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  Abortion

Abortion is defined as the removal or expulsion of an embryo or fetus from the uterus (womb) resulting to death. In the medical field, the definition of abortion is further elaborated as a miscarriage or induced termination before twenty weeks’ of gestation which is considered to be the period of non-viability. However, in layman’s term, abortion is more commonly referring to any procedure which is induced at any point in pregnancy. On the other hand, stillbirth is more appropriately described as a pregnancy that ends with a dead infant upon birth at any gestational stage due to causes including spontaneous abortion or complications during childbirth.

Abortion
Abortion


In medicine, the following medical terms are used to define an abortion: Spontaneous abortion (miscarriage) which is due to either an accidental trauma or natural causes such as discrepancy of the number of chromosomes, early disease, or environmental factors. Induced abortions are deliberately induced abortions which are further categorized into two types namely: therapeutic and elective abortion. Therapeutic abortions are performed because of the following indications: saving a pregnant woman’s life; preserving the woman's physical or mental health; terminating a pregnancy that would result in a child born with a congenital defect which would be associated with significant morbidity and mortality; and to selectively reduce the number of fetuses in order to lessen health risks associated with multiple pregnancy. Elective abortion is a type of induced abortion performed for any other reasons other than stated above.

For purposes of discussion the two forms of abortion namely, spontaneous and induced abortions are further explained in the succeeding paragraphs. Spontaneous abortion is a form of abortion referring to miscarriages due to natural causes as mentioned above. This will result to embryo or fetal loss before the 20th week of development which is actually occurring in early pregnancies. After the 20th week but earlier than 37 weeks of gestation, spontaneous abortions that occur are generally considered to be preterm deliveries already. Women who have a previous history of more than three spontaneous abortions, who have had a previous history of induced abortion, diagnosed with systemic disease or belonging to over 35 years age group have a greater risk for spontaneous abortion as compared to those without those aforementioned pertinent histories. Other causes of spontaneous abortion include: maternal or fetal infection, impaired immune responses, accidental or an intentional abdominal trauma. In trauma cases, the higher the degree of force applied, the more serious the internal injuries are with or without succeeding in inducing miscarriage. Some countries such as Burma, Indonesia, Malaysia, the Philippines, and Thailand, employs a traditional method of attempting induced abortion which is through forceful massage of the abdominal area.

In induced abortion, the following factors are considered before choosing how to intentionally abort a fetus or embryo to terminate pregnancy. These factors are chiefly based upon the age of gestation of the fetus, in addition to the legality, availability, and/or doctor-patient preference for specific procedures.

There are two common procedures employed for induced abortion namely surgical and chemical abortion. During the first twelve weeks of pregnancy, the most common surgical procedure of choice is the suction-aspiration, also known as vacuum abortion. Vacuum abortion is further categorized into Manual vacuum aspiration, or MVA abortion (“mini-suction”) and electric vacuum aspiration or EVA. The MVA consists of removing the fetus or embryo by suctioning, using a manual syringe and does not require cervical dilatation, while the Electric vacuum aspiration or EVA abortion method utilizes an electric pump. Beginning from the 15th week until the 26th week, a surgical dilation and evacuation (D & E) is preferred. D&E is a method consisting of opening the cervix of the uterus and emptying it using surgical instruments and suction.

Among all other surgical procedures, it’s the Dilation and Curettage (D&C) which is considered to be the standard diagnostic and therapeutic gynecological procedure of choice. Indications in performing D&C include: investigating for abnormal uterine bleeding, possibly malignancy, and abortion. It is also possible to obtain endometrial tissues for biopsy by doing curettage (surgical scraping). This is performed using a curette which cleans the inner walls of the uterus.

In very late abortions, intact dilation and extraction (intact D & X) (also called Intrauterine cranial decompression) may be performed. This procedure necessitates surgical decompression of the fetus's head before evacuation, and is sometimes termed as "partial-birth abortion." Another surgical procedure perfomed in late stages of pregnancy is hysterotomy abortion. Hysterotomy is almost similar to a caesarian section or C-section but results in fetal loss. It can be performed vaginally, with an incision just above the cervix in the late mid-trimester of pregnancy.

Chemical abortion (also called medical abortion) or a non-surgical abortion is considered to be effective in the 1st trimester of pregnancy particularly within the first 49 days of gestation. Premature deliveries may be done with the use of prostaglandin (e.g. misoprostol, an anti-ulcer medicine). Approximately 92% of cases, women undergoing medical termination of pregnancy with a combined regimen successfully completed medical abortion without any need for surgical intervention. However, in cases of failure of medical abortion, vacuum or manual aspiration is used as a back-up method to complete the abortion surgically. In alternative and complementary medicine particularly in folk medicine, some herbs are reported to possess abortifacient properties. The following herbs have been used as an abortifacient in the past namely: tansy, pennyroyal, black cohosh, and the silphium (presently extinct). Nevertheless, doctors do not recommend the use of herbs in such a manner because it can cause serious even life threatening side effects, such as multiple organ failure.

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