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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.