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One of the most difficult and painful decisions that a woman or a couple has to take in life is going for an abortion.

Abortion is the term used for the medical termination of pregnancy, which can be performed medically or surgically. The procedure to be followed and the safety of abortion depend on the trimester of pregnancy in which the procedure is performed. The earlier the procedure is performed, the lesser is its complications.

The abortion procedure is safe in most cases but it is usually accompanied by some side effects such as heavy bleeding, pelvic cramps, nausea, and vomiting. However, if you notice more serious symptoms like excessive blood loss, fever, and extreme pain, you must immediately report to your gynaecologist.

Abortion does not affect future pregnancies or fertility of the woman, and hence, is not an unsafe option to opt for as long as it is performed under the guidance of a trained gynaecologist.

  1. What is an abortion
  2. Types of abortion
  3. Time limit for abortion
  4. Safe and unsafe abortion
  5. Causes of abortion
  6. Abortion procedure
  7. Side effects of abortion
  8. Risks or complications of abortion
  9. Chances of getting pregnant after abortion
  10. Indian law on abortion

An abortion refers to the termination of pregnancy. It is carried out by the removal or expulsion of the foetus from the womb of the woman. It either results in or is done because of the death of the embryo or foetus.

Based on whether the abortion has occurred normally or is being induced, it is of the following two types:

Spontaneous or natural abortion or miscarriage

A spontaneous or a natural abortion is when the embryo or the foetus dies due to complications of pregnancy. This is commonly termed as miscarriage.

Induced abortion

An induced abortion is the one which is performed purposely to expel or remove the foetus from the uterus which may be done either medically or surgically. It is performed in cases where it poses a hazard to the health, safety or survival of the bearing mother.

According to the Ministry of Health and Family Welfare, India, terminating a pregnancy is safe till second trimester (20 weeks). Getting an abortion done beyond this time has very high risks of complications, which can occur during or after the procedure.

As we have mentioned above, getting an abortion done is safe when it is conducted before 20 weeks or up to the second-trimester of pregnancy. As the foetus grows further with the pregnancy continuing beyond the second trimester, the risks and complications associated with an abortion increase making it highly unsafe. Hence, it is recommended by doctors that a woman should take the decision of abortion before entering the third-trimester.

The safety of the abortion also depends on the healthcare facility where the surgical or medical abortion is performed. A procedure performed by a qualified doctor or gynaecologist who is authorised to prescribe abortion pills or conduct surgical abortion is often safe and must be the only centre visited for an abortion procedure. It must be ensured that the clinic should follows all sterilisation procedures before conducting an abortion to ensure protection against infections.

The different reasons for a spontaneous and an induced abortion have been listed below.

Induced abortion

An induced abortion is performed only when the mother and the doctor decide for it. Hence, it may have a lot of personal, social, and medical causes involved. As per a recent study conducted in 14 countries, the main reasons for an abortion are:

  • Child spacing
    As it has been widely advised that couples must maintain a difference of at least three years between two pregnancies, women opt for an abortion when they have recently undergone childbirth and are looking for spacing.
     
  • Unwanted pregnancy
    Some women who inadvertently get pregnant go for an abortion more often than not. Such pregnancies usually result from having unprotected sex or due to the failure of contraceptives. This is one of the most common reasons that women go for an induced abortion.
     
  • Financial problems
    Raising a child comes with a lot of responsibilities. It is important to have a regular financial source which is adequate enough to take the responsibility of being a parent. Hence, couples with financial issues go for an abortion.
     
  • Career decisions
    Pregnancy immensely alters the personal and professional life of a woman. Sometimes, it gets hard for her to modify her professional goals and aspirations. Sometimes at a crucial stage of life, woman opt for an abortion for either further studies or job or career.
     
  • Issues with the partner
    Many couples often say that they got pregnant together because having a child is a two-way street and it is the responsibility of both the partners to be equally involved. In some cases where women have issues with their partners such as an unhappy married life, disagreement regarding pregnancy, financial insecurity, or a divorce, they are pushed to the decision of abortion.
     
