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Termination of Pregnancy
In situations when gestation carries a significant fetal or maternal risk, it may be appropriate to terminate the pregnancy. The safest time for termination is during the first trimester. Abortions may be induced by medication or performed surgically. This chapter discusses both medical and surgical abortions, with an emphasis on their timing and prevalence in the United States and elsewhere. It also discusses anesthesia and other medications (including antibiotics) used during or after abortion, focusing on their potential impact on cardiovascular function.
Medical Abortion
Medical abortions are those induced by abortifacient drugs. The most common early first-trimester medical abortion regimens use methotrexate in combination with a prostaglandin analog for up to 7 weeks’ gestation, mifepristone (RU-46) in combination with a prostaglandin analog (misoprostol or gemeprost) for up to 9 weeks’ gestation, or a prostaglandin analog alone. Mifepristone–misoprostol combination regimens work faster and are more effective at later gestational ages than methotrexate–misoprostol combination regimens are. Combination regimens are more effective than misoprostol alone. In very early abortions, up to 7 weeks’ gestation, medical abortion using a mifepristone–misoprostol combination regimen is considered to be more effective than surgical abortion (vacuum aspiration). Early medical abortion regimens using mifepristone followed 24 to 48 hours later by buccal or vaginal misoprostol are 98% effective up to 9 weeks’ gestational age. If medical abortion fails, surgical abortion must be used to complete the procedure.
Medical abortion regimens using mifepristone in combination with a prostaglandin analog are the most common methods used for second-trimester abortions in Canada, most of Europe, China, and India.
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