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Abortion by jekky
Types of abortion Spontaneous abortion Main article Miscarriage A complete spontaneous abortion at about six weeks from conception i e eight weeks from LMP Spontaneous abortion also known as miscarriage is the expulsion of an embryo or fetus due to accidental trauma or natural causes before approximately the 22nd week of gestation the definition by gestational age varies by country Most miscarriages are due to incorrect replication of chromosomes they can also be caused by environmental factors A pregnancy that ends before 37 weeks of gestation resulting in a live born infant is known as a premature birth When a fetus dies in utero after about 22 weeks or during delivery it is usually termed stillborn Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap Between 10 and 50 of pregnancies end in clinically apparent miscarriage depending upon the age and health of the pregnant woman Most miscarriages occur very early in pregnancy in most cases they occur so early in the pregnancy that the woman is not even aware that she was pregnant One study testing hormones for ovulation and pregnancy found that 61 9 of conceptuses were lost prior to 12 weeks and 91 7 of these losses occurred subclinically without the knowledge of the once pregnant woman The risk of spontaneous abortion decreases sharply after the 10th week from the last menstrual period LMP One study of 232 pregnant women showed virtually complete pregnancy loss by the end of the embryonic period 10 weeks LMP with a pregnancy loss rate of only 2 percent after 8 5 weeks LMP The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo fetus accounting for at least 50 of sampled early pregnancy losses Other causes include vascular disease such as lupus diabetes other hormonal problems infection and abnormalities of the uterus Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion A spontaneous abortion can also be caused by accidental trauma intentional trauma or stress to cause miscarriage is considered induced abortion or feticide Induced abortion A pregnancy can be intentionally aborted in many ways The manner selected depends chiefly upon the gestational age of the embryo or fetus which increases in size as it ages Specific procedures may also be selected due to legality regional availability and doctor patient preference Reasons for procuring induced abortions are typically characterized as either therapeutic or elective An abortion is medically referred to as therapeutic when it is performed to save the life of the pregnant woman preserve the woman s physical or mental health terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity or selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy An abortion is referred to as elective when it is performed at the request of the woman for reasons other than maternal health or fetal disease Abortion methods Gestational age may determine which abortion methods are practiced Medical Main article Medical abortion Medical abortions are non surgical abortions that use pharmaceutical drugs and are only effective in the first trimester of pregnancy citation needed Medical abortions comprise 10 of all abortions in the United States and Europe citation needed Combined regimens include methotrexate or mifepristone followed by a prostaglandin either misoprostol or gemeprost misoprostol is used in the U S gemeprost is used in the UK and Sweden When used within 49 days gestation approximately 92 of women undergoing medical abortion with a combined regimen completed it without surgical intervention Misoprostol can be used alone but has a lower efficacy rate than combined regimens In cases of failure of medical abortion vacuum or manual aspiration is used to complete the abortion surgically Surgical A vacuum aspiration abortion at eight weeks gestational age six weeks after fertilization 1 Amniotic sac 2 Embryo 3 Uterine lining 4 Speculum 5 Vacurette 6 Attached to a suction pump In the first 12 weeks suction aspiration or vacuum abortion is the most common method Manual Vacuum aspiration MVA abortion consists of removing the fetus or embryo placenta and membranes by suction using a manual syringe while electric vacuum aspiration EVA abortion uses an electric pump These techniques are comparable and differ in the mechanism used to apply suction how early in pregnancy they can be used and whether cervical dilation is necessary MVA also known as mini suction and menstrual extraction can be used in very early pregnancy and does not require cervical dilation Surgical techniques are sometimes referred to as Suction or surgical Termination Of Pregnancy STOP From the 15th week until approximately the 26th dilation and evacuation D E is used D E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction Dilation and curettage D C the second most common method of abortion is a standard gynecological procedure performed for a variety of reasons including examination of the uterine lining for possible malignancy investigation of abnormal bleeding and abortion Curettage refers to cleaning the walls of the uterus with a curette The World Health Organization recommends this procedure also called sharp curettage only when MVA is unavailable The term D and C or sometimes suction curette is used as a euphemism for the first trimester abortion procedure whichever the method used Other techniques must be used to induce abortion in the second trimester Premature delivery can be induced with prostaglandin this can be coupled with injecting the amniotic fluid with hypertonic solutions containing saline or urea After the 16th week of gestation abortions can be induced by intact dilation and extraction IDX also called intrauterine cranial decompression which requires surgical decompression of the fetus head before evacuation IDX is sometimes called partial birth abortion which has been federally banned in the United States A hysterotomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia It requires a smaller incision than a caesarean section and is used during later stages of pregnancy From the 20th to 23rd week of gestation an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedure to ensure that the fetus is not born alive Other methods Bas relief at Angkor Wat Cambodia c 1150 depicting a demon inducing an abortion by pounding the abdomen of a pregnant woman with a pestle Historically a number of herbs reputed to possess abortifacient properties have been used in folk medicine tansy pennyroyal black cohosh and the now extinct silphium see history of abortion The use of herbs in such a manner can cause seriousven lethalide effects such as multiple organ failure and is not