Abortion, a medical procedure to terminate a pregnancy

What is an abortion?

Abortion is a procedure performed to intentionally terminate a pregnancy before the fetus can live outside the womb.

This procedure is performed to remove the pregnancy tissue, fetus, and placenta from the uterus.

In some countries, abortion is considered a legal procedure. This is different from the fact that abortion in Indonesia is still considered illegal unless it is approved by a doctor.

Generally, abortion is approved based on certain medical reasons or considerations due to physical conditions to pregnancy complications that endanger the life of the baby or the mother.

It should be noted that abortion is not the same as a miscarriage because the process of terminating a pregnancy occurs without medical intervention.

There are many reasons that make someone decide to do this procedure

Do not turn a blind eye that many women or partners end up making abortion decisions because of unplanned pregnancies.

Therefore, planning a pregnancy is something that needs to be done.

Here are some reasons why a woman decides to have an abortion, such as:

Personal problems and conditions.
Health risks that occur to the mother.
Babies will experience certain medical conditions after birth.

When is the right time to do this procedure?

Quoted from Harvard Health Publishing, the majority of abortions are performed in the first 12 weeks gestational age.

In addition, women may do this from the first trimester and before 24 weeks of gestation based on the doctor's approval.

Also quoted from the Indonesian Pediatrician Association, this procedure is usually performed before 20 weeks of pregnancy or when the fetus weighs less than 500 grams.

To find out when the time is right for your condition, always consult a doctor.

What do you need to know before having an abortion?

The first thing you and your partner need to do is to consult with an obstetrician first.

Most likely, the doctor will:

Evaluate your overall medical history.
Confirm pregnancy by doing a physical exam.
Perform pregnancy checks such as ultrasound, blood tests, and urine tests.
Describe processes and procedures and possible risks.

In some cases, you will need to do an ultrasound to determine the development of gestational age and the size of the fetus.

Not only that, your doctor also needs to make sure you don't have an ectopic pregnancy.

In addition, the doctor will also perform blood tests. This is done to check whether the rhesus of the mother and fetus is the same or not.

Women with temporary Rh-negative blood will need to receive an injection of Rh immunoglobulin (RhIG) to prevent problems after a miscarriage or the process of terminating a pregnancy.

What is the process of having an abortion?

It has been explained a little above if the procedure or process of abortion must be performed by a gynecologist who has an official license to practice and operational standards.

Based on the type of treatment, abortion is divided into two, namely medical abortion (using pills) and abortion with the surgical method.

The following is the process of terminating a pregnancy according to the types, such as:

Medical abortion

Medical abortion or termination of pregnancy is done by taking or getting a special medicine into the body to end the pregnancy.

Conditions for women who are not allowed to have a medical abortion method or type:

Gestational age is more than 70 days.
Have bleeding problems or are taking blood thinners.
Are currently taking steroid drugs.
Have an uncontrolled seizure disorder.
Have acute inflammatory bowel disease (for misoprostol).

1. Medical abortion using mifepristone and misoprostol

This is the type of combination abortion most doctors use.

Then, this is also a method that can be used from the beginning of pregnancy to the 10th week of pregnancy.

These drugs can be taken orally directly or inserted into the vagina.

The way mifepristone works is by blocking the progesterone hormone so that the uterine lining thins and prevents embryo development.

Meanwhile, the way Misoprostol works will make the uterus contract even more and push the embryonic tissue out of the vagina.

You will experience cramps and heavy bleeding after 1-4 hours of taking the misoprostol.

As many as 92% to 97% of women who use this method will complete the abortion within 2 weeks.

After that, you need to return to the doctor to make sure this process is completely finished.

2. Medical abortion using methotrexate

This abortion process is carried out at a maximum gestational age of 7 weeks. However, this drug is rarely used since the previous method was approved by the FDA.

Usually, methotrexate is used in women who are allergic to mifepristone. Please also note that this type of drug should not be used when the gestational age has reached 50 days.

After being injected by injection, about 68% to 81%, the fetus will pass within 2 weeks.

Surgical abortion method

Doctors will perform this type of abortion at 9 to 14 weeks of gestation. Here are some methods of operation that can be done.

1. Vacuum aspiration

This type or method of abortion is performed when the womb is in the first or second trimester.

The way it works is by sucking the fetus and placenta out of the uterus using a small tube. This procedure should only be performed by a trained doctor, in a hospital.

You will be given a local anesthetic on the cervix to reduce pain.

However, you may experience abdominal cramps because the uterus contracts when the tissue is removed.

This procedure is usually done for about 10 minutes and cannot be done in all cases.

For example, when the uterus is abnormally shaped it can cause pregnant women to experience blood clotting disorders and pelvic infections.

2. Dilation and evacuation

Dilation and evacuation (D&E) is an abortion procedure that is performed in the second trimester, or usually after 14 weeks of gestation.

This abortion is recommended for cases of pregnancy because the fetus's physical condition is very severe or there are special medical problems.

D&E is a procedure that combines vacuum aspiration, forceps (special clamping device), and curette dilation.

On the first day, the doctor will dilate the cervix to make it easier to remove the pregnancy tissue.

On the second day, the doctor uses forceps to remove the fetus and placenta, and will use a spoon-like device called a curette to scrape the uterine lining.

This procedure is classified as painful, but the doctor will provide medication to reduce the pain.

3. Dilation and curettage

This abortion process is also commonly referred to as curettage or curettage whose purpose is to remove abnormal tissue in the uterus.

Dilation refers to the widening or opening of the cervix because the cervix of the mother certainly does not open on its own. After diltation, the next step is curettage.

If you do this early in your pregnancy, this method will be easier and safer.

4. Abdominal hysterotomy

This is an abortion method that is included in major surgery because it requires an incision in the abdomen. An incision in the abdomen is made to remove the fetus from the uterus.

Note that this process is rare, but necessary when dilation and evacuation are not possible.

You will be given complete anesthesia so that you are unconscious during the operation.

What are the risks & complications of abortion?

All abortion methods, whether using pills or surgery, have the same possibility of complications. However, these risks and complications are low.

Here are some signs and symptoms of complications from abortion that need to be followed up, such as:

The bleeding is quite heavy.
Severe stomach or back pain.
Fever lasts more than 24 hours.
Whitish or spots accompanied by an unpleasant odor.

Not only that, it is possible that some women will experience various psychological conditions that involve emotional feelings.

For example, feelings of loss and deep sadness.

If this condition persists for a long time, there is nothing wrong with consulting a psychologist or psychiatrist to avoid depression.

How fast is the recovery process after the abortion?

After having surgery, you are allowed to go home the same day. Except in certain cases, you will need to spend the night in the hospital.

Rest at home for one to two days and don't forget to take painkillers if needed.

Over the course of a few days, you may experience cramping and bleeding such as when having a period.

You can discuss with your doctor or medical staff the need for contraception, antibiotics, or injections if your blood type is rhesus negative.

The abortion process that has been done should not affect fertility. However, if pregnancy returns, the patient has an increased risk of preterm birth.