  • Very young age
    Girls who get pregnant at a very young age and are not in a physical or mental state to continue a pregnancy or raise a child often get advised for an abortion by their doctors.
     
  • Pregnancy before marriage
    Many girls, especially in India, are not allowed to continue pregnancy out of a wedlock or before marriage. There is a huge taboo around this. In cases where girls get pregnant before marriage, an abortion is forced along with other mental traumas that the girl has to go through. In some cultures, it is considered shameful and a sign of 'bad character'.
     
  • Health risks
    If the continuation of pregnancy poses a serious health risk to the foetus or the mother, doctors advise going for an abortion.
     
  • Family or peer influences
    In some unfortunate instances where a woman is influenced by her relatives, friends, or family, she opts for an abortion. It is, therefore, suggested that a pregnancy should always be discussed with a counsellor or a gynaecologist.
     
  • Wanting a boy
    To say the least, a criminal offence which is widespread in most Indian states and some Asian countries is committed by people who prefer to have a boy. This decision is usually made spontaneously without the consent of the mother or even the father.

Spontaneous abortions

There are certain causes in which the health of the woman may be affected, such as:

  • Genetic abnormalities
    Parents who have a dormant or occult (hidden) genetic abnormality may transfer these genes to the foetus making it incompatible to survive.
     
  • Immunological causes
    A miscarriage may also occur when the mother's immune system start acting against the foetus.
     
  • Abnormal clots
    Thrombophilia is a disorder in which abnormal clots may be formed in the placenta. As a result, the oxygen supply to the foetus is reduced and it becomes a reason for its demise.
     
  • Hormonal disorders
    Some hormonal disorders such as hypothyroidism (low thyroid hormone levels), high level of serum thyroid antibodies, and an absence of thyroid antibodies but a raised serum (TSH) thyroid stimulating hormone, and PCOS (Polycystic ovarian syndrome) have been found to be associated with miscarriages. 
     
  • Faulty embryo selection
    If the embryo is defective or possesses a poor quality being less viable for implantation, the foetus fails to grow normally, which may lead to a miscarriage.
     
  • Lifestyle
    Women who do not eat a nutritious diet, drink alcohol, smoke, perform strenuous exercises, do not maintain a proper hygiene or have very low to no physical activity may be responsible for unfulfilled nutritional and immunological requirements of the foetus resulting in its demise.
     
  • Uterine malformations
    Defects in the structure and function of the uterus may also lead to poor attachment, reduced transfer of nutrition, and decreased waste removal leading to its death after some time.

There are two ways by which an abortion is done - medical and surgical. Both the procedures are different for a first- trimester and a second-trimester pregnancy.

First Trimester

The abortion which is carried out within the first thirteen weeks of pregnancy is known as a first-trimester abortion. Most of the pregnancies are terminated during the first trimester as it is a lot safer than termination in the second trimester.

  • Medical abortion
    A medical abortion includes taking of 'abortion pills' as prescribed by your doctor. These medicines may either be taken orally or placed in the vagina or both. It is mostly done at a clinic to observe the immediate response of the body. However, you can also take these medications at your home as per the instructions of your gynaecologist.
     
  • Surgical abortion
    Surgical termination of pregnancy is done by a method called suction-curettage. You may be given a local or general anaesthesia, or sedatives, to reduce your sensitivity towards pain incurred during the procedure. In this method, your cervix (birth canal) is dilated either by using medicines or with the help of dilator instruments. When the cervix is dilated enough, a suction tube is entered through the vagina into the uterus. This tube is then connected to a vacuum which helps in sucking out and detaching the embryo or the foetus from the uterine wall.

Once the procedure is done, your doctor may prescribe a few painkillers to be taken at home. It is best that you see your doctor at least once within two weeks of the procedure. This will help in diagnosing if there are any remains of the foetus left after the procedure. It will also help in identifying any other side-effects or infections.

Second Trimester

When the pregnancy is terminated between the thirteenth and twentieth week, it is known as a second-trimester abortion. Just like a first-trimester pregnancy, it can also be conducted medically or surgically. Doctors suggest that surgical abortion has fewer complications as compared to medical in the case of a second-trimester surgery.  

