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ABORTION PROCEDURES

SURGICAL METHODS


VACUUM ASPIRATION


This is the most commonly used technique in developed countries. The cervix (neck of the womb) is dilated with instruments and a tube connected to a suction pump is inserted into the womb. The suction pump creates a vacuum, the force of which dismembers the child, sucking it out of the womb. Body parts are sucked into a jar and checked to see whether the abortion is complete.

This procedure accounts for the large majority of abortions up to 12 weeks, and is also used for mid-trimester abortions often in conjunction with D&C or D&E.

DILATION AND CURRETTAGE (D&C); DILATION AND EVACUATION (D&E)


D&C: This method utilises a loop shaped steel knife. The uterus is entered through the vagina. THe cervix ( mouth of the womb) is stretched open. The abortionist then cuts the tiny body to pieces and slices th eplacenta from the walls of the uterus. THis used to be the most common method of first trimester abortions

D&E: This method utilises a sharp toothed pliers-like instrument. The abortionist grasps a part of the body and tears it away. The dismemberment of the living baby continues without any foetal anaesthetic until all parts, plus the deeply rootes afterbirth, are removed. Bleeding is profuse. This technique is an adaptation of D&C, used well into the second trimester and even beyond. D&C or D&E are used in about a third of all early second trimester abortions(13-19 week) in Britain, often in conjunction with vaccuum aspiration.

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HYSTERECTOMY


This is a mini cesearaen section in which the mother's abdomen is cut open and a living child removed from the womb. It is now very rare, although it is believed that it may be used to obtain early intact foetuses, which cannot be obtained through suction or currettage.(cf. McCullagh,The foetus as Transplant Donor,John Wiley 1987).

"MEDICAL" METHODS


The term medical abortion is used to refer to abortion by chemical rather than surgical means. There are several techniques used.

PROSTAGLANDIN


Prostaglandin can be given by pessray, drip, catheter or injection. The drug causes the womb to contract, delivering the baby prematurely and usuall killing the child in the process. In mid or late pregnancy, where the technique is most often employed, abnormally painful labour occurs, accompanied by gastrointestinal upsets. It is the most common technique in Britain for very late abortions (20 weeks or later).
At this stage the drug is often given with other agents, such as urea, a poison, which introduced directly into the womb in order to ensure that the baby is dead when delivered.

THE ABORTION PILL (RU486, ALSO KNOWN AS MIFEPRISTONE OR MIFEGYNE)


This drug kills the baby by attacking the womb lining, teh baby's source of nourishment and physical protection. It does this by interfering with the hormone needed to maintain the womb lining. It is used early in pregnancy, accompanied by prostaglandin, because alone it is less effective. At least three clinic visits are made: one for the RU486 tablets, another 2 days later for the prostaglandin and a third 8-12 days afterward to check whether the abortion is complete. Between visits women are left to bleed at home. Very few women have opted for it in Britain, although it has been available since 1991. Its use is much more widespread in France where it was developed (and the French government intervened to ensure it was marketed, in spite of the misgivings, at one time, of the manufacturers).

Although tested in over 20 countries and heavily promoted by the World Health Organisation, it is only licensed and available in 3 wesyern countries, France, the UK, and Sweden.


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