A medical abortion, sometimes called the abortion pill or RU-486, causes the termination of a pregnancy by using a combination of medications. The protocol approved by the Food and Drug Administration allows this type of abortion up to 70 days after the last menstrual period. It is usually used up to seven weeks, but sometimes up to nine weeks from the last menstrual period. The current regimen approved by the FDA includes one dose of mifepristone (RU-486). This causes the blockage of progesterone, a hormone needed for the fetus to grow and develop. Frequently, after taking the mifepristone, a woman will return to the doctor and be administered misoprostol to make the uterus contract and empty. It normally takes about 6-24 hours after taking the misoprostol for the abortion to be complete. If the medical abortion is incomplete, a surgical abortion will be necessary, as well, to avoid complications like excessive bleeding or infection. Bleeding may occur for weeks after the medical abortion. Please be advised to follow doctor’s instructions regarding amount of bleeding. Medical attention may become necessary. (Reference 2)

Suction Aspiration (Also called Manual Vacuum Aspiration):

This method is used early in the first trimester. The cervix is stretched open with dilators (metal rods). A hollow plastic tube is inserted into the uterus. The fetus and the remaining contents of the uterus are removed using a handheld suction device.

Dilation and Curettage (D&C) with Vacuum Aspiration (Also called Suction Curettage):

This is a surgical procedure usually used in the first 12 weeks of pregnancy. The doctor normally opens the cervix with dilators (metal rods) and then empties the uterus with a hollow plastic instrument connected by tubing to a suction machine. After suctioning, the doctor may scrape the walls of the uterus with a curette, a loop-shaped knife, to ensure the fetus, placenta, and contents of the uterus have been completely removed.

Dilation and Evacuation (D&E):

This surgical procedure is generally performed from 13-24 weeks of pregnancy. The doctor must first insert laminaria sticks into the cervix for 1-2 days to start the dilating process. These dried seaweed sticks absorb moisture and expand, causing the cervix to enlarge. On the day of the procedure, the physician will use dilating rods to further enlarge the cervical opening. Then the fetus is dismembered and removed with forceps, along with the placenta and other tissue. A curette may then be used to scrape the uterus to make sure that all tissue has been removed.

Dilation and Extraction (D&X):

This procedure takes two to three days. During the first two days, the cervix is dilated and medication is given for cramping. On the third day, the woman receives medication to start labor. After labor begins, the physician uses ultrasound to locate the positioning of the fetus. Using forceps the fetus is delivered up to the head. Next, scissors are inserted into the skull to create an opening. A suction catheter is placed into the opening to remove the skull contents. The skull collapses and the fetus is removed. (Reference 3)

Anesthesia Options. Three options are available for pain relief during a surgical abortion:

1. Local anesthesia: A local anesthetic is injected into the cervix to cause a numbing effect before dilation.
2. Local anesthesia with sedation: Along with a local anesthetic injected into the cervix, a medication is given to help the woman relax or become “sleepy” during the procedure.
3. General anesthesia: Anesthetic medications are given intravenously to cause the woman to be “asleep”, completely unaware of her surroundings. (Reference 3)