Termination of Pregnancy (Induced Abortion)

What is an induced abortion?

Termination of pregnancy means removal or expulsion of the developing foetus from the mother’s womb well before the foetus reaches the age of viability. Abortion can used to refer to a number of different ways in which pregnancy is lost. A miscarriage is medically known as a spontaneous abortion. However, most of us talk about abortion and mean the intentional termination of pregnancy. This is medically known as an induced abortion where the mother has opted to end the pregnancy.

When is an abortion done?

According to World Health Organization (WHO), termination of pregnancy is done before 20 weeks of conception. If it occurs before 12 weeks it is known as early abortion and between 12 and 20 weeks it is referred to as as late abortion. In South Africa, induced abortions are legal and can only be done before 12 weeks of pregnancy.

There are some instances where an abortion may be conducted between 12 to 20 weeks but this is rare. It may only be considered if there are serious medical complications for the mother should the pregnancy continue. Having an abortion after 12 weeks is also much more dangerous.

Dangers of Illegal Abortions

Previously termination of pregnancy was induced by various methods like intake of herbal abortifacients, irritating the uterus with sharp tools, physical trauma to the uterus and foetus or other unsafe procedures. Some of these methods are still used for illegal “home” abortions in South Africa and are extremely dangerous.

There is a high rate of complications and death in mothers who opt for these abortion methods. It also leads to secondary infertility in many women. South African females can go to legitimate clinics for an abortion without opting for these unsafe practices. With the legalisation of abortion in South Africa as of 1996, the number of abortion-related deaths dropped by 90%.

Is an abortion safe?

Termination of pregnancy when induced medically is a safe medical procedure. Globally, illegal abortions lead to up to  70,000 maternal deaths and 5 million hospital admission every year. Fortunately South African women have options to access medical abortions done by trained health care professionals.

Previously,  the legality of termination of pregnancy mainly depends upon the deleterious effect the birth may have on mother’s mental or physical health, if the pregnancy is a consequence of rape, incestual relationship or there is evidence of a foetal defect. Many women who did not qualify for a legal abortion under these circumstances therefore had to opt for these illegal abortions.

However, South African women need to be aware that they have safe options. Buying “abortion pills” from street vendors or websites, undergoing an abortion by a person who has no medical training and attempting traditional practices to abort the pregnancy are not necessary and are not safe. It can lead to death.

Methods of Abortion

The methods for a termination of pregnancy using accepted medical practices depends upon the gestational age of fetus. First trimester procedures are performed under local anaesthesia and second trimester procedures are done under deep sedation. Not all the medical abortion procedures may not be legal or available in South Africa. It is therefore important to speak to a medical professional about your options for termination of pregnancy.

First Trimester Abortion

In the first trimester, termination of pregnancy is attempted with the use of drugs like :

• Mifepristone along with one prostaglandin analog like misoprostolor gemeprost. This regimen is effective up to 9 weeks of conception and is preferred in comparison to surgical procedures (vacuum aspiration).
• Methotrexate along with one prostaglandin analog is effective up to 7 weeks of pregnancy

Failure of termination of pregnancy by the above two methods may then require surgical intervention.

Second Trimester Abortion

For termination of pregnancy during the second trimester of pregnancy, mifepristone and a prostaglandin analog may also be used but the preferred method is dilation and evacuation.

• Up to 15 weeks of gestation, suction aspiration is usually done to terminate pregnancy. In this process, manual or electric suction equipment is used to remove th foetus, placenta and the membranes. Dilation and curettage is another surgical method.
• From 15th week to around 26th week, commonly practiced methods are dilation and evacuation along with injection of saline or urea in the amniotic fluid. Intact dilation and extraction (IDX) is another method of termination of pregnancy but his method of abortion is banned in many countries.

Third Trimester Abortion

Third trimester termination is done by above mentioned IDX method or by hysterotomy which is similar to a caesarean section. It is performed under general anaesthesia. An abortion in the third trimester is almost never considered unless the situation is such that the mother’s life is in extreme danger. Other medical options are first considered to stabilise the mother until the baby can be born, although preterm.