An unsafe abortion is the termination of a pregnancy by people lacking the necessary skills, or in an environment lacking minimal medical standards, or both
An unsafe abortion is a life-threatening procedure. It includes self-induced abortions, abortions in unhygienic conditions, and abortions performed by a medical practitioner who does not provide appropriate post-abortion attention.
About 25 million unsafe abortions occur a year, of which most occur in the developing world. Unsafe abortions results in complications for about 7 million women a year.
Unsafe abortions are also one of the leading causes of deaths during pregnancy and childbirth (about 5-13% of all deaths during this period).
Most unsafe abortions occur where abortion is illegal, or in developing countries where affordable and well-trained medical practitioners are not readily available, or where modern birth control is unavailable.
Unsafe abortion was and is a public health crisis. More specifically, lack of access to safe abortion was and is a public health risk. The more restrictive the law, the higher the rates of death and other complications
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Friday, August 9, 2019
Self-induced abortion
A self-induced abortion (or self-induced miscarriage) is an abortion performed by the pregnant woman herself or with the help of other, non-medical assistance.
Although the term includes abortions induced with legal over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, sometimes more dangerous means. Such practices may present a threat to the health of women.
If the abortion does not result in termination of the pregnancy, damage to the fetus can occur. Self-induced abortion is often attempted during the earliest stages of pregnancy (the first eight weeks from the last menstrual period)
In recent years, significant reductions in maternal death and injury resulting from self-induced abortions have been attributed to the growing use of misoprostol (known commercially at "Cytotec"), an inexpensive, widely available drug with multiple uses, including the treatment of post-partum hemorrhage, stomach ulcers, and induction of labor.
The World Health Organization has endorsed a standardized regimen of misoprostol to induce abortion up to 9 weeks of pregnancy. This regimen has been shown to be up to 83% effective in terminating a pregnancy.
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Although the term includes abortions induced with legal over-the-counter medication, it also refers to efforts to terminate a pregnancy through alternative, sometimes more dangerous means. Such practices may present a threat to the health of women.
If the abortion does not result in termination of the pregnancy, damage to the fetus can occur. Self-induced abortion is often attempted during the earliest stages of pregnancy (the first eight weeks from the last menstrual period)
In recent years, significant reductions in maternal death and injury resulting from self-induced abortions have been attributed to the growing use of misoprostol (known commercially at "Cytotec"), an inexpensive, widely available drug with multiple uses, including the treatment of post-partum hemorrhage, stomach ulcers, and induction of labor.
The World Health Organization has endorsed a standardized regimen of misoprostol to induce abortion up to 9 weeks of pregnancy. This regimen has been shown to be up to 83% effective in terminating a pregnancy.
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Hysterotomy abortion
Hysterotomy abortion is a form of abortion in which the uterus is opened through an abdominal incision and the fetus is removed, similar to a caesarean section, but requiring a smaller incision.\'
As major abdominal surgery, hysterotomy is performed under general anaesthesia, and is only used in rare situations where less invasive procedures have failed or are medically inadvisable (such as in the case of placenta accreta).
This method has the greatest risk of complications out of all the abortion procedures.[2] Health officials in the United States warned practitioners against performing hysterotomy abortion in an outpatient setting after it led to the deaths of two women in New York during 1971.
The rate of mortality of abortion by hysterotomy and hysterectomy reported in the United States between 1972 and 1981 was 60 per 100,000, or 0.06%
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As major abdominal surgery, hysterotomy is performed under general anaesthesia, and is only used in rare situations where less invasive procedures have failed or are medically inadvisable (such as in the case of placenta accreta).
This method has the greatest risk of complications out of all the abortion procedures.[2] Health officials in the United States warned practitioners against performing hysterotomy abortion in an outpatient setting after it led to the deaths of two women in New York during 1971.
The rate of mortality of abortion by hysterotomy and hysterectomy reported in the United States between 1972 and 1981 was 60 per 100,000, or 0.06%
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Intact dilation and extraction
ntact dilation and extraction (IDX, intact D&E) is a surgical procedure that removes an intact fetus from the uterus.
The procedure is used both after late-term miscarriages and in late-term abortions. It is also known as intact dilation and evacuation, dilation and extraction (D&X, or DNX, disfavored term), and, in United States federal law, as partial-birth abortion.
However, partial-birth abortion is not an accepted medical term, and is not used by abortion practitioners or the medical community at large.
In 2000, although only 0.17% (2,232 of 1,313,000) of all abortions in the United States were performed using this procedure,[3] it developed into a focal point of the abortion debate. It was outlawed in most cases by the 2003 Partial-Birth Abortion Ban Act, which was upheld in the case of Gonzales v. Carhart.
