Methods of Termination of
pregnancy
Methods
1.medical method
2. Surgical methods
1. Medical: early
• Prostaglandins (analogues) – misoprostol
• Mefepristone
• Methotrexate
• Combinations of the above
• Others
2. Medical: late
• Oxytocin
• Prostaglandins
• Hypertonic solutions
• Combinations
3. Surgical - early
• MVA and electrical vacuum suction
• D & C (dilators, metal) – Hegar, laminaria
• Menstrual regulation
3. Surgical - late
• Cervical preparation
• Dilatation and Evacuation
• Condom – Foley catheter
• Laminaria
• Laparotomy
Uterine-Evacuation Methods
• Uterine evacuation removes contents of the
uterus
• Several methods for providing 1st trimester
uterine evacuation:
– Vacuum aspiration techniques
– Medication (or pharmacological) techniques
– Sharp curettage
Which Method is Best?
• Use of a certain method depends on:
– Safety, efficacy and cost
– Staff skills
– Equipment, supplies, drugs available
– The woman’s clinical condition
– Her personal preference
According to the World Health
Organization
• VA or MA are preferred methods for first
trimester abortion
• WHO recommends replacing sharp
curettage with VA or MA
MVA
Manual vacuum Aspiration
- manual needs no electric power
- cannula
-cylinder
- valve
- planger
EVA
Electrical vacuum Aspiration
- electric source
- electric vacuum aspirator machine
- cannula
Medication or Pharmacological
Methods
• Prostaglandins (analogues) – misoprostol
• Mefepristone
• Methotrexate
• Combinations of the above
• Oxytocin
• Hypertonic solutions
• Combinations
Medical Abortion
Medical Abortion cont.
• Medical abortion can be also called
Abortion pills.
• What is medical abortion?
- it is emptying the uterine contents -
with the use of drugs.
- is a form of early abortion method
caused by
the combination of two medication.
Medical Abortion cont
• What are the medications to be combined
1.methotrexate and misoprostole
2.mifepristone [RU 486]and misoprostol
• methotrexate and misoprostol combination
is currently used in Canada
• And mifepristone and misoprostol
combination in Europe northern America.
Medical Abortion cont
• Methotrexate is a drug used to treat
psoriasis,and cancer. It also stops the
• growth of the pregnancy when given to a
woman very early in
pregnancy.Methotrexate is usually given by
injection.
• Misoprostol is a drug used to treat stomach
ulcer.
Medical Abortion cont
• Action mechanism
• Mifepristone blocks the hormone progesterone
needed to maintain the pregenancy.because this
hormone is blocked ,the uterine lining begins to
shed
• The cervix begins to soften and bleeding may
occur.
• Misoprostol causes uterine contraction after being
inserted in the vagina.
Medical Abortion cont
• Methotrexate stops the growth of pregnancy
[trophoblasts]
•
Medical Abortion cont
• Indication in early pregnancy
• Methotrexate and misoprostol up to seven
weeks from the start of last period
• Mifepristone and misoprpstol is used
slightly longer , up to nine weeks after the
last period.
Medical Abortion cont
• Application of the medical abortion
• Take menstrual history
- last normal menstrual period
- counseling
- decide the termination
- medical abortion vs. surgical termination
• US if availabel
Medical Abortion cont
• Mifepristone and mesoprostol
• mifepristone is taken orally
• then misoprostopl is inserted vaginally
with in 24 – 72 hours after taking the
mifepristone this causes contraction .if no
miscarriage induced you have to contact
your treating physician to add misoprostol
vaginal tablet.
Medical Abortion cont
• In methotrexate and misoprostol
combination after the injection of
methotrexate misoprostol vaginal tablet is
inserted in the vagina five to seven days. in
most cases uterus will be emptied with in 24
hrs.
Medical Abortion cont
• What to expect during the medical
abortion process
• mifeprestone -bleeding can start
immediately or later ,spotting mild to
sever bleeding can occur.
• or some experience no bleeding
• until mesoprostol is inserted vaginally.
Medical Abortion cont
• Mesoprostol -after insertion abdominal
cramp ,bleeding ,and clots may begin within
20 minutes ,within the next 6 to 8 hours,
most women will miscarry
Medical Abortion cont
• Side effects
- specially from misoprostol –heavy
bleeding headache, nausea, vomiting
,diarrhea, and heavy cramping
Medical Abortion cont
• Advantages of medical abortion
- avoids surgery and the risk of damage of the
uterus with the instrumental
- can be done early before signs of pregnancy
- may feel less invasive than surgery.
- may seem more private to some women
since much of the procedure can occur at
home.
Medical Abortion cont
• Disadvantages
- takes place over a week or more and
involves several visits to the doctor.
- ten percent risk that the procedure will be
incomplete and a surgical abortion will
need to be done.
- sometimes causes heavy bleeding
the drugs may have unpleasant side
effects,
Medical Abortion cont
• Riskes
- heavy bleeding sometimes need surgical
intervention or blood transfusion.
- if the abortion fails and the pregnancy
continues there is high risk of fetal
deformities .
Medical Abortion cont
• Criteria
- Are less than 8 weeks since the last
menstrual period Are willing and abele to
give informed consent.
- access to health facility
- agree to have surgical abortion if
mesoprostol doesn’t induce termination .
Medical Abortion cont
• may not be recommended in case of
• blood clotting problems
• sever anemia
• adrenal failer
• long term corticosteroid therapy
• inherited porpheria
• allergic reaction to the drugs used
• sever diarrhae
Medical Abortion cont
• Future fertility is not affected with the use
of mifepristone and mesoprostol
• - Emergency contraception should not be
confused for abortion pills
