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Summary
Induced abortion is the use of interventions (e.g., medication, procedures) to end a pregnancy. Common indications include patient choice, anticipated harm to the pregnant individual, and fetal genetic or anatomical abnormalities. Abortion may be performed via medical or surgical procedure. When performed under clinical guidance, induced abortion is highly effective and safe.
Epidemiology
In 2017 in the US: [2]
- Approx. 18% of pregnancies ended in abortion
- Approx. 60% of abortions occurred at ≤ 10 weeks' gestation
Indications
Common indications include: [3][4]
- Patient choice to end the pregnancy
- Anticipated harm to the pregnant individual
- Genetic or anatomical abnormalities in the fetus
Preparation
Prior to induced abortion, the following steps should be considered: [3][4]
- Confirm pregnancy (e.g., with a urine pregnancy test).
- Perform a gestational age assessment.
- Consider ultrasound for patients with : [3]
- Symptoms or risk factors for ectopic pregnancy
- History of irregular menstrual cycles
- Last menstrual period > 56 days prior (or unknown)
- Use shared decision-making to select the method of induced abortion.
- Educate patients on expected symptoms and adverse effects, e.g.: [3]
- Bleeding and cramping (heavier than menstruation) [3][5]
- GI symptoms: nausea, vomiting, diarrhea
- Low-grade fever and chills
- Offer additional care as indicated (e.g., referral for psychosocial services, contraception counseling, STI screening).
Procedure/application
- Provide adequate pain management during and after the procedure. [3]
- Consider anti-D prophylaxis in Rh-negative women.
| Methods of induced abortion [3][6] | ||
|---|---|---|
| Medical abortion | Surgical abortion | |
| Definition |
|
|
| First trimester (≤ 12 weeks' gestation) |
|
|
| Second trimester (between 13 and 24 weeks' gestation) |
|
|
| Advantages |
|
|
| Disadvantages |
|
|
Postabortion [10]
- For confirmation of abortion or evaluation of abortion complications, obtain: [3]
- Serum hCG level (if prior level is known) [3][5]
- Pelvic US: to evaluate for a gestational sac [3]
- Treat any complications.
- If a gestational sac is present, consider expectant management or repeat induced abortion. [3]
- Counsel patients on recommended follow-up:
- A routine follow-up visit is not required for uncomplicated induced abortion. [3][8][11]
- Perform a pregnancy test 4 weeks after abortion. [3]
- Seek medical attention for symptoms of incomplete abortion or complications (e.g., prolonged or excessive pain or bleeding). [3]
Patients with uncomplicated induced abortions do not need a follow-up office visit, but one should be offered to all patients. [3]
Management options for an incomplete abortion after an induced abortion include watchful waiting, medication abortion, or procedural abortion. [3]
Complications
Compared to unsupervised self-managed abortion, complications from medically supervised abortions are exceedingly rare, but may include: [4][6]
- Hemorrhage
- Infection
- Disseminated intravascular coagulation treatment (DIC) [4]
- Cervical laceration
- Uterine perforation
- Retained products of conception
- Pulmonary embolism, amniotic fluid embolism [4][12]
We list the most important complications. The selection is not exhaustive.
Unsupervised or unsafe self-managed abortion
- Definition: actions taken to end a pregnancy without any medical supervision [5]
- Epidemiology: In 2017, 18% of nonhospital facilities in the US treated women following self-managed abortion. [2]
-
Initial management [5]
- Stabilize patients with life-threatening complications, e.g., initiate:
- Immediate hemodynamic support
- Sepsis management
- Management of trauma patients, including FAST
- Urgent surgical consults (e.g., general surgery, gynecology)
- Pelvic examination to assess for products of conception, injuries, signs of infection (e.g., purulent drainage)
- Obtain diagnostic studies if clinically indicated, e.g.: [5]
- CBC with differential, type and screen
- CMP
- hCG (urine or blood)
- Cultures: blood, cervical, aspiration of endometrium
- Consider imaging to evaluate for complications. [5]
- US pelvis: internal bleeding, incomplete abortion, retained products of conception, ectopic pregnancy
- CT abdomen/pelvis: pelvic abscess, bowel injury, hematoma
- Stabilize patients with life-threatening complications, e.g., initiate:
-
Identify and treat potential complications.
- Organ dysfunction (e.g., renal failure, liver damage)
- Uterine perforation or bleeding
- Abdominal or pelvic organ injury
- Infection
- If no complications, provide expectant management with pregnancy test 4 weeks after abortion. [10]
In the US, as of June 2022, medical practitioners are not required to report individuals who have performed an unsupervised self-managed abortion. [10]
Legal implications
- Abortion is no longer federally protected under the constitution of the United States.
- Providers should be aware of local laws and regulations when counseling patients.
- See also “Abortion and stillbirth laws.”
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