Abortion: Teen Version

What is an induced termination of pregnancy?

Induced termination of pregnancy (TOP) is the act of ending a pregnancy intentionally. It may be done with surgery or medicine. TOP prevents the live birth of a baby. The procedure may also be called an induced or therapeutic abortion.

Most commonly, a TOP is done because the pregnancy is unplanned or unwanted. However, sometimes there are medical or mental health reasons for choosing a TOP.

Dealing with an unplanned or unwanted pregnancy is very difficult. Talking with your healthcare provider and partner, family, school counselors, teachers, or clergy may help you decide what to do. It may not be easy to talk about, but you need good information to make good choices. Trying to keep your pregnancy a secret, or waiting too long to make a decision, may put you and your baby at risk. You may choose to:

• Continue the pregnancy and raise the child.
• Continue the pregnancy and find someone to adopt the baby.
• End the pregnancy by having a legal TOP.

Specially trained counselors can help you explore your choices and answer questions. The goal of counseling is to provide information that will help you make the decision.

What types of procedures may be performed?

The type of procedure used for a TOP depends on the stage of pregnancy and state and federal laws.

• If it has been just 1 or 2 weeks since your period should have started, a procedure called a menstrual extraction might be done.
• If it has been less than 7 weeks since your last period, then a medicine, such as the oral medicine mifepristone (Mifeprex, or RU 486), may be used.
• If it has been 7 to 13 weeks since the first day of your last menstrual period, the most common procedure is vacuum curettage.
• The procedure most often used between the 13th and 21st weeks of pregnancy is called a dilation and evacuation (D&E). This procedure should be performed only by specially trained providers who are skilled in the technique.
• For pregnancies after 14 to 16 weeks, medicines may be used to make the uterus contract and deliver the baby and placenta. This is similar to inducing labor. In the past, it was common to inject a salt solution (saline) into the womb to start contractions and delivery of the baby, but this method is not as good as some of the newer medicines.

Be sure to talk to your healthcare provider about the possible side effects and complications of the type of procedure you are going to have. There are often medical reasons to choose one type of procedure over another.

What happens before the procedure?

Your healthcare provider will ask about your medical history and give you a physical exam, including a pelvic exam. You may have a Pap test and urine and blood tests. You may have an ultrasound exam to determine the stage of your pregnancy. If you decide to have a TOP, your provider will tell you about any special steps you need to take before the procedure.

Most states require that parents be notified before a TOP. Some require parental permission before someone under the age of 18 can end a pregnancy.

How are these procedures performed?

Menstrual extraction

Menstrual extraction is a procedure that can be done only very early in pregnancy. It can be done in your healthcare provider's office.

Your provider will put a speculum into your vagina. He or she will then place a small tube into your womb through the cervix. (The cervix is the opening to the womb.) The tube is used to remove the pregnancy tissue with a syringe or a suction machine.

Medicines used early in pregnancy

Mifepristone (Mifeprex or RU 486) is a medicine you can take by mouth to end a pregnancy. It is also called the abortion pill. It may be used within 7 weeks of the first day of your last period. It blocks one of the hormones you need to stay pregnant. The earlier in the pregnancy the medicine is taken, the more likely it is to be effective.

You will probably start having vaginal bleeding 1 or 2 days after you take mifepristone. Usually 2 days after taking the mifepristone you will take another medicine called misoprostol. This second medicine causes cramping of the uterus and helps empty the uterus.

After you have taken both medicines your healthcare provider may want you to have an ultrasound scan to make sure that all pregnancy tissue is gone.

If you have heavy bleeding after taking the medicine, you may need a procedure called a dilation and curettage (D&C). The D&C is a scraping of the inside of the uterus. It removes any remaining pregnancy tissue and blood clots. It stops heavy bleeding. Most women do not need to have a D&C after using mifepristone.

Mifepristone cannot be used if you have certain medical conditions. Discuss this with your healthcare provider.

Other combinations or types of medicines may be prescribed by your healthcare provider to end a pregnancy.

Vacuum curettage

A vacuum curettage is a surgical procedure usually done in an operating room, emergency room, or specially equipped procedure rooms. It is also called a suction dilation and curettage, or suction D&C. Before the procedure you will be given a local or general anesthetic to keep you from feeling pain during the procedure.

