There are two methods by which abortion can be done:

Medical Abortion - Non-surgical abortion in which medicines are used to induce abortion

Surgical Abortion - Use of transcervical procedures for terminating a pregnancy, including vacuum aspiration, and dilatation and evacuation (D and E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is lesser than = 7 weeks; medical method with Mifepristone with Misoprostol is favorable as the success rate is as high as 97%.

If pregnancy is between 7-12 weeks; surgical abortion is the only option.

If pregnancy is beyond 12 weeks - 20 weeks, then the woman needs to be hospitalized and will be given either Mifepristone followed by Misoprostol tablet or only Misoprostol tablets and woman will then abort like a miscarriage in the hospital. If any products are remaining, then it will be evacuated surgically.

Surgical abortion is preferred if patient desires concurrent tubal ligation or IUCD (CuT) insertion.

If a woman fulfills the criteria for selecting either method i.e. before 7 weeks, final choice has to be given to the woman.

Summary of choice between Surgical or Medical abortion in India

lesser than = 7 weeks - Medical method or surgical method

7-12 weeks - Surgical abortion

12 - 20 weeks - Medicines with or without surgical procedure in hospital

Advantages of Medical Abortion

Avoid surgery

Controlled by the woman and may take place at home

No need for admission to the hospital

Usually, well tolerated by women, if properly counselled and motivated

No need to take leave from work, as bleeding can be managed with menstrual pads even while in the office or at work.

Disadvantages of medical abortion

Takes time (hours to days) to complete abortion, and the timing may not be predictable. Women experience bleeding and cramping, and potentially some other side-effects (nausea, vomiting, fever, and shivering). May require more clinic visits than surgical abortion.

Advantages of Surgical Abortion

Quick procedure

Complete abortion easily verified by evaluation of aspirated products of conception

Takes place in a hospital so Sterilization or placement of an intrauterine device (IUD) may be performed at the same time as the procedure. It can be performed under local anaesthesia if woman is properly motivated and counselled

Disadvantages of surgical abortion

Requires instrumentation of the uterus

Small risk of uterine or cervical injury

Timing of abortion controlled by the doctor and hospital

Anaesthesia needs to be administered. Most doctors perform this procedure under short general anaesthesia. A woman needs to be in the hospital for at least 6 hours. Effect of sedation will be there throughout the day.

Methods of Abortion for Unwanted Pregnancy

Many studies have shown that excessive caffeine intake affects your chances of conceiving by influencing the ovulation, hormone, and the fallopian tubes but the opinions on this issue are divided. However, research on this topic mostly indicates that, though caffeine can give you a kickstart in the morning, it can have quite a reverse effect on your efforts to conceive.

How intake of excessive caffeine reduces your chances of conceiving?

The fallopian tubes are responsible for carrying the eggs from ovaries to the uterus by rhythmic movements and too much caffeine can affect this movement and cause disruption in the journey of the eggs. Moreover, consuming more caffeine has also been associated with baby's growth restriction, miscarriages, and weight issues. It is preferable to get rid of caffeine altogether from your diet when you are trying to conceive but if you are an avid coffee drinker then you might want to cut back or replace your caffeine intake with milk and syrup which is far more healthy and beneficial.

Which foods and beverages do you need to avoid?

There are so many caffeinated foods and beverages, that it is almost impossible to avoid them. But it is better to take note of them so that you can regulate your caffeine intake. Coffee, tea, soft drinks, energy drinks are obvious sources of caffeine as they are supposed to give you energy. Some herbal teas also contain caffeine. Chocolate, ice creams and candies with coffee flavors, over the counter drugs for allergies, cold and headache also contain caffeine so it is important to read the ingredients list before consuming any of them.

To higher your chances of getting pregnant, it is important to cut back on caffeine. Most doctors are of the opinion that exceeding 50 mg of caffeine intake daily can seriously hamper your chances of conceiving.

How Excessive Caffeine can Stop you from Becoming Pregnant

Hypertension or high blood pressure is common in pregnant women, even in those who have no previous history of high blood pressure. This leads to complications in about 6 to 10% of all pregnancies around the world. High blood pressure may develop before or after conception and as such needs special medical attention.