  • Medical abortion
    A medical abortion in the second-trimester is performed within the doctor’s clinic. The doctor may ask you to take abortion pills orally. Sometimes, vaginal pills or intravenous (administration of medicines through the veins) injections may be given. These medicines start showing their effect after twelve hours of administration. The mechanism of action of these pills can be explained on the basis of contraction of the uterine muscles which lead to the expulsion of the foetus.
    Your doctor may prescribe a few painkillers because a medical abortion in the second trimester can cause severe cramping.
     
  • Surgical abortion
    A procedure called Dilatation and Evacuation is the choice of surgery to abort a second-trimester pregnancy. In this procedure, some medicines may be given a day before the surgery, which help in dilating the cervix. On the day of surgery, the cervix is further dilated using dilator instruments. If required, local or general anaesthesia is given to relieve pain. A suction tube is then used to remove the foetus from the uterus.

After getting the abortion done, you may experience a few of the following symptoms:

  • Nausea and vomiting
    It is usually experienced by women as a side effect of medical abortion using abortion pills.
     
  • Heavy bleeding 
    A heavy bleeding results when the endometrium contracts and sheds its inner lining to remove the foetus from the womb. It may last up to two weeks.
     
  • Pelvic cramps
    The cramps in your pelvic area, which are felt after an abortion may sometimes be more severe than what you normally experience while on your period.

Most abortions which are conducted in a healthcare facility may have some side effects as mentioned above, but in a few cases, severe complications may also be experienced. These include:

Fetal remains

In some cases, complete detachment of the foetus from the uterine lining may not occur. This is known as incomplete abortion. In such a case, further treatment with medications or surgery may be required.

Infections

Infection may occur in case of a surgical abortion. Antibiotics and painkillers are advised in such cases.

Damage to the organs

While performing the procedure, damage may occur to the cervix or the uterus. If this happens, the doctor may suggest another surgery.

Excessive blood loss

If the bleeding does not stop even after two weeks of medication or surgery, it may lead to anaemia. In such cases, a blood transfusion is required to restore the health of the woman.

Induced abortions do not affect your chances of getting pregnant in the future. In fact, it is possible to get pregnant after a short duration following an abortion procedure. But, it is advised to consult your gynaecologist for the right contraceptive method to prevent any unwanted pregnancy and abortions.

This is because spontaneous abortions if occurring repeatedly may pose you to a higher risk of having a miscarriage in the future. Hence, a complete check-up and treatment of the underlying medical conditions is necessary to ensure a healthy full-term pregnancy.

According to Section 3 of the Medical Termination of Pregnancy Act, 1971, an abortion can be conducted when:

  • There is a health risk to the mother if she continues the pregnancy.
  • The child has a high chance of being born with physical or mental disabilities.
  • A pregnancy is caused due to a crime such as rape or in a case where the woman is mentally challenged.

Recently, the abortion limit has been extended up to 24 weeks for a rape victim.

According to the Section 312 to 315 of the Indian Penal Code, a person who conducts an illegal abortion is liable for a three-year imprisonment with or without a fine. A couple who indulges in a sex-selective abortion (abortion of the female child) is liable for a seven-year imprisonment with or without a fine.

और पढ़ें ...

References

  1. Elisabeth Clare Larsen et al. New insights into mechanisms behind miscarriage. BMC Med. 2013; 11: 154. PMID: 23803387
  2. Tae Yeong Choi et al. Spontaneous abortion and recurrent miscarriage: A comparison of cytogenetic diagnosis in 250 cases. Obstet Gynecol Sci. 2014 Nov; 57(6): 518–525. PMID: 25469342
  3. Margreet Wieringa-de Waard et al. The natural course of spontaneous miscarriage: analysis of signs and symptoms in 188 expectantly managed women. Br J Gen Pract. 2003 Sep; 53(494): 704–708. PMID: 15103878
  4. National Health Service [Internet]. UK; Abortion.
  5. American College of Obstetricians and Gynecologists [Internet] Washington, DC; Induced Abortion
  6. National Health Service [Internet]. UK; Abortion.