Your provider will dilate and open up the cervix just enough to allow a small plastic tube to be put into the womb. The tube will be attached to a vacuum pump. The pump will suction the pregnancy tissue out of the womb. Your provider may also use a spoonlike tool called a curette to scrape the walls of the womb and make sure that all pregnancy tissue has been removed.

Dilation and evacuation (D&E)

A D&E is a surgical procedure that may be done if you are 13 to 21 weeks pregnant. Because the baby is larger at this stage of the pregnancy, the cervix needs to be opened more than for a vacuum curettage. To do this safely, the cervix may need to be prepared 24 to 48 hours before the procedure. To prepare the cervix, your provider will gently place some special material in the shape of very small sticks inside the cervix. The sticks are called laminaria and are made from a type of seaweed. The sticks absorb water from the body, which makes them swell. This causes the cervix to gently open up. After placement of the sticks, you will usually go home. Your provider will examine your cervix the next day. If it has opened enough, the D&E can be done. If not, a second set of sticks may be inserted and the D&E may be done the next day.

The D&E is done in an operating room. General anesthesia is usually used, so you are asleep during the procedure. The procedure is similar to a suction curettage. After the sticks are removed, the cervix may be gently opened more with metal rods. The pregnancy tissue will be removed with instruments and suction. The uterus will be scraped to be sure the tissue has been removed. You will then be given medicine through an IV to contract the uterus.

Medicines used for second-trimester TOPs

Certain medicines may be used for TOPs after the 14th to 16th weeks of pregnancy. These medicines cause contractions that lead to labor and delivery. The medicine is usually given at the hospital. This method is often used when there is a need to examine a baby after a TOP. This happens most often when there is a suspected severe birth defect in the baby and examination of the baby will help provide a explanation for why the problem happened.

The medicines used most often are dinoprostone and misoprostol. Your provider puts a series of suppositories of the medicine in your vagina until the baby and placenta are delivered. The medicine may cause some nausea, fever, and diarrhea. These side effects are temporary and can be controlled with other medicines. Your provider will give medicine to relieve any pain. Nearly all women deliver the baby within 24 hours after starting the medicine.

After the baby is delivered by any of these procedures, you may need to have a dilation and curettage (D&C) to remove any pregnancy tissue left in the womb.

What happens after the procedure?

After each of these procedures, you are observed for 1 or more hours to check for complications. The length of time in recovery depends on the type of procedure you had and the kind of anesthetic you were given.

If your blood is Rh negative, you will need a shot of Rho (D) immune globulin. It will help prevent problems with incompatible blood types in future pregnancies.

Before you go home, you may be given an antibiotic to prevent infection. You may also be given a drug to contract the uterus. Your provider will tell you how long to wait before having sex again. You may discuss ways to prevent pregnancy, and your provider may prescribe a method for you. Someone should drive you home.

It’s normal to have some cramping for a few days after the TOP while the uterus contracts to its normal size. It is also normal to have some small amounts of bleeding for several days. Other possible side effects from a TOP and the medicines used during the process include:

• headaches
• nausea and vomiting
• feeling warm or having chills
• dizziness
• tiredness

Most women are able to return to their normal daily activities within a day or so after the TOP if there are no complications. Recovery time may be longer if the TOP was done after 16 weeks of pregnancy.

Make sure you follow all of your provider's instructions for taking care of yourself and for a follow-up visit.

What are the possible complications of a TOP?

TOPs done by licensed healthcare providers are generally safe. The rate of complications from TOPs done by licensed providers is very low. Possible complications include:

• a tear in the uterus if a surgical tool goes through the wall of the uterus and possible injury to another nearby organ, such as the bowel or bladder, which would require more surgery
• infection
• excessive bleeding
• an unsuccessful procedure that does not end the pregnancy
• psychological or emotional problems after the TOP
• scar tissue inside the uterus
• trouble getting pregnant after several TOPs or after a complicated TOP
• problems with the baby’s development if a TOP fails and the pregnancy continues, although this is rare

Report any of the following symptoms of possible complications to your healthcare provider right away:

• severe abdominal pain
• fever over 100.5°F (38°C)
• dizziness or fainting
• foul-smelling discharge from the vagina
• bleeding that is more than a heavy period or has large blood clots
• signs that you are still pregnant, such as breast tenderness, tiredness, and nausea

Some women are depressed after having a TOP. This may happen right after the TOP or weeks or months later. If you are feeling depressed, tell your provider. Your provider can help you find support and counseling.