]

Legal Stand of Each Country – Abortion Law

Though different countries have different laws and constitutions, the legal aspects of abortion are generally based on human rights and safety.

There are countries where abortion is fully legal. No restrictions, no questions asked, abortion is an option as long as the pregnant woman wants it, she is in her right state of mind, and she is of legal age. There are countries where abortion is permitted to preserve the mother’s health. And of course there are countries where abortion is the last resort to save the mother’s life. There are cases wherein the pregnancy is putting the mother’s life at a great risk and the only way to save her life is to get rid of the baby.

Below is a map of the world with the color coded legends which determine the country’s legal stand when it comes to abortion.

Abortion laws

Picture : Abortion Laws

Image Source: womenonwaves.org

Countries where abortion is legal to protect the mother’s health

  • America & Carribean: Argentina, Bolivia, Costa Rica, Ecuador, Peru
  • Asia Pacific: Pakistan, South Korea, Thailand
  • Europe: Poland
  • Middle East & North Africa: Kuwait, Morocco, KSA
  • Subsaharan Africa: Burkina Faso, Burundi, Cameroon, Eritrea, Ethiopia, Guinea, Malawi, Mozambique, Zimbabwe [13]

Countries where abortion is illegal and is only performed by a physician to save the mother’s life

  • Asia Pacific: Bangladesh, Indonesia, Laos, Myanmar, Papua New Guinea, Philippines, Sri Lanka
  • Europe: Ireland, Malta
  • Middle East & North Africa: Egypt, Lebanon, Oman, Sudan, Libya, Iran, Syria, UAE, Yemen, Afghanistan
  • South America: Brazil, Chile, Columbia, Honduras, Nicaragua, Dominican Republic, Paraguay, Guatemala, Panama, Venezuela, Haiti, El Salvador, Mexico,
  • Subsaharan Africa: Angola, Benin, Central African Republic, Chad, Congo, Democratic Republic of Congo, Gabon, Guinea-Bissau, Kenya, Lesotho, Madagascar, Mali, Mauritania, Mauritius, Niger, Nigeria, Senegal, Somalia, Tanzania, Togo, Uganda [13]

Pieces of Advice – Help

Now that you know what happens to the baby during abortion, couples particularly women, should be responsible enough to take the consequences of your actions. Most cases of abortion are due to unwanted and unplanned pregnancy. So who suffers after you decide to abort the pregnancy? It’s your baby. That innocent beautiful creature is who suffers the most. Abortion wastes a precious life.

Abortion should only be done if it’s a matter of life and death. If the pregnancy is killing the mother… well, it’s really hard to choose between the life of the mother and the baby. Ethically and morally, I am in no position to give an advice with regards to whose life should be saved. But practically, the mother’s life should be saved because she can make more babies in the future, unless her condition does not permit her to.

References:

  1. http://www.newadvent.org/cathen/01046b.htm
  2. http://womensissues.about.com/od/reproductiverights/tp/Ten-Abortion-Facts.htm
  3. http://www.lifeissues.org/abortion/
  4. http://nursingcrib.com/nursing-notes-reviewer/types-of-abortion/
  5. http://www.nlm.nih.gov/medlineplus/druginfo/meds/a600042.html
  6. http://womensissues.about.com/od/reproductiverights/a/AbortionTypes.htm
  7. http://www.emedicinehealth.com/abortion/page4_em.htm
  8. http://www.all.org/article/index/id/MjQ0NA
  9. http://www.lifesitenews.com/abortiontypes/
  10. http://www2.hu-berlin.de/sexology/ATLAS_EN/html/abortion_methods.html
  11. http://www.emmagoldman.com/information/abortion-pac.html
  12. http://www.bpas.org/bpaswoman/after-an-abortion
  13. http://www.womenonwaves.org/en/page/460/abortion-laws-worldwide

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