Hypertension prevents sufficient flow of blood to the placenta and this inhibits the normal growth of the fetus. This could result in low birth weight of the child. However, if diagnosed in time and treated properly, hypertension does not affect the child's health too much. There are various types of hypertension during pregnancies, such as:

Gestational hypertension: This type of hypertension is developed about 20 weeks after conception. There is no abnormality in urine or any signs of other organ damage (as is common with hypertension during pregnancy) but the condition can worsen and complicate very quickly. Pregnant women below the age of 20 and above the age of 40 are often diagnosed with high levels of blood pressure. Women who have heart or kidney conditions before pregnancy and women carrying more than one child are also likely to develop gestational hypertension.
Chronic hypertension: Chronic hypertension is high blood pressure which develops around 20 weeks before conception and does not normalize within 12 weeks after childbirth. The patient may also have been suffering from high blood pressure for a long time but the complications appear only during pregnancy because high blood pressure rarely exhibits symptoms without an associated condition.
Chronic hypertension superimposed with Preeclampsia: Women who have hypertension before pregnancy may develop even higher blood pressure levels during pregnancy. This leads to several health disorders like frequent headaches, fatigue and depression.
Preeclampsia: Preeclampsia is often a serious complication of gestational pregnancy and affects about 5% to 7% of all pregnancies globally. Gestational pregnancy does not always develop into preeclampsia but it needs to be diagnosed and treated in time to avoid the complication. Women who have conceived for the first time or have a history of hypertension in the family are at a greater risk of preeclampsia. The symptoms of the condition are throbbing headaches, blurred vision, nausea and vomiting, pain in the upper abdominal region and shortness of breath.

Types Of Hypertensions Experienced During Pregnancy

When we talk about infertility attention usually falls on treatment for women. However, infertility can affect men as well. The condition of infertility, can be described as the inability to become pregnant for a period of 1 year despite having unprotected, well-timed sexual intercourse. A low sperm count is one of the primary reasons for infertility in men.

Typically there should be fifteen million sperm per milliliter of semen. Low sperm count refers to the ejaculation of less than a normal amount of sperm in semen. This can also be termed as oligospermia. A complete absence of sperm in semen is known as azoospermia. Low sperm count does not mean that you cannot impregnate your partner but it reduces the chance of a successful conception. Thus, one of the most common ways to treat infertility caused by low sperm count is IVF.

IVF involves harvesting eggs from the woman s uterus and sperm from the male partner and combining them in a laboratory to form a zygote. When IVF is used to treat male infertility, a semen analysis is the first step. This helps determine the patient s sperm count, sperm motility, volume, pH levels, white blood cell levels etc.
The ejaculated semen is then processed so as to separate the sperm cells from the plasma. In this process sperm cells with higher motility are identified and segregated. These cells have a higher chance of fertilizing the egg.
Sperm cells are then injected into the harvested egg. Some techniques may require the injection of 50,000 or more sperm cells while others such as intracytoplasmic sperm injection (ICSI) can be effective with a single sperm cell. Once the egg is fertilized, it is allowed to develop for a few days in the laboratory. 
Two or three embryos are then selected to be reintroduced into the woman s uterus with the help of a catheter. The remaining fertilized embryos are preserved in an embryo bank in case the pregnancy is not successful. If these need to be used later, the woman does not have to go through the initial stages of IVF treatment to stimulate the follicles and harvest eggs from the ovaries.
When it comes to IVF, the success rates are very high. However, one of the most common side effects is the birth of twins or triplets. This is because multiple embryos are inserted into the uterus. The number of babies born then depends on the number of embryos that are implanted successfully.

Declining Sperm Count - How IVF Can Help Deal With It?

Miscarriage is termed as the loss of the fetus in or before 20th week of pregnancy. Medically, miscarriage is known as spontaneous abortion, though the word spontaneous is more of a keyword as it is not an abortion.

Symptoms of Miscarriage 
Miscarriage happens due to weakness, back pain, fever, abdominal pain along with severe cramps and bleeding, which starts from slow to heavy.

