Choice between Surgical and Medical Abortion

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 pregnancy, including vacuum aspiration, and dilatation and evacuation (D&E).

Surgical or Medical Abortion for Unwanted Pregnancy

If pregnancy is <= 7 weeks; medical Method with Mifepristone with misoprostol is favorable as 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 woman needs to be hopsitalized 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 to be given to the woman.

Summary of Choice between Surgical or Medical abortion in India

<= 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

Avoids 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 manged with menstrual pads even while in 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 wneeds to be administered. Most doctors perform this procedure under short general anaesthesia. Woman needs to be in the Hospital for at least 6 hours. Effect of sedation will be there throuout the day.