Abortion Methods for Terminating Unwanted Pregnancy

Medical abortion

In case of an unwanted pregnancy or in case of a pregnancy that you can’t keep for various reasons, you will need a consultation of a gynecologist, who will give you answers to questions that are bothering you.

In the Republic of Moldova abortion is allowed by law. Every woman who performs the termination of a pregnancy must be properly informed and is free to choose the method of pregnancy interruption and the method of anesthesia, based on the information given during the counseling.

What means a safe abortion?

Abortion is a safe medical procedure, when it is carried out by qualified medical personnel, with the appropriate equipment, through a correct method and according to sanitary standards.

In case of abortion in the first pregnancy trimester, the manual or electrical vacuum aspiration and medical abortion are recommended, but these methods can only be used up to 9 weeks of pregnancy.

Medical abortion is the method of choice up to 9 weeks of pregnancy. From the list of surgical methods cervix dilatation and evacuation of conception product with vacuum aspiration can also be recommended.

What is medical abortion?

Este o metodă nechirurgicală de întrerupere a sarcinii nedorite, recomandată de Organizaţia Mondială a Sănătăţii, ca fiind eficientă şi fără de riscuri. Avortul medicamentos este procedura prin care se folosesc pastile pentru intreruperea sarcinii confirmate și se poate realiza intr-o unitate medicala cat si la domiciliu.

The effectiveness of the method represents on average 95-98% and depends on the term of the pregnancy and on the correct administration of the pills for medical abortion.

How does medical abortion work?

This method consists of two stages: in the first stage the pills for unwanted pregnancy are given, and these pills are preventing the development of fetal egg, in the second stage another medication is given, which causes uterine contractions and independent expulsion of conception product.

The regimen for pills administration in case of a medical abortion

The first pill is given on the first day, during the visit to the physician, followed by administration in 1-3 days of the second pill (in the medical clinic or at home, depending on woman’s choice). After 2 weeks a medical visit is compulsory for condition assessment and confirmation of lack of pregnancy.

The symptoms that can be expected after the administration of pills for medical abortion

• Cramps in the lower abdomen, what can be reduced by administering anti-inflammatory pills such as paracetamol, diclofenac, ketanov etc.
• Removal of the fetal egg that is associated with more intense bleeding.
• Hemorrhagic (bloody) moderate or light discharges over the course of 1-3 weeks or even until the next menstruation.

Possible side effects

In some cases the following side effects may develop: nausea, vomiting, headache, dizziness, diarrhea, weakness, fever, chills, all of these being of short duration.

What complications can occur?

Complications are quite rare and can include: pregnancy continuation, incomplete abortion, severe hemorrhage.

What happens in case of continuing pregnancy or incomplete abortion?

In case of pregnancy continuation the woman is given an extra dose of pills, or abortion is completed through manual vacuum aspiration, according to woman’s decision. Incomplete abortion will also require vacuum aspiration.

Advantages of medical abortion:

• Avoiding surgery and anesthesia;
• Much lower risks for infectious complications compared with surgical abortion;
• It is a more “natural” method of pregnancy interruption;
• It is more confidential and comfortable.

Who can’t use medical abortion for termination of pregnancy?

Women with:

• ectopic pregnancy or any suspicion for it;
• intrauterine devices (must be extracted in advance);
• adrenal insufficiency;
• coagulopathy or being on anticoagulant therapy;
• women on therapy with steroids;
• allergic reactions to medications;
• term of pregnancy more than 12 weeks.

Over how long after a medical abortion can a woman become pregnant again and when will she have a normal menstrual cycle?

Medical abortion has no negative influence both on the ability of the woman to become pregnant again and on her health in general. Another pregnancy after medical abortion can occur in 10-11 days after the procedure, that’s why it’s a good thing to take a decision about contraception already at the first visit to the physician. Menstruation after medical abortion will start as usual, or about 2 weeks later.

Repeated administration of this method might have a negative influence on the body?

According to medical studies, the repeated use of medical abortion has no negative influence on physical or mental health of the woman.

Where can you do medical abortion?

Choose the closest facility, but also the one that provides safe abortion on the map with public medical institutions, providing abortion service with data on quality of these services.

Manual Vacuum Aspiration

According to the World Health Organization (WHO), abortion is a safe medical procedure, when it is carried out by qualified medical personnel, with the appropriate equipment, the correct method and with respect of sanitary standards (WHO, 2003).

Manual Vacuum Aspiration (MVA) is recommended by WHO as one of the methods of pregnancy interruption in the first trimester.

What is Manual Vacuum Aspiration?

MVA is the process through which the content of the uterus is evacuated using negative pressure produced by a special syringe. For aspiration there are used plastic flexible cannulas of different sizes depending on the term of pregnancy. This method avoids the trauma of the cervix and of the endometrium.

The advantages of the Manual Vacuum Aspiration:

• This method avoids trauma to the cervix and endometrium: before the term of 7 weeks, the cannula can be inserted without cervix dilation and control curettage of the uterus is not needed.
• Immediate examination of the aspiration product (the fetal egg remains intact in the syringe) allows to confirm complete evacuation of the uterine content and to diagnose early ectopic pregnancy.
• The procedure takes much less time than dilatation and curettage (D&C), and can be performed under local anesthesia. In this case the patient can leave the hospital in 15 minutes.
• The results of over 80 scientific studies in which there have been included about 80.000 women showed that the number of severe complications and sterility is much lower in case of manual vacuum aspiration as compared to D&C.

There are no contraindications to MVA up to 12 weeks of pregnancy. The procedure is to be applied with caution in the following cases:

• Abnormalities of the uterus
• Disorders of blood coagulation
• Acute pelvic infections
• Any condition that causes medical instability of the patient.

What need to know a patient after MVA?

• After termination of pregnancy, for 2 weeks, it is normal to have pain in form of spasms in the lower abdomen and slight bleeding.
• Most women can return to normal activities virtually immediately after the MVA.
• You can become pregnant immediately after the abortion, without a menstruation before. From these reasons, if at the time pregnancy is not desired, the sexual contacts should be protected. Contraception can prevent pregnancy.
• Emergency contraception can be used for up to 72 hours after unprotected intercourse.
• It is advisable to come back to the doctor for a routine checkup in 2-3 weeks after abortion. It is recommended that the patient refrain from sexual intercourse during bleeding.
• Places where the women can benefit of the chosen contraception method and how to use it correctly.

Contraception after abortion

• The usual methods of contraception can be recommended in most cases.
• Rarely, complications after abortion may limit the choice – very rarely! If this happens, the woman will be offered a temporary method of contraception.
• Natural family planning: is used only after restoration of regular cycle (at least 3 consecutive cycles), then, it is recommended the use of modern methods or abstaining from sexual contacts.

You should refer immediately to the physician if:

• You have severe abdominal pain
• You have a fever over 38 C or chills
• You have a severe bleeding – there are large clots of blood or you’re forced to use in one hour 2-3 large absorbents, for two consecutive hours.
• They are bad smelling or purulent vaginal eliminations
• You have severe weakness, you lost consciousness (you had fainting), or you have difficulties with breathing
• Persistent vomiting or feeling of nausea