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Summary
Induced abortion is the use of interventions to end a pregnancy and remove products of conception from the uterus. Common indications include patient choice, anticipated harm to the pregnant individual, and fetal genetic or anatomical abnormalities. A preabortion evaluation involves confirmation of pregnancy and determination of gestational age, with additional studies as indicated based on patient history and preferences. Uterine evacuation for induced abortion is achieved using the same medications and/or procedures that are used to manage pregnancy loss. A combined regimen of mifepristone and misoprostol is recommended for medication abortion in the first and second trimester of pregnancy. Recommended procedural abortion techniques are uterine aspiration in the first trimester and dilation and evacuation in the second trimester. Postabortion care involves monitoring for complications of induced abortion and providing additional care related to family planning and psychosocial support as indicated.
Definitions
- Induced abortion: the use of interventions (e.g., medications, procedures) to end a pregnancy
- Medication abortion: the administration of medications to end a pregnancy [4]
- Procedural abortion: the physical removal of products of conception from the uterus to end a pregnancy
- Self-managed abortion: the management of an abortion by the pregnant individual outside of a health care setting [5][6][7]
- Unsafe abortion: the termination of a pregnancy by an individual lacking necessary skills, in unsafe conditions (e.g., using nonsterile tools), and/or using unsafe methods (e.g., toxins, abdominal trauma) [6][8]
Epidemiology
- More than 90% of abortions occur before 13 weeks' gestation. [9]
- Nearly 25% of female individuals will have an abortion by 45 years of age. [10]
Epidemiological data refers to the US, unless otherwise specified.
Preabortion evaluation
- Confirm the diagnosis of pregnancy.
- Perform a gestational age assessment.
- Consider indications for induced abortion:
- Patient's choice to end the pregnancy
- Anticipated harm to the pregnant individual
- Genetic or anatomical abnormalities in the fetus [11]
- Perform additional studies, if indicated.
- Ultrasound: if risk factors for ectopic pregnancy or uncertain gestational age
- Hemoglobin and/or hematocrit: if concern for anemia
- Screening for RhD alloimmunization in pregnancy: if Rh status is unknown [6][12][13]
- STI testing: in patients with symptoms or if requested
- Use shared decision-making to select a method for induced abortion.
- Offer analgesia and/or sedation based on the planned method.
- Discuss family planning and contraception after spontaneous or induced abortion. [14]
Methods
| Types of induced abortion [15] | ||
|---|---|---|
| Medication abortion [4][16] | Procedural abortion | |
| First trimester [4][6][17] |
|
|
| Second trimester [11] |
|
|
Prophylactic antibiotics should be provided for all procedural abortions, but are not indicated for medication abortion. [11]
A limited number of facilities in the US provide second-trimester abortions and these are almost always are procedural. [9]
Postabortion care
A follow-up visit is typically unnecessary after an uncomplicated induced abortion, but should be offered to all patients. [4][6][19]
-
All patients
- Educate patients on expected symptoms (e.g., bleeding, cramping) after abortion. [4]
- Advise patients to seek medical attention for: [4]
- Symptoms of incomplete abortion and/or complications
- Suspected ongoing pregnancy
- Offer additional care as indicated, e.g.,
- Family planning
- Contraception after spontaneous or induced abortion
- Psychosocial services and counseling on pregnancy loss
-
Patients with complications of induced abortion [20]
- Stabilize patients with life-threatening complications (e.g., hemorrhage, sepsis). [20]
- See also:
-
Patients with incomplete abortion
- Management depends on patient presentation and preferences
- Options include expectant management, medical abortion, or procedural abortion
-
Patients with suspected ongoing pregnancy [21]
- Assess for ongoing pregnancy if indicated or at patient request with: [4]
- Quantitative serum hCG level (if prior level is known) [4][20][21]
- Urine pregnancy test 4–6 weeks after abortion. [4]
- Pelvic ultrasound [4] [4]
- Offer repeat doses of misoprostol or procedural abortion if pregnancy is ongoing. [4]
- Assess for ongoing pregnancy if indicated or at patient request with: [4]
Patients who self-manage abortion may seek medical care to confirm that abortion is complete.
Complications
Complications are rare, including after self-managed medication abortion in the first-trimester. Risk of complications increases with later abortions and unsafe abortions. [7][22][23]
- Retained products of conception
- Hemorrhage
- Infection
- Disseminated intravascular coagulation
- Pulmonary embolism, amniotic fluid embolism [24]
- Additional complications of procedural abortion include:
- Cervical laceration
- Uterine perforation
- Pelvic organ damage
Induced abortion does not increase the risk of mental health disorders, infertility, or breast cancer. [22]
We list the most important complications. The selection is not exhaustive.
Legal implications
- Abortion is not federally protected by case law in the United States.
- Be aware of local laws and regulations when counseling patients.
- See also “Abortion and stillbirth laws.”
Related One-Minute Telegram
- One-Minute Telegram 102-2024-1/3: Telehealth for medication abortion may be as effective and safe as in-person care
- One-Minute Telegram 92-2024-3/3: Abortion ban and mental health
- One-Minute Telegram 54-2022-1/3: Google searches for abortion pills after SCOTUS leak
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