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Last updated:  23 July 2014

 The aim of this information on medical abortion is to fully inform women and the public in general on what happens in these procedures in the clearest but least graphically confronting way possible. There are no photographs of aborted babies included on this page or anywhere else on this site out of consideration for women who have already had an abortion, their partners and family members.  However, for information and educational purposes, this page does contain a realistic medical drawing showing how the abortion pill works in an early abortion. 

  

What Are Medical Abortions and Where Are They Performed?

Medical abortions are performed by abortionists in a clinic or hospital, or early in a pregnancy by a woman at home using the pills and instructions she has been given.  

Medical abortions are carried out at in the first, second or third trimesters.  In most countries where abortion is legal, medical abortions may be performed at any time during a pregnancy but rarely occur in the third trimester.  Some countries or states or territories restrict abortions after certain time in a pregnancy, such as after 20 weeks gestation (since LMP) usually with exceptions (e.g. risk to woman's life or if the baby has an abnormality).

The procedures vary depending on the stage in pregnancy and include the Abortion Pill, Misoprostol or other Prostaglandins (which induce labour) or chemicals which are injected either into the amniotic sac or the fetus to directly cause the death of the baby or premature delivery of the baby resulting in death.

 

First Trimester - Performed up to end of 13 weeks (since LMP)

A first trimester abortion is one which is performed within the first 3 months of pregnancy.  Since a woman will not normally know if she is pregnant until at least the 4th week of pregnancy, these abortions are usually performed between 4 and 14 weeks since last menstrual period (LMP).

First trimester development (weeks since LMP): From fertilization: a new human embryo exists, already a boy or girl. 5 weeks: heart is beating and brain is developing. 6 weeks: baby has head, chest and abdomen, is ½ cm long and arms and legs have started to develop. 7th week: baby's brain has all the divisions, subdivisions and cavities as in an infant's brain; face and fingers are taking shape and when face is touched, embryo reflexively moves away8 weeks: he/she is 1cm long. 9 weeks: baby can move hands and neck and may get hiccups.  10 weeks: baby is almost 1¼ inches, makes startle movements and general movements of whole body; all fingers and toes are fully formed, hairs on eyebrow and other areas of face appear. 11 weeks: baby is a fetus, can sigh, stretch and starts sucking thumb.  His/her face, palms of hands, and soles of feet are sensitive to light touch. 12 weeks: baby is 3 inches long with all major body parts and apart from the tiny size, closely resembles a newborn. 13 weeks: baby can make complex facial expresssions and by end of this week will be almost 4 inches, having grown almost an inch every week since 10 weeks. 

 

In the first trimester, medical abortions are performed using either of the following drug regimens:  

    1. Mifepristone ('the Abortion Pill') alone   
    1. Mifepristone with misoprostol
    2. Misoprostol alone
    3. Methotrexate with misoprostol

Mifepristone is 'the abortion pill'.  It directly causes the death of the baby by detaching the embryo from the uterine lining.

Misoprostol is a drug which causes a woman's uterus to contract and cervix to soften.  This causes a induced miscarriage (abortion) because the drug causes her body to deliver the embryo and placenta.

The preferred abortion method is mifepristone used with 'misoprostol'.  It is the most effective way to cause a complete abortion in the first trimester.

Methotrexate is another drug which may be used in a first trimester abortion.  It interferes with cell growth.  It is administered by injection and is also used to directly cause the death of the embryo before misoprostol is administered to cause the woman's body to deliver the embryo and placenta.

 

The Abortion Pill - Mifepristone

Mifepristone is also called 'the abortion pill' or RU486.  The time in pregnancy the abortion pill is used varies.  It will cause a complete abortion at 13 weeks gestation but is usually used up to 9 weeks since LMP.  The risk of complications or an incomplete abortion after using the abortion pill starts rising significantly after 10 weeks.  It is a common form of early legal abortion in the U.S. and is legally available in Australia for an abortion at less than 9 weeks since LMP (7 weeks since fertilization).

