American Medical Association Family Medical Guide - American Medical Association [274]
Abortion
Talking to a counselor or therapist as well as your doctor may be helpful during this time. If you are under age 18, find out from an organization such as Planned Parenthood if the law in your state requires that your parents be notified before you have an abortion. After age 18 and until the 12th week of pregnancy, an abortion is a private medical decision made by a woman and her doctor. Some states have enacted laws to govern termination of a pregnancy after the 12th week.
Although the risks from an early abortion are fewer than the risks involved in carrying a pregnancy to term, complications of abortion can include infection, bleeding, and continuation of an unwanted pregnancy.
Mifepristone
Mifepristone is a synthetic hormone medication that can induce an abortion in a woman who is up to 9 weeks pregnant when it is taken with medications called prostaglandins, which cause the uterus to contract. The success rate is higher if it is taken earlier than 6 weeks. Mifepristone induces abortion by making the lining of the uterus shed. It can take several days to terminate a pregnancy using mifepristone. You will have cramps for a few days and vaginal bleeding (similar to a period) for 1 week to 10 days.
Vacuum suction
Vacuum suction (also called vacuum aspiration) can be performed up to the 16th week of pregnancy. After dilating (widening) the cervix with slender rods, a flexible tube connected to a suction machine is inserted through the cervix and into the uterus. The machine suctions the embryo or fetus, the placenta, and the lining of the uterus out of the uterus. Sometimes a D and C (see page 869) is performed at the same time or instead of vacuum suction. In a D and C, a spoon-shaped instrument called a curet is used to remove any remaining tissue.
Dilation and evacuation
Between weeks 13 and 16 of pregnancy, dilation and evacuation is the most common abortion procedure. It is similar to vacuum suction (above) except that the cervix must be opened wider because larger grasping and removal instruments are used after the initial suctioning. Dilation and evacuation is a safe method when performed by a doctor who has experience performing this procedure.
Late-stage abortion
From the 16th to the 24th week, termination of a pregnancy is possible using surgical methods similar to dilation and evacuation or by using nonsurgical methods such as the use of a saline solution or medication to induce abortion. Labor may be induced with vaginal suppositories or medications introduced intravenously (through a vein) or injected through the uterine wall into the amniotic fluid (the fluid that surrounds the fetus). Inducing labor may be preferable to surgically terminating a pregnancy at this stage if an autopsy needs to be performed to look for structural malformations in the fetus.
Prenatal Care
It is important to start prenatal care early, even before you get pregnant, to make sure that both you and your baby are healthy by the time of delivery. Besides regular checkups with your doctor to monitor the progress of your pregnancy and to receive information about how to have a healthy pregnancy, prenatal care may involve tests to detect genetic diseases or birth defects in the fetus such as congenital heart disease (see page 389), neural tube defects (see page 398), or chromosome abnormalities such as Down syndrome (see page 955). A woman and her partner may also want to sign up for childbirth preparation classes to prepare themselves for labor and delivery.
Regular Prenatal Checkups
Once your pregnancy has been confirmed, your doctor may refer you to an obstetrician (a doctor who specializes in the care of a woman during pregnancy, labor, delivery, and the period immediately after delivery), or schedule you for subsequent checkups and tests. Prenatal checkups are usually scheduled monthly until the third trimester, when they are