Abortion is an outpatient medical procedure, performed using medication or as a minimally invasive surgical procedure, to terminate a pregnancy. The procedure is typically done in the first trimester of pregnancy unless a doctor identifies risks further on. A doctor will perform an abortion if a woman chooses not to continue with a pregnancy, to complete a partial miscarriage, or if an individual has a condition that makes pregnancy life-threatening.
Abortions are performed in an outpatient clinic, a doctor's office, or in a hospital. In almost all instances, they are safe when a licensed physician performed the procedure, or via medication in the privacy of one's own home. Women receive follow-up examinations two weeks after a procedure. Complications can arise in women who have IUDs, suspected ectopic pregnancies, certain medical conditions such as bleeding disorders that require blood thinners, or allergies to medications.
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Abortions induced via medication use of two different pills. Taken together, the drugs terminate the pregnancy and reduce the side effects, which typically include cramping in the uterus and lower back, and abdomen pain. Once the medication has taken effect, bleeding is common, including blood clots. The pills are effective for women up to ten weeks into pregnancy. Doctors recommend women undergoing this type of abortion have fast access to emergency care in case of side effects from the medications.
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A doctor can perform a first-trimester abortion as early as six weeks into pregnancy, but generally, the procedures happen between the ninth and thirteenth week. Doctors can perform surgical abortions in the office or clinic. Patients receive local anesthesia, and many have the option of additional oral or IV sedation. Abortions performed in the first trimester use a procedure called dilation and curettage (D&C), in which the cervix is dilated to allow access. The doctor scrapes the uterine lining with an instrument called a curette. This removes the embryo and the uterine tissue. Another first-trimester abortion procedure is a vacuum aspiration, which uses a suction tool to remove the embryo and the uterine lining.
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Second-trimester abortions follow a similar procedure that is slightly more invasive due to the embryo being larger. A trained physician performs second-trimester abortions using a dilation and evacuation procedure. This procedure combines vacuum evacuation of most of the tissue, followed by a D&C. Third-trimester abortions are more complicated and doctors typically perform them in a hospital. Dilation and extraction (D&X) involves removing the fetus with forceps, again followed by a D&C. The patient will receive anesthesia for both these procedures and will require a check-up two weeks later.
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While a D&X may be performed well into the third trimester, this procedure is most often carried out to complete a late-term miscarriage. The limit for legal abortions varies by state, ranging from 15 to 22 weeks. Before the procedure, the doctor will perform an ultrasound to determine the gestation length and age of the embryo.
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Many women describe the pain from abortion, both surgical and medically induced, as similar to heavy menstrual cramps. In the case of outpatient surgical abortion procedures, the doctor can administer a local anesthetic. The local anesthesia will numb the cervix, although the patient may feel some pressure. Patients also report residual soreness for a few days following an abortion. For many women, over-the-counter painkillers bring relief.
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Unless there are complications, abortion should not affect a woman's ability to have children in the future, as the procedures typically do not impact reproductive health. After an abortion, even one in the second or third trimester, menstruation should return within four to six weeks, and the woman should be able to become pregnant soon after. Women who become pregnant after an abortion should inform their doctor right away, so the physician can ensure there is no scarring of the uterus or other after-effects from the abortion that may impact the pregnancy.
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Although first-trimester surgical abortions and medically induced (pill) abortions are minimally invasive, they are not entirely painless. The doctor may prescribe antibiotics or a mild pain reliever in addition to the anesthetic. Afterward, the individual may take over-the-counter pain relievers or use a heating pad to alleviate the cramping and soreness. Patients should rest for a few days, and consult with the physician before resuming exercise or sexual activity -- many advise against using tampons and vaginal sexual activity for four to six weeks following the procedure.
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Cramping, spotting and bleeding, vomiting and diarrhea, and risk of infection are physical side effects of early-term abortions. Second- or third-trimester abortions may pose further complications including sepsis, scarring of the uterine lining or cervix, perforation of the uterus, or damage to other organs. These complications are very rare.
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Although the psychological and emotional side effects experienced by women after an abortion vary enormously, there are some commonly reported emotional responses to the procedure. A sudden lack of pregnancy hormones -- progesterone and estrogen -- produced at the start of pregnancy can cause irritability and mood swings; when the pregnancy ends, the body takes time to adjust the corresponding hormone levels. Some women report feelings of loss and sadness or depression. Any psychological side effects from abortion should be discussed with a doctor or psychologist, as some may require treatment.
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