MEGHAN GEORGE HE-230 OL

Elective Abortion

Abortion

This presentation is intended for anyone after puberty to the start of menopause. *Roughly ages 12- early 40s*

It is intended to inform students about the options of abortion, if they should choose to have one.

What is Abortion and elective abortion?

“Abortion is the medical term for any interruption of a pregnancy before a fetus

is viable (able to survive outside of the uterus if born at that time)”

“Elective abortion is the planned medical termination of a pregnancy”

-(Pillitteri, pp. 555, 2010)

Pro-Choice

A Pro-Choicer would say that the decision to abort a pregnancy is to be made only by the woman herself and that the government has no right to interfere Abstinence Contraception use Emergency contraception Abortion Childbirth

Pro-Life

A Pro-Lifer would say that from the moment of conception, the embryo or fetus is alive and that the government has a moral obligation to preserve it, and that abortion is equivalent to murder Prohibits:

Abortion Assisted suicide Death penalty

Roe vs.Wade

Roe vs. Wade occurred in 1973 in the Supreme Court Norma McCorvey’s alias was Jane Roe Henry B. Wade was the district attorney of Dallas, TX Norma argued that the Texas Abortion Law violated her constitutional rights and rights of other women Roe v. Wade legalized abortion in the United States, which was not legal in many states and was limited by law in others. The Roe v. Wade decision held that a woman, with her doctor, could choose abortion in earlier months of pregnancywithout legal restriction, and with restrictionsin later months.

Facts about abortion

19% of teens who have had sexual intercourse become pregnant each year. 78% of these pregnancies are unplanned. 6 in 10 teen pregnancies occur among 18-19 year olds.

Each year, 2 out of every 100 women of childbearing age have an abortion. 47% have had at least one previous abortion, and 55% have had a previous birth.

An estimated 43% of women will have at least one abortion by the time they are 45 years old.

Worldwide, the lifetime average is about 1 abortion per woman.

How old are women having abortions?

>15 15-19 20-24 25-29 30-34 35-39 40+0.50%

16.40%

32.60%

23.40%

14.50%

8.70%

3.20%

Age

What is the Race/Ethnicity of the Women having Abortions?

34%

37%

22%

7%

Race

WhiteBlackHispanicOther

How Many Abortions are Performed at each Stage of Pregnancy?

<9 weeks 9-10 weeks

11-12 weeks

13-15 weeks

16-20 weeks

21+ weeks

61.30%

17.80%9.60% 6.70% 3.50% 1.10%

Gestational Age

Why do Women have abortions?

98% of all abortions are related to issues of “personal choice”

Not feeling emotionally capable: 32%

Financially incapable of raising a child: 25%

Concern about the drastic change: 16%

What percentage of all abortions are because of “hard cases”?

Rape: 0.3%

Incest: 0.03%

Protection of the mother’s life: 0.2%

First Trimester Abortions

First Trimester Abortions

Generally, first trimester abortions are very safe.Steps:

1) Counseling Options counseling: for those who are undecided about their

decision. Abortion-specific: Tells about the different options.

2) Informed consent: must be obtained to move forward. 3) Obtain a medical and surgical history: to determine high-

risk patients 4) Lab work: to ensure the pregnancy, make sure there is no

infection present. 5) Clinical exam or ultrasound: estimate gestational age 6) Pain control: to control pain during the procedure

Mifepristone

What does mifepristone do? Given orally or vaginally Blocks the effects of progesterone Uterine lining thins and the pregnancy detaches Cervix softens and dilates Increased production of prostaglandins which makes the uterine contract

On the first visit, the woman is given pills (mifepristone) that cause the death of the embryo. Two days later, if the abortion has not occurred, she is given a second drug (misoprostol) which causes cramping that expels the embryo. The last visit is to determine if the procedure has been completed. 

Misoprostol is either orally or inserted vaginally and is given a few days after mifepristone and increases it’s effectiveness by 95-98%

Advantages of Mifepristone

Avoids surgical instrumentsNo anesthesia requiredHigh success rate (95-98%)Resembles a “natural miscarriage”More privacy for the womenBoth drugs administered orallyEarly in pregnancyProcedure completion within 24 hours of

misoprostol administration in 90% of womenApproved for the FDA for early abortion

Disadvantages of Mifepristone

Requires at least 2 visits Effectiveness decreases with use after 7

weeks in regimens using oral misoprostol. Efficacy remains high up to 9 weeks with vaginal misoprostol.