Sometimes the abortion pill is used as a 'pre-treatment' in Induced Abortions in the second trimester (in pregnancies at 14 - 21 weeks since LMP) to increase the effectiveness of misoprostol which causes a woman to go into premature labour and deliver the baby and placenta.2

RU486 or mifepristone works by blocking progesterone, which is a naturally-occurring hormone in pregnancy and needed at the right levels to maintain a pregnancy.  If a woman takes the abortion pill, this causes:

  1. Changes in lining of the uterus.
  2. The embryo to detach from the lining.
  3. A softening and opening of the cervix.
  4. The uterus to be more sensitive to the hormone, prostaglandin (which may be given to cause contractions).

 

 This illustration by certified medical illustrator Peg Gerrity shows how the abortion pill terminates an early pregnancy, by blocking the naturally occurring hormone progesterone which is needed to maintain the lining of the uterus.  This causes the lining of the uterus (womb) to break down and the new embryo to detach.  This effectively starves the tiny baby of nutrients and what he/she needs to continue to grow and develop, causing death.

 

After the baby has died, the woman's body may naturally expel the embryo and placenta as happens in a spontaneous miscarriage or she may be given a further medication called misoprostol which causes her uterus to contract and get this process underway.

 

Copyright © Peg Gerrity. All rights reserved.

 

 

Misoprostol

Misoprostol is a synthetic prostaglandin and is often used in combination with the abortion pill in the first trimester or even up to 13 weeks since LMP to cause the uterus to contract and expel the dead embryo or fetus.  

Misoprostol may also be used on its own to cause an early labour and delivery of a baby who cannot survive labour or outside the womb.  This medication can cause very strong, violent contractions, depending on the dosage used.

  1. The woman takes misoprostol pills orally or vaginally which induces labour over a number of hours.
  2. The abortionist may rupture the membranes prematurely.
  3. The dead embryo or fetus and placenta are delivered either at home or in the clinic.

 

Prostaglandins

Other prostaglandins are usually used after 8 weeks gestation (since LMP) and in the second trimester to cause the delivery of a fetus who cannot survive outside the womb.  The procedure is similar to the use of misoprostol:

  1. A prostaglandin hormone drug is administered to the woman either vaginally or orally or it is injected directly into the amniotic sac which induces a violent labour.  Since intra-amniotic infusions (injected directly into the amniotic sac) have been associated with greater risk of uterine rupture, usually the prostaglandin is given orally or vaginally.
  2. The abortionist may rupture the membranes prematurely.
  3. The baby cannot survive labour in the first trimester and so a dead baby and placenta is delivered.

 

 

Second or Third Trimester Abortions - Performed from 14 weeks (since LMP) onwards

In the second or third trimester, to perform a medical abortion, the abortionist either administers the woman misoprostol or another hormone prostaglandin to cause a premature labour.  The baby either dies during the process or shortly afterwards.  Alternatively, for mid-late second trimester or third trimester abortions, the abortionist may inject a chemical either into the amniotic fluid or directly into a fetus to cause the death of the baby.

 

Second trimester development (weeks since LMP): At 14 weeks: the fetus is 5 inches long. 15 weeks: baby responds to light touch virtually anywhere on his/her body. 16 weeks: baby is almost 7 inches long. 18 weeks: if poked with a needle, the fetus releases stress hormones. 20 weeks: baby is 10 inches long with eyebrows and head hair. 21 weeks: baby has breathing cycles. 22 weeks: baby can hear sounds. His/her skin and all its structures are completely formed. At 22 weeks the fetus may survive outside the womb with specialist care.  25 weeks: breathing motions are more frequent, shows blink-startle response. 26 weeks: eyelids open. 

 

Induced Abortion with Misoprostol

An induced abortion is performed by administering a woman certain drugs which cause her to go into labour prematurely.  It is a procedure usually performed in the second trimester in a hospital or abortion clinic because an abortionist is needed at this point to assist in the delivery of a dead or dying baby.  The intent of this procedure is to cause the delivery of a fetus who cannot survive outside the womb without specialist care and to bring about the death of the baby during the procedure or shortly after delivery.

