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Termination Of Pregnancy

OVERVIEW — Abortion, also known as pregnancy termination, is a procedure that is performed to end a pregnancy. In India, abortion is a safe and legal option for women who  choose not to continue with a pregnancy.

Deciding to have an abortion is a very personal decision. Any woman considering abortion should understand the risks and benefits of the various types of abortion, as well as the alternatives to abortion, including parenting and adoption.

TYPES OF ABORTION PROCEDURES — There are two basic ways abortions are performed:

  • One is called "medication abortion," meaning that you take medicine to end the pregnancy.
  • The other is called "aspiration" or "surgical" abortion, meaning that a doctor does a procedure to remove the pregnancy.

Medication or surgical abortion? — The type of abortion procedure you may have depends on a number of factors, including how far along you are in your pregnancy, what type of abortions are available in your area, and your personal preferences. "Early" medication abortion, in which a woman takes medicine by mouth, is most effective if the pregnancy is less than 7 weeks. If the pregnancy is later (beyond 10-12 weeks), you may be given medicines that induce labor to cause an abortion. This type of abortion would be performed in a hospital and is usually called "labor induction." It is not as common as aspiration or early medication abortion.

Reasons that you might prefer an early medication abortion:

  • You prefer to be in the privacy of your home when you pass the pregnancy
  • You would prefer not to have anesthesia
  • You would prefer not to have a doctor perform a procedure with medical instruments to remove the pregnancy from your uterus

It is important to know that in approximately 3-5 percent of cases, the medication may not work and an aspiration procedure is necessary.

Reasons that you might prefer surgical abortion:

  • You prefer to have the abortion completed in one visit
  • You are not comfortable with the idea of vaginal bleeding and passing the pregnancy at home
  • You would prefer to have anesthesia to minimize pain

Initial evaluation — With both medication and aspiration abortion, you will need the following before the procedure:

  • An ultrasound to confirm that you are pregnant and determine how far along the pregnancy is.
  • A blood test to determine your blood type and to make sure you do not have anemia. If you have a negative blood type , you will be given an injection of a medication  after the abortion. This helps to prevent complications in future pregnancies.
  • You may be offered testing for sexually transmitted infections.

EARLY MEDICATION ABORTION — Early medication abortion usually involves taking two different medications to end an early pregnancy.

Expected side effects — Abdominal pain and vaginal bleeding are expected side effects with early medication abortion. Some women also have fever, nausea, vomiting, or diarrhea.

Pain and cramps — Most women will have abdominal cramps after taking the second medication . These cramps may be mild or strong. The pain usually improves after the pregnancy has passed out of your uterus, which for most women occurs within 2 to 24 hours after taking the misoprostol.

Vaginal bleeding — It is normal to experience vaginal bleeding with an early medication abortion. The bleeding may be heavy, especially in the first few hours  and decreases after you pass the pregnancy tissue out of your uterus, and then continues for several days. It should be lighter than a menstrual period after the first few days.

Fever, nausea, vomiting, diarrhea — Some women experience a mild fever, nausea, vomiting, or diarrhea. This usually goes away quickly on its own without treatment.

How effective is early medication abortion? — Early medication abortion is very effective in ending pregnancies up to 7 weeks

If early medication abortion does not work in ending your pregnancy, you will need to have an aspiration abortion to remove it. Continuing a pregnancy after taking medications for an abortion is not safe due to the risk of birth defects from the misoprostol.

ASPIRATION OR "SURGICAL" ABORTION — Aspiration abortion is a procedure that is done in hospital to end a pregnancy. The procedure is done by removing the pregnancy tissue from the uterus through the opening, called the cervix.

In most cases,  you will have an IV line placed in a vein, and medication will be given to make you relax or feel sleepy. Many people do not remember much about the procedure after the sedative medication is given.

The abortion procedure usually takes between 5 and 20 minutes, and is usually shortest when the pregnancy is early. You will be monitored in a recovery area for about an hour after the procedure (longer if you are given a sedative).

Expected side effects — Vaginal bleeding, abdominal pain, and cramping are expected side effects after an aspiration abortion.

Abdominal pain and cramping — Most women have some abdominal pain and cramping after an aspiration abortion. The pain usually lasts several hours. I

Vaginal bleeding — It is normal to have some vaginal bleeding after an aspiration abortion.The bleeding usually lasts a few days to two weeks. You may also pass some tissue or blood clots.

WHEN TO SEEK HELP AFTER ABORTION 

Call your doctor immediately if:

  • You are bleeding so heavily that you soak through one menstrual pad per hour for two hours in a row and you are still bleeding.
  • You have severe pain that is not relieved by pain medications.
  • You have shaking chills or develop a temperature higher than 100.4ºF or 38ºC (use a thermometer to measure your temperature).
  • You have foul-smelling or pus-like vaginal discharge.

In addition, you should be aware of signs that your abortion was not complete. Call your doctor  if:

  • You do not have vaginal bleeding after a medication abortion.
  • Your pregnancy symptoms (breast tenderness, nausea) do not resolve within one week after your abortion. You should not do a home pregnancy test, even if you still feel pregnant, because it is likely to be positive for up to 6 weeks after having an abortion.
  • You continue to bleed for more than 2 weeks after your abortion.
  • You do not have a menstrual period within 6 weeks after your abortion.

FOLLOW-UP CARE 

You should avoid sex or putting anything in your vagina (tampons, douches) for at least a few days to a week after an abortion. This may help prevent infection and give you time to recover.

About one week after a medication abortion, you should have a follow-up visit with your doctor.

 At this visit, you can review how you are feeling and discuss contraception ("birth control").

ABORTION COMPLICATIONS — Legal abortions are safe and usually cause no serious complications. However, complications do sometimes occur, as with any medical or surgical procedure. Complications can include excessive bleeding, infection, injury to the cervix or uterus (aspiration procedures only) and the potential need to remove pregnancy tissue by aspirating the uterus. These complications occur in a very small number of cases

MYTHS AND FACTS ABOUT ABORTION

  • Abortion is not safe – MYTH. Legal abortions are one of the safest medical procedures available today. While abortion is not risk-free, the risk of having an abortion is far less than the risk of carrying a pregnancy and giving birth. Abortions done early in pregnancy (before 12weeks of pregnancy) have fewer risks than abortions done later in pregnancy.
  • Abortions that are performed by someone without training are not safe and can lead to serious complications, including bleeding, infection, infertility, and even death – FACT.
  • Abortion will make me infertile – MYTH. Legal abortions do not make it more difficult to become pregnant in the future .
  • Abortion increases my risk of breast cancer – MYTH. Several studies have conclusively shown that having an abortion does NOT increase the risk of developing breast cancer.
  • Abortion increases my chance of miscarriage – PROBABLE MYTH. There have been a number of studies that have tried to determine if abortion increases the risk of miscarriage with future pregnancies. Most well-designed studies have not found that legal abortion in the first trimester increases the risk of miscarriage, preterm delivery, or other pregnancy complications.

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