recommended by physicians Abortion is sometimes attempted by causing trauma to the abdomen The degree of force if severe can cause serious internal injuries without necessarily succeeding in inducing miscarriage Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries In Southeast Asia there is an ancient tradition of attempting abortion through forceful abdominal massage One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld Reported methods of unsafe self induced abortion include misuse of misoprostol and insertion of non surgical implements such as knitting needles and clothes hangers into the uterus These methods are rarely seen in developed countries where surgical abortion is legal and available Health risks Early term surgical abortion is a simple procedure which is safer than childbirth when performed before the 21st week Abortion methods like most minimally invasive procedures carry a small potential for serious complications The risk of complications can increase depending on how far pregnancy has progressed Women typically experience minor pain during first trimester abortion procedures In a 1979 study of 2 299 patients 97 reported experiencing some degree of pain Patients rated the pain as being less than earache or toothache but more than headache or backache Local and general anesthetics are used during surgical procedures Mental health Main article Abortion and mental health The relationship between induced abortion and mental health is an area of controversy No scientific research has demonstrated a direct causal relationship between abortion and poor mental health though some studies have noted that there may be a statistical correlation Pre existing factors in a woman s life such as emotional attachment to the pregnancy lack of social support pre existing psychiatric illness and conservative views on abortion increase the likelihood of experiencing negative feelings after an abortion In a 1990 review the American Psychological Association APA found that severe negative reactions after abortion are rare and are in line with those following other normal life stresses The APA revised and updated its findings in August 2008 to account for the accumulation of new evidence and again concluded that induced abortion did not lead to increased mental health problems A 2008 review by a group from the Johns Hopkins Bloomberg School of Public Health concluded that the highest quality studies found few if any mental health differences between women who had abortions and their comparison groups whereas studies with the most flaws reported negative mental health consequences of abortion As of August 2008 the United Kingdom Royal College of Psychiatrists is also performing a systematic review of the medical literature to update their position statement on the subject Some proposed negative psychological effects of abortion have been referred to by pro life advocates as a separate condition called post abortion syndrome However the existence of post abortion syndrome is not recognized by any medical or psychological organization and some physicians and pro choice advocates have argued that the effort to popularize the idea of a post abortion syndrome is a tactic used by pro life advocates for political purposes Incidence of induced abortion The incidence and reasons for induced abortion vary regionally It has been estimated that approximately 46 million abortions are performed worldwide every year Of these 26 million are said to occur in places where abortion is legal the other 20 million happen where the procedure is illegal Some countries such as Belgium 11 2 per 100 known pregnancies and the Netherlands 10 6 per 100 have a low rate of induced abortion while others like Russia 62 6 per 100 and Vietnam 43 7 per 100 have a comparatively high rate The world ratio is 26 induced abortions per 100 known pregnancies By gestational age and method Histogram of abortions by gestational age in England and Wales during 2004 Average is 9 5 weeks Abortion in the United States by gestational age 2004 Data source Centers for Disease Control and Prevention Abortion rates also vary depending on the stage of pregnancy and the method practiced In 2003 from data collected in those areas of the United States that sufficiently reported gestational age it was found that 88 2 of abortions were conducted at or prior to 12 weeks 10 4 from 13 to 20 weeks and 1 4 at or after 21 weeks 90 9 of these were classified as having been done by curettage suction aspiration Dilation and curettage Dilation and evacuation 7 7 by medical means mifepristone 0 4 by intrauterine instillation saline or prostaglandin and 1 0 by other including hysterotomy and hysterectomy The Guttmacher Institute estimated there were 2 200 intact dilation and extraction procedures in the U S during 2000 this accounts for 0 17 of the total number of abortions performed that year Similarly in England and Wales in 2006 89 of terminations occurred at or under 12 weeks 9 between 13 to 19 weeks and 1 5 at or over 20 weeks 64 of those reported were by vacuum aspiration 6 by D E and 30 were medical Later abortions are more common in China India and other developing countries than in developed countries By personal and social factors A bar chart depicting selected data from the 1998 AGI meta study on the reasons women stated for having an abortion A 1998 aggregated study from 27 countries on the reasons women seek to terminate their pregnancies concluded that common factors cited to have influenced the abortion decision were desire to delay or end childbearing concern over the interruption of work or education issues of financial or relationship stability and perceived immaturity A 2004 study in which American women at clinics answered a questionnaire yielded similar results In Finland and the United States concern for the health risks posed by pregnancy in individual cases was not a factor commonly given however in Bangladesh India and Kenya health concerns were cited by women more frequently as reasons for having an abortion 1 of women in the 2004 survey based U S study became pregnant as a result of rape and 0 5 as a result of incest Another American study in 2002 concluded that 54 of women who had an abortion were using a form of contraception at the time of becoming pregnant while 46 were not Inconsistent use was reported by 49 of those using condoms and 76 of those using the combined oral contraceptive pill 42 of those using condoms reported failure through slipping or breakage The Guttmacher Institute estimated that most abortions in the United States are obtained by minority women because minority women have much higher
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