Pregnancy Termination

In the United States, about 1.5 million legal abortions are performed each year; 90% of these procedures are performedin the first trimester of pregnancy. Teenagers and women older than age 40 years have the highest abortion rates.Before 16 weeks of gestation, legal abortion as practiced in the United States may be performed safely in an office setting with simple instruments. Adequate preoperative and postoperative counseling is essential, and options to pregnancy termination should be presented.

The risk of death from first-trimester abortion is less than 1 per 100,000 abortions. The risk of death increases with
gestational age and by type of procedure. Dilation and evacuation (D&E) is safer than other options for the early mid-trimester.
Hysterotomy and hysterectomy, two procedures rarely indicated for abortion, are the least safe. General
anesthesia increases the risk of death from vacuum curettage abortion.
Maternal conditions for which termination of a desired pregnancy should be considered include cyanotic heart disease
with pulmonary hypertension, severe hypertension, previous myocardial infarction, and other comparable major
illnesses. Major anomalies and mid-trimester premature rupture of membranes are recognized fetal implications for
termination. With any maternal or fetal condition that would pose a risk to the health of the mother or fetus, the decision
should be carefully weighed by the woman in consultation with the physician.
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Sensitive pregnancy tests allow early diagnosis of pregnancy, and many women seek abortion services within 1-2 weeks
of the missed period. Abortion of these early pregnancies with a small-bore vacuum cannula is called menstrual
regulation, menstrual extraction, or minisuction. The only instruments required are a speculum, a tenaculum, a Karman
cannula, and a modified 50 mL syringe. At the end of the procedure, the tissue is rinsed and examined in a clear dish
of water or saline over a light source to detect chorionic villi and the gestational sac. This examination is performed to
rule out ectopic pregnancy and to decrease the risk of incomplete abortion.
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