Abortion Procedures

Abortion ProceduresThe type of abortion procedure used in elective pregnancy termination is primarily determined by how far a woman is into pregnancy. During the first trimester, you will usually have the option of having a medical abortion procedure or a surgical abortion procedure. Before considering the options, it is recommended that you obtain a sonogram to determine if the pregnancy is viable (uterine, non-ectopic pregnancy) and for accurate pregnancy dating .

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Abortion: What abortion procedures are used during the first trimester?

In most cases, you will have a choice between medical or surgical abortion procedures during the first trimester. Medical abortions are only available up through nine weeks gestation. The types of abortion procedures performed during the first trimester are:

  • Methotrexate & Misoprostol (MTX):  a medical abortion procedure used up to the first seven weeks of pregnancy. This medication combination is not as commonly used in the U.S. with the availability of mifepristone, which works more effectively for this use.
  • Mifepristone and Misoprostol:  a medical abortion procedure used up to the first seven to nine weeks of pregnancy. It can also be referred to as RU-486, the abortion pill and Mifeprex.
  • Manual Vacuum Aspiration (MVA): a procedure used as early as 3 -12 weeks since the last period. Considered less invasive with only a local anesthesia being used on the cervix.
  • Aspiration: a surgical abortion procedure used to terminate pregnancy up to 16 weeks from the last period. It can also be referred to as suction curettage, dilation and curettage (D & C) or vacuum aspiration.

What abortion procedures are used during the second trimester?

Medication based abortion procedures are not an option during the second trimester. The types of abortion procedures performed during the second trimester are:

  • Dilation & Curettage (D & C):  a surgical abortion procedure used to terminate a pregnancy up to 16 weeks gestation. It is also referred to as suction curettage or vacuum aspiration.
  • Dilation & Evacuation (D & E):  a surgical abortion procedure used to terminate a pregnancy after 16 weeks gestation.
  • Induction Abortion: a rarely  performed surgical procedure where salt water, urea, or potassium chloride is injected into the amniotic sac; prostaglandins are inserted into the vagina and pitocin is injected intravenously.

What abortion procedures are used during the third trimester?

Third trimester or late term abortions are not legal in a number  of states except in certain medical situations. The time frame referred to as late term is often based on when a baby is considered “viable” ( meaning able to survive outside the womb). However, the point of “viability” is a grey area in many medical communities. Most medical communities establish 24 weeks gestation, the later part of the second trimester, as the earliest time of viabilty. Therefore, the availability of any procedure used in the third trimester is based on the laws of that state. The procedures that can be done in the third trimester include:

  • Induction Abortion: a rarely done surgical procedure where salt water, urea, or potassium chloride is injected into the amniotic sac; prostaglandins are inserted into the vagina and pitocin is injected intravenously.
  • Dilation and Extraction: a surgical abortion procedure used to terminate a pregnancy after 21 weeks of gestation. This procedure is also known as D & X, Intact D & X, Intrauterine Cranial Decompression and Partial Birth Abortion. *This procedure is now considered against the law in the U.S. according to the Partial Birth Abortion Ban Act of 1995*

“Induced Abortion.” The American College of Obstetricians and Gynecologists. 2001.

Pymar HC, Creinin MD (2000). Alternatives to mifepristone regimens for medical abortion. American Journal of Obstetrics and Gynecology, 183 (2): s54-s64.

Paul M, et al. (1999). A Clinician’s Guide to Medical and Surgical Abortion. New York: Churchill Livingstone.

Creinin MD, et al. (2001). Medical management of abortion. American Journal of Obstetrics and Gynecology Practice Bulletin, no. 26, pg.1-13.

Goldberg ab, et al. (2001). Misoprostol and pregnancy. New England Journal of Medicine, 344 (1): 3845.

Stewart GK (1998). Intrauterine devices. In RA Hatcher et al., eds., Contraceptive Technology, 17th rev.ed., pp.511-544. New York: Ardent Media.

Spitz IM, et al. (1998). Early pregnancy termination with mifepristone and misoprostol in the U.S. New England Journal of Medicine, 338 (18): 1241-1247.

Reproductive Health Technologies Project, http://www.rhtp.org

Last Updated: 07/2014