Takes days or, rarely, weeks to complete.Post-procedure bleeding may last longer

than with surgical abortion. Women may see blood clots and pregnancy

tissue.

Vacuum Aspiration

Cervix is opened with tapered rods

A cannula (straw-like tube) is attached to a suction apparatus and is inserted through the cervix into the uterus

Contents are emptied by suction99% effective!

Advantages of Vacuum Aspiration

Typically one requires 1 visit to the provider

Completed within minutesAllows for sedation High success rateEarly pregnancy

Disadvantages of Vacuum Aspiration

Involves a surgical procedureLess privateAlthough risks do exist, they are very low.

• Hemorrhage (<1%) • Infection (<2%)• Missed abortion (<1/2 of 1%)• Retained tissue (<1%)• Perforation/cervical tear (<1%)

Dilation and curettage (D&C)

In this procedure, the abortionist uses a loop shaped knife to cut the baby into pieces and scrape the uterine wall. The baby's body parts are then removed and checked to make sure that no pieces were left in the mother's womb.

Done when you are less than 13 weeks pregnantUterine is scrapped clean with a curetteWomen remain in clinic 1-4 hours after

procedurePotential risk for uterine perforation

Why do people get abortions after the first trimester?

Some of the main reasons for later abortions include:o Fetal anomalies discovered by genetic testing or ultrasound

that are performed after 15 weeks o Maternal medical problems that would worsen with full

term pregnancy, such as heart diseaseo Late detection of pregnancyo Difficulty getting money to pay for serviceo Exposure to intimate partner violence. o Lack of financial and/or emotional support from partner. o Psychological denial of pregnancy, as may occur in cases of

rape or incest

Second Trimester Abortion

Dilation and evacuation (D&E)

Preformed from 12 to 16 weeks pregnant Typically performed over a two-day period but doesn't

require an overnight stay in the hospital Inpatient or ambulatory procedure Dilation is done with either Misoprostol or laminaria tent

(seaweed that is dried and sterilized and placed into the vagina)

Suction the uterine contents or the abortionist will use forceps to grab parts of the baby (arms and legs) and then tears the baby apart. The baby's head must be crushed in order to remove it because the skull bone has hardened by this stage in the baby's growth.

Takes about 15 minutes Remain flat after the procedure to prevent hypotension (low

blood pressure) Remain in the hospital for 4 hours after procedure to monitor

vital signs

Prostaglandin or saline induction

16 to 24 weeksInpatient or ambulatory basisGiven Prostaglandin F2α injection or

prostaglandin E3 suppository which cause cervical dilation and uterine cramping which expels the products of conception.

After, the products of conception should be examined to determine whether all the fetus, placenta, and membranes are expelled.

Hysterotomy

More than 16 to 18 weeksRemoval of the fetus surgicallyResembles a cesarean section>1%

Third Trimester Abortion

“Partial Birth Abortion”

During the last 3 months of pregnancy

Fetus had a congenital anomaly that would be incompatible with life or severe compromised child

Labor was induced by oxytocin and cervical ripening

No longer legal in the United States

References

Abortion: MedlinePlus. (n.d.). U.S National Library of Medicine. Retrieved September 29, 2015 , from http://www.nlm.nih.gov/medlineplus/ abortion.htm

Abortion - surgical: MedlinePlus Medical Encyclopedia. (n.d.). U.S National Library of Medicine. Retrieved September 29,2 015, from http:// www.nlm.nih.gov/medlineplus/ency/article/002912.htm

Facts on Induced Abortion in the United States. (n.d.). Facts on Induced Abortion in the United States. Retrieved September29,2015, from http:// www.guttmacher.org/pubs/fb_induced_abortion.html

Jones RK, Zolna M, Henshaw SK, Finer LB. Abortion in the United States: Incidence and access to services, 2005. Perspectives on Sexual and Reproductive Health, 2008, 40 (1):6-16.

Lipp, A. (2008). Supporting the significant other in women undergoing abortion. British Journal Of Nursing (Mark Allen Publishing), 17(19), 1232-1236.

Pillitteri, A. (2010). Maternal & child health nursing: care of the childbearing & childrearing family (6th ed.). Philadelphia: Wolters Kluwer Health/ Lippincott Williams & Wilkins.

Roehrs, C., Masterson, A., Alles, R., Witt, C., & Rutt, P. (2008). Caring for families coping with perinatal loss. Journal Of Obstetric, Gynecologic, And Neonatal Nursing: JOGNN / NAACOG, 37(6), 631-639.