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Methods for Induced Abortion

Stubblefield, Phillip G. MD; Carr-Ellis, Sacheen MD; Borgatta, Lynn MD, MPH

doi: 10.1097/01.AOG.0000130842.21897.53
Clinical Gynecologic Series: An Expert's View

We describe present methods for induced abortion used in the United States. The most common procedure is first-trimester vacuum curettage. Analgesia is usually provided with a paracervical block and is not completely effective. Pretreatment with nonsteroidal analgesics and conscious sedation augment analgesia but only to a modest extent. Cervical dilation is accomplished with conventional tapered dilators, hygroscopic dilators, or misoprostol. Manual vacuum curettage is as safe and effective as the electric uterine aspirator for procedures through 10 weeks of gestation. Common complications and their management are presented. Early abortion with mifepristone/misoprostol combinations is replacing some surgical abortions. Two mifepristone/misoprostol regimens are used. The rare serious complications of medical abortion are described. Twelve percent of abortions are performed in the second trimester, the majority of these by dilation and evacuation (D&E) after laminaria dilation of the cervix. Uterine evacuation is accomplished with heavy ovum forceps augmented by 14–16 mm vacuum cannula systems. Cervical injection of dilute vasopressin reduces blood loss. Operative ultrasonography is reported to reduce perforation risk of D&E. Dilation and evacuation procedures have evolved to include intact D&E and combination methods for more advanced gestations. Vaginal misoprostol is as effective as dinoprostone for second-trimester labor-induction abortion and appears to be replacing older methods. Mifepristone/misoprostol combinations appear more effective than misoprostol alone. Uterine rupture has been reported in women with uterine scars with misoprostol abortion in the second trimester. Fetal intracardiac injection to reduce multiple pregnancies or selectively abort an anomalous twin is accepted therapy. Outcomes for the remaining pregnancy have improved with experience.

We review current techniques for induced abortion as practiced in the United States, including both medical and surgical methods through the second trimester.

From Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts.

Received February 11, 2004. Received in revised form April 13, 2004. Accepted April 15, 2004.

Address reprint requests to: Phillip G. Stubblefield, MD, Boston Medical Center, 720 Harrison Avenue, Suite 1105, Boston, MA 02118; e-mail: phillip.stubblefield@bmc.org.

© 2004 The American College of Obstetricians and Gynecologists