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The procedure is used both after late-term miscarriages and in late-term abortions. It is also known as intact dilation and evacuation, dilation and extraction (D&X, or DNX, disfavored term), and, in United States federal law, as partial-birth abortion.
However, partial-birth abortion is not an accepted medical term, and is not used by abortion practitioners or the medical community at large.
In 2000, although only 0.17% (2,232 of 1,313,000) of all abortions in the United States were performed using this procedure,[3] it developed into a focal point of the abortion debate. It was outlawed in most cases by the 2003 Partial-Birth Abortion Ban Act, which was upheld in the case of Gonzales v. Carhart.
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D&E abortion
D&E is performed under anesthesia, most commonly sedation with light general anesthesia, although local paracervical block or regional anesthesia may be used. It may be performed with or without ultrasound guidance. Performance under ultrasound guidance has greatly improved our understanding about what actually occurs during a D&E. Prior to the procedure, the cervix is usually softened and passively dilated using osmotic dilators and/or misoprostol. This facilitates cervical dilation during the procedure without injury to the cervix.
The first step in the procedure itself is dilation of the cervix. The second step is insertion of a vacuum curette through the cervix. Under ultrasound, the tip of that curette is placed up against the fetal chest or abdomen. The suction is turned on. Amniotic fluid is removed and the fetus dies instantly due to removal of the fetal heart, lungs, and abdominal contents.
This leaves the fetal cranium and skeleton with soft tissue to be removed. The thorax, pelvis, cranium, and each arm and leg are removed separately using surgical instruments. The fetal cranium will usually have to be crushed in order to be extracted. Use of ultrasound greatly facilitates this part of the procedure although it may be done safely without ultrasound guidance. In the absence of ultrasound, the tissue will be carefully inspected to ensure all fetal tissue is removed. It is important to recognize that this is the removal of dead tissue to protect the patient from bleeding and infection well after the fetus died instantly. The fetus is almost never dismembered alive.
After removal of all fetal tissue, the uterine cavity is thoroughly curetted to ensure that all placental tissue, blood, and membranes are removed. The uterus will then be massaged to ensure it is firmly contracted to minimize post operative bleeding. The entire procedure usually takes less than 30 minutes and is well tolerated.
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The first step in the procedure itself is dilation of the cervix. The second step is insertion of a vacuum curette through the cervix. Under ultrasound, the tip of that curette is placed up against the fetal chest or abdomen. The suction is turned on. Amniotic fluid is removed and the fetus dies instantly due to removal of the fetal heart, lungs, and abdominal contents.
This leaves the fetal cranium and skeleton with soft tissue to be removed. The thorax, pelvis, cranium, and each arm and leg are removed separately using surgical instruments. The fetal cranium will usually have to be crushed in order to be extracted. Use of ultrasound greatly facilitates this part of the procedure although it may be done safely without ultrasound guidance. In the absence of ultrasound, the tissue will be carefully inspected to ensure all fetal tissue is removed. It is important to recognize that this is the removal of dead tissue to protect the patient from bleeding and infection well after the fetus died instantly. The fetus is almost never dismembered alive.
After removal of all fetal tissue, the uterine cavity is thoroughly curetted to ensure that all placental tissue, blood, and membranes are removed. The uterus will then be massaged to ensure it is firmly contracted to minimize post operative bleeding. The entire procedure usually takes less than 30 minutes and is well tolerated.
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Dilation and evacuation
Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus (potentially including the fetus, placenta and other tissue) after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to prevent infection by ensuring that the uterus is fully evacuated.
In various health care centers it may be called by different names:
- D&E (Dilation and evacuation)
- ERPOC (Evacuation of Retained Products of Conception)
- TOP or STOP ((Surgical) Termination Of Pregnancy)
D&E normally refers to a specific second trimester procedure. However, some sources use the term D&E to refer more generally to any procedure that involves the processes of dilation and evacuation, which includes the first trimester procedures of manual and electric vacuum aspiration
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Partial-Birth Abortion Ban Act
The Partial-Birth Abortion Ban Act of 2003 (Pub.L. 108–105, 117 Stat. 1201, enacted November 5, 2003, 18 U.S.C. § 1531,[1] PBA Ban) is a United States law prohibiting a form of late termination of pregnancy called "partial-birth abortion", referred to in medical literature as intact dilation and extraction.[2] Under this law, any physician "who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both". The law was enacted in 2003, and in 2007 its constitutionality was upheld by the U.S. Supreme Court in the case of Gonzales v. Carhart.
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