Pregnancy is divided into three trimesters. The first trimester lasts through the 12th week. The second trimester begins at week 13 and continues through week 24. The third trimester is the remaining time until the fetus is delivered. For each trimester specific methods of abortion are used.
In New Zealand the specific procedures used may vary from the descriptions below. For information on the frequency of use for the procedures outlined see the latest Abortion Supervisory Committee report, which is available in our New Zealand Abortion Statistics section.
In this method, the doctor must first paralyse the cervical muscle ring (womb opening) and then stretch it open. This is difficult because it is hard or “green” and not ready to open. He then inserts a hollow plastic tube, which has a knife-like edge on the tip, into the uterus. The suction tears the body of the fetus into pieces. The doctor then cuts the deeply rooted placenta from the inner wall of the uterus.
The scraps are sucked out into a bottle. The suction is 29 times more powerful than a home vacuum cleaner. Great care must be taken to prevent the uterus from being punctured during this procedure, which may cause haemorrhage and necessitate further surgery. Also, infection can easily develop if any fetal or placental tissue is left behind in the uterus.
DILATATION & CURETTAGE (D&C)
This is similar to the suction procedure except that the cervix is dilated or stretched to permit the insertion of a curette, a loop-shaped steel knife, up into the uterus. With this, he cuts the placenta and fetus into pieces and scrapes them out into a basin. Bleeding is usually profuse.
Blood loss from D & C, or “mechanical” curettage is greater than for suction aspiration, as is the likelihood of uterine perforation and infection. This method should not be confused with routine D&C’s done for reasons other than undesired pregnancy (to treat abnormal uterine bleeding, dysmenorrhea, etc.)
INTRACARDIAC INJECTIONS (FOR SELECTIVE REDUCTION)
Since the advent of fertility drugs, multi-fetal pregnancies have become common. Since these are usually born prematurely and some have other problems, a new method has been developed.
A needle is inserted through the mother’s abdomen, into the chest and heart of one of the fetuses and a chemical injected to kill the fetus. This is oftern termed “pregnancy reduction.” It is done to reduce the number or to terminate a disabled fetus, if such is identified. If successful, the dead body of the fetus is absorbed.
Sometimes, however, this method results in the loss of all of the babies.
Dilatation & Evacuation (D&E)
The D&E or Dilatation & Evacuation method was developed and largely replaced saline and prostaglandin abortions. It involves the live dismemberment of the fetus and piecemeal removal from below. Used to abort through to 24 weeks, this method is similar to the D&C.
The difference is that forceps with sharp metal jaws are used to grasp parts of the developing fetus, which are then twisted and torn away. A pliers-like instrument is used because the bones of the fetus are calcified, as is the skull. There is typically no anaesthetic for the fetus. The doctor inserts the instrument up into the uterus, seizes a leg or other part of the body, and, with a twisting motion, tears it from the body of the fetus.
This is repeated again and again. The spine must be snapped, and the skull crushed to remove them. The nurse’s job is to reassemble the body parts to be sure that all are removed. If not carefully removed, sharp edges of the bones may cause cervical laceration. Bleeding from the procedure may be profuse.
The actual termination of the fetus may be performed prior to the surgical procedure via an injection to stop the heartbeat. The tissues of the dead fetus will soften, making dismemberment easier. The standard D&E procedure is difficult after 20 weeks gestational age due to the toughness of the fetal tissues.
In this procedure, an abortion occurs by means of inducing labour.
When termination takes place later in the pregnancy, there is an additional process called fetocide recommended so that the fetus is terminated and there is no risk that the fetus is born alive.
Fetocide is typically undertaken by either:
- Injecting lignocaine or potassium chloride into the fetus’s heart directly through the woman’s abdomen.
- Injecting Fentanyl and lignocaine into the cord of the fetus directly through the woman’s abdomen.
The ‘Early Medical Abortion’ (as it is termed by the New Zealand abortion industry) is a method of chemical abortion that is sometimes used up to 9 weeks.
There are different drugs which can be used:
- Prostaglandin alone
- Methotrexate plus prostaglandin
- Mifepristone plus prostaglandin
Mifepristone plus prostaglandin is the combination that is used in New Zealand.
The procedure will usually consist of the patient taking one Mifepristone tablet containing 200mg of mifepristone. This acts by blocking the effects of progesterone, a hormone which is needed for pregnancy to continue.
This will be followed 24-48 hrs later by the insertion into the vagina of four tablets each containing 200µg of Misoprostol. This is a different type of hormone (a prostaglandin) that helps to expel the fetus/embryo – usually the fetus/embryo is passed that day. In some cases the doses of both drugs may be changed by the doctor.
A second dose may be given if the woman has not passed the fetus within 4 hours time.