Induced abortion

Last updated: July 18, 2022

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Induced abortion is the use of interventions (e.g., medication, procedures) to end a pregnancy. Common indications include patient choice, anticipated harm to the pregnant individual, and fetal genetic or anatomical abnormalities. Abortion may be performed via medical or surgical procedure. When performed under clinical guidance, induced abortion is highly effective and safe.

In 2017 in the US: [3]

  • Approx. 18% of pregnancies ended in abortion
  • Approx. 60% of abortions occurred at ≤ 10 weeks' gestation

Common indications include: [2][4]

  • Patient choice to end the pregnancy
  • Anticipated harm to the pregnant individual
  • Genetic or anatomical abnormalities in the fetus

Prior to induced abortion, the following steps should be considered: [2][4]

Methods of induced abortion [2][6]
Medical abortion Abortion procedures

First trimester (≤ 12 weeks' gestation)

Second trimester (between 13 and 24 weeks' gestation)

Advantages
  • Noninvasive
  • No anesthesia
  • May be performed at home during the first trimester
  • Preferred for certain medical conditions [2]
Disadvantages
  • Usually requires follow-up
  • More perceived bleeding than abortion procedures
  • Takes longer to complete than abortion procedure [2]
  • Contraindicated in patients with: [2]
  • Invasive
  • Requires anesthesia
  • Always performed in a clinical setting

Postabortion [9]

  • For confirmation of abortion or evaluation of abortion complications, obtain: [2]
    • Serum hCG level (if prior level is known) [2][5]
    • Pelvic US: to evaluate for a gestational sac [2]
  • Treat any complications.
  • If a gestational sac is present, consider expectant management or repeat induced abortion. [2]
  • Counsel patients on recommended follow-up:
    • A routine follow-up visit is not required for uncomplicated induced abortion. [2][7][10]
    • Perform a pregnancy test 4 weeks after abortion. [2]
    • Seek medical attention for symptoms of incomplete abortion or complications (e.g., prolonged or excessive pain or bleeding). [2]

Patients with uncomplicated induced abortions do not need a follow-up office visit, but one should be offered to all patients. [2]

Management options for an incomplete abortion after an induced abortion include watchful waiting, medication abortion, or procedural abortion. [2]

Compared to unsupervised self-managed abortion, complications from medically supervised abortions are exceedingly rare, but may include: [4][6]

We list the most important complications. The selection is not exhaustive.

As of June 2022, medical practitioners are not required to report individuals who have performed an unsupervised self-managed abortion. [9]

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  1. Medical management of abortion.
  2. American College of Obstetricians and Gynecologists’ Committee on Practice Bulletins—Gynecology, Society of Family Planning. Medication Abortion Up to 70 Days of Gestation: ACOG Practice Bulletin. Obstet Gynecol. 2020; 136 (4): p.e31-e47. doi: 10.1097/aog.0000000000004082 . | Open in Read by QxMD
  3. Abortion Incidence and Service Availability in the United States, 2017.
  4. Harris LH, Grossman D. Complications of Unsafe and Self-Managed Abortion. N Engl J Med. 2020; 382 (11): p.1029-1040. doi: 10.1056/nejmra1908412 . | Open in Read by QxMD
  5. Grossman D, Perritt J, Grady D. The Impending Crisis of Access to Safe Abortion Care in the US. JAMA Intern Med .. 2022 . doi: 10.1001/jamainternmed.2022.2893 . | Open in Read by QxMD
  6. Moss DA, Snyder MJ, Lu L. Options for women with unintended pregnancy.. Am Fam Physician. 2015; 91 (8): p.544-9.
  7. ACOG, no authors listed. Second-trimester abortion. Obstetrics and Gynecology. 2013 . doi: 10.1097/01.AOG.0000431056.79334.cc. . | Open in Read by QxMD
  8. Orlowski MH, Soares WE, Kerrigan KA, Zerden ML. Management of Postabortion Complications for the Emergency Medicine Clinician. Ann Emerg Med. 2021; 77 (2): p.221-232. doi: 10.1016/j.annemergmed.2020.09.008 . | Open in Read by QxMD
  9. Abortion care guideline. https://www.who.int/publications-detail-redirect/9789240039483. Updated: March 9, 2022. Accessed: June 29, 2022.
  10. Borgatta L, Kapp N. Labor induction abortion in the second trimester. Contraception. 2011; 84 (1): p.4-18. doi: 10.1016/j.contraception.2011.02.005 . | Open in Read by QxMD
  11. Lyus RJ, Gianutsos P, Gold M. First Trimester Procedural Abortion in Family Medicine. J Am Board Fam Med. 2009; 22 (2): p.169-174. doi: 10.3122/jabfm.2009.02.070204 . | Open in Read by QxMD

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