Misoprostol may also be used on its own in the second trimester to induce labour but may also be used with mifepristone as a pre-treatment at 14 - 21 weeks (since LMP) to make the procedure with misoprostol more effective.

After about 19 weeks it is not uncommon that the baby is born alive but dies shortly afterwards or within an hour or so depending on age.  The procedure is as follows:

  1. In some countries, such as in Europe, the woman may be given mifepristone in a second trimester abortion as a pre-treatment a day or two before misoprostol is taken but use of mifepristone at this gestational age is not permitted in the US or Australia.
  2. The woman takes misoprostol pills either orally or vaginally.  This induces labour over a number of hours. 
  3. The baby is delivered prematurely and if alive, is left to die.
  4. The abortionist examines the woman and if the abortion is not complete, may rupture the membranes or gives the woman a repeat of misoprostol. 
  5. If the medical abortion is not successful, the patient may undergo a surgical abortion.

 

 Induced Abortion with Prostaglandins

 A woman may be administered a prostaglandin (synthetic hormone) in the second trimester to cause the delivery of a fetus who cannot survive outside the womb or after 22 weeks without specialist care.  The procedure is very similar to the use of misoprostol:

  1. A prostaglandin hormone drug is administered to the woman either vaginally or orally or it is injected directly into the amniotic sac which induces a violent labour.  Since intra-amniotic infusions (injected directly into the amniotic sac) have been associated with greater risk of uterine rupture, usually the prostaglandin is given orally or vaginally.
  2. The abortionist may rupture the membranes prematurely.
  3. The baby is delivered prematurely and if alive, is left to die.

 

Intrauterine Instillation or Intracardiac Injection

Alternatively, for mid-late second trimester or third trimester abortions, the abortionist may inject a chemical either into the amniotic fluid or directly into a fetus to cause the death of the baby.  The woman then goes into labour and delivers the dead or dying baby.

   

Saline Amniocentesis (Salt Poisoning) or 'Saline-induced Abortion'

Twenty years ago saline-induced abortion was the only way to successfully perform a mid-second trimester abortion but has been largely replaced by Dilation and Evaluation abortions because a D & E is not as uncomfortable for the woman.  However, D & E abortions are risky if the abortionist is inexperienced or does not have a require a certain level of competency3.  Hence saline-induced abortions are still used by the abortionists in the second trimester.

This is done for as late second or third trimester abortion:

  1. A concentrated salt solution is injected into the amniotic sac by needle through the mother's abdomen.  
  2. The baby swallows the solution which causes salt poisoning, hemorrhaging of the brain and other organs and convulsions. The baby's skin is often stripped or burned off by the salt solution.   The baby usually dies 1 - 2 hours later.
  3. The woman goes into labour within the next 48 hours and delivers a dead or dying baby.

 

Hypertonic urea (Ureaphil) Abortion

This procedure may be used in the second trimester to cause premature labour.  Urea 40 - 40% is injected into the uterus through the cervix.  The cervix is dilated (opened) using a laminaria or Dilapan or an intravaginal prostaglandin such as misopostol.  As with other methods of induced abortion, the premature baby is delivered either dead or dies shortly after birth.

 

Intracardiac Injections

This procedure may be used in the second or third trimester when the baby is big enough that the abortionist is able to accurately give an injection into the baby through the mother's stomach.  It may be used to selectively abort one or more babies in a multiple pregnancy.

Chemicals used may be potassium chloride or digoxin.

 

  

Footnotes:

1  Children By Choice Association Incorporated. Sept 2013. Medication Abortion. Retrieved July 23, 2014

2  Trupin, Suzanne R. 2014. Elective Abortion Treatment and Management: First- and second-trimester medical abortion. Medscape Reference.  http://emedicine.medscape.com/article/252560-treatment  Retrieved July 23, 2014.

3  Trupin, Suzanne R. 2014. Elective Abortion Treatment and Management: Saline-induced abortion. Medscape Reference.  http://emedicine.medscape.com/article/252560-treatment  Retrieved July 23, 2014.

 

 

 

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