Cause of Miscarriage 
Common cause of miscarriage is when the fetus is known to have fatal genetic problems and these are not related with the mother. The other causes are infection, medical problems like thyroid and diabetes, immune system rejection, hormonal imbalance, abnormalities of the uterus, and physical problems of the mother. If a woman is over 35 years of age, has thyroid and diabetes and had an miscarriage earlier then that woman is at a high risk of getting a miscarriage.

Sometimes a miscarriage might take place due to the cervical insufficiency. This is due to the weak cervix, also known as the incompetent cervix, which is unable to hold the pregnancy. A miscarriage in this condition usually occurs in the second trimester. Though there are a very few symptoms in this, but there might be a feeling of sudden pressure that the water is going to break and tissues from the placenta and fetus are released without any pain. This can however, be treated by a stitch in the cervix at 12 weeks. This stitch helps to hold the cervix until the full term is completed. If it is first pregnancy and cervical insufficiency is diagnosed, then also a stitch can be applied, thus resulting in full term and avoiding miscarriage.

Diagnosis of Miscarriage: 
-   The doctor does a pelvic test, an ultrasound and blood tests to confirm a miscarriage
-   Blood tests are done to analyze the pregnancy hormone hCG. This is monitored regularly if miscarriage is suspected
-   Genetic tests, blood tests and medication are important in women who have a history of prior miscarriages
-   Pelvic ultrasound and hysterosalpingography are tests, which are done when there are repeated miscarriages
-   Test like hysteroscopy is also done. In this the doctor observes the inside of the uterus with a device, which is thin telescope like device. This is inserted in the vagina and cervix.
-   If the cervix is dilated, then the woman might be diagnosed with an incompetent cervix and this can be corrected by cerclage, a procedure done to close the cervix.
-   If the blood type of the pregnant woman is Rh negative, she is prescribed a blood product called Rh immune globulin (Rhogam). This prevents from forming, antibodies which could turn to be harmful for the baby.

Bleeding in Early Pregnancy: Diagnosing Miscarriage

Most people will give you a blatant No. And they are quite right to do so. But if you have been a habitual offender who can't unwind without their drink, pregnancy is going to be a big problem. So does the rule stand in all cases? What if you drank when you didn't know you were pregnant yet? What if you had a light drink here and there, will it literally spell disaster? Let's find out.

Contradictory advice everywhere: Most doctors will advice you to stay away completely from alcohol as soon as that first positive emerges in your test. Others may give you a little leeway and let you have an occasional drink. There are friends who'll confess to have cheated during their pregnancy and snuck in a beer or two and say that their kids turned out just fine. There are other friends will scorn on you for even thinking such a thing. Same goes for your relatives. Like all things in pregnancy, random advice will just not work.

How much can you drink? Let's assume that you are confident nothing will happen and want to be adventurous and give it a cautious try. Danish researchers have some good news for you. Some studies have shown that low to moderate consumption of alcohol does not harm the baby. In fact, in 2012, Danish researchers released a highly publicized study that found no major problems in children below 5 years whose mothers had consumed 1- 8 alcoholic drinks a week during pregnancy.

Unfortunately, not all research is made equal. With pregnancy, each mother, each child and progression of each pregnancy is different. It really has to be on a case by case basis and nothing can be taken on face value. Most people will still advise you to completely go off alcohol as there is 'no safe' amount during pregnancy. Some women have a larger quantity of the enzyme that breaks down alcohol. If a woman with lower levels of this enzyme drinks alcohol, it is more likely to harm her unborn child as the alcohol will remain in her bloodstream longer.

How alcohol can affect your child?

A number of disorders that can affect your child when in the womb and even after because of alcohol consumption. These disorders are collectively called 'Fetal Alcohol Spectrum Disorder'. It is characterized by increased risk in miscarriage and stillbirth. It can also result in the baby having low birth weight and increase problems with learning, speech, attention span, language and hyperactivity. Alcohol consumption may also affect girl child and a baby boy differently. While both may turn out to have aggressive and delinquent behaviour, girls are more likely to develop mental health problems too.

If you are unable to give up on alcohol, you need to immediately get professional help to overcome your addiction. Also note that the term 'non-alcoholic' beverage is misleading as they can contain trace amounts of it. Consult a doctor today on which drinks are safe for you.

Alcohol in Pregnancy: Is it Safe?

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