Surgical abortion

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Surgical abortion

Chapter 10 – Pregnancy Options

Topic

Unintended pregnancy
How common is unintended pregnancy in Australia?
How do women present with an unintended pregnancy?
Management of unintended pregnancy
- General guide to non-directive decision-making counselling
Continuing the pregnancy – parenting
- Parenting with a partner
- Parenting alone
Continuing the pregnancy – adoption
Fostering
Induced Abortion
Surgical abortion
Medical abortion
Mental health post abortion
Contraception post abortion
Resources
References

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Methods and timing of surgical abortion

Surgical abortion involves inserting a small plastic tube through the cervix to remove the lining and contents of the uterus by applying suction. Most surgical abortions are performed under IV sedation or ‘twilight sleep’. There may also be the option of having a local anaesthetic only or a general anaesthetic, depending on the setting.

There are two recommended methods for first trimester surgical termination of pregnancy; electric vacuum aspiration (EVA) and manual vacuum aspiration (MVA). Dilatation and curettage is no longer recommended for abortion.⁽¹⁵⁾

Electric vacuum aspiration (EVA) is commonly used for termination of pregnancy in the first trimester up to 14 weeks. At 12-14 weeks larger tubing and forceps may also be required. Manual vacuum aspiration (MVA) can be used in the first trimester; some providers recommend it only to 10 weeks. It is useful for procedures done under local anaesthetic as it is quieter and may be less painful.⁽¹⁶⁾ MVA is widely used in low resource settings as it is economical.

Surgical abortion is often delayed until 6 weeks gestation due to the risk of missing a very tiny early pregnancy when evacuating the uterine contents.

Cervical ripening agents, such as misoprostol, may be used orally or ... Buy now

Complications of surgical abortion

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Expected process of surgical abortion

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Management of complications following surgical abortion in primary care

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O’Keeffe S. Crisis Pregnancy and Pregnancy Decision Making: An Outline of Influencing Factors. Report No. 1. [Internet]: Crisis Pregnancy Agency; 2004. Available from: https://www.sexualwellbeing.ie/for-professionals/research/research-reports/crisis-pregnancy-and-pregnancy-decision-making-an-outline-of-influncing-factors.pdf.

Gipson J, Koenig MA, Hindin MJ. The effects of unintended pregnancy on infant, child, and parental health: A review of the literature. Stud Fam Plann. 2008;39:18-38.

Whitworth M, Dowswell T. Routine pre‐pregnancy health promotion for improving pregnancy outcomes (Cochrane Review). The Cochrane Database of Systematic Reviews. 2009;Oct 7(4):CD007536.

Rowe H, Kirkman M, Hardiman EA, Mallett S, Rosenthal DA. Considering abortion: a 12-month audit of records of women contacting a Pregnancy Advisory Service. MJA. 2009;190(2):69-72.

Taft A, Shankar , Black KI, Mazza D, Hussainy S, Lucke JC. Unintended and unwanted pregnancy in Australia: a cross-sectional, national random telephone survey of prevalence and outcomes. MJA. 2018;209(9):407-8.

Marie Stopes International. Real Choices: Women, contraception and unplanned pregnancy. [Internet]. Marie Stopes International; 2008.

Rowe H, Holton S, Kirkman M, Bayly C, Jordan L, McNamee K, et al. Prevalence and distribution of unintended pregnancy: the Understanding Fertility Management in Australia National Survey. Aust N Z J Public Health. 2016 Apr;40(2):104-9.

Grayson N, Hargreaves J, Sullivan EA. Use of routinely collected national data sets for reporting induced abortion in Australia. Report No. 17. [Internet]. Sydney: Australian Institute of Health and Welfare, AIHW National Perinatal Statistics Unit; 2005. Available from: https://www.aihw.gov.au/getmedia/7f961837-d79f-44d2-9b70-5e66facd3678/10206.pdf.aspx?inline=true.

Scheil W, Jolly K, Scott J, Catcheside B, Sage L, Kennare R. Pregnancy Outcome in South Australia 2015. Adelaide: SA Health, Government of South Australia, Pregnancy Outcome Unit; 2017. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/66323264-dc4f-4667-b118-acabd078685a/Pregnancy+Outcome+in+SA+2015.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-66323264-dc4f-4667-b118-acabd078685a-nwMxA59.

10.

Children by Choice. Australian Abortion Statistics [internet]. Children by Choice; 2017 [updated 2017 Sept 19]. Available from: https://www.childrenbychoice.org.au/factsandfigures/australian-abortion-statistics.

11.

Family Planning NSW. Reproductive and Sexual Health in Australia. Ashfield: Family Planning NSW; 2013.

12.

Aldis J, Barnett M, Bateman E, Bell P, Blazevska J, Buckmaster A, et al. Australia’s welfare snapshots 2019. [Internet]. Australian Government, Australian Institute of Health and Welfare; 2019. Available from: https://www.aihw.gov.au/getmedia/82f724a3-c82a-412f-bb7b-5424fcfe1a4e/Australias-welfare-snapshots-2019.pdf.aspx.

13.

Finer L, Frohwirth LF, Dauphinee LA, Singh S, Moore, AM. Timing of steps and reasons for delays in obtaining abortions in the United States. Contraception. 2006;74:334-44.

14.

Moore A, Frohwith L, Blades N. What women want from abortion counseling in the United States: a qualitative study of abortion patients in 2008. Soc Work Health Care. 2011;50(6):424-42.

15.

Ipas. Clinical Updates in Reproductive Health [internet]. Chapel Hill, NC: Ipas; 2018. Available from: https://ipas.azureedge.net/files/CURHE18-march-ClinicalUpdatesinReproductiveHealth.pdf.

16.

World Health Organisation (WHO). Medical Management of Abortion. [Internet]. Geneva: World Health Organisation; 2018. Available from: https://apps.who.int/iris/bitstream/handle/10665/278968/9789241550406-eng.pdf?ua=1.

17.

Allen R, Goldberg AB. Cervical dilation before first-trimester surgical abortion (<14 weeks’ gestation). Contraception. 2016 Apr;93(4):277-91.

18.

Lohr P, Fjerstad M, DeSilva U, Lyus R. Abortion. BMJ. 2014;348:29-33.

19.

Royal College of Obstetricians and Gynaecologists. The Care of Women Requesting Induced Abortion. Evidence-based Clinical Guidelines No.7. [Internet]. London, England: RCOG Press; 2011. Available from: https://www.rcog.org.uk/globalassets/documents/guidelines/abortion-guideline_web_1.pdf.

20.

eTG Complete [internet]. Therapeutic Guidelines; 2019. Antibiotic.

21.

NPS MedicineWise. MS-2 Step GyMiso Tablet Pack [internet]. NPS MedicineWise; 2017. Available from: https://www.nps.org.au/medicine-finder/ms-2-step-gy-miso-tablet-pack.

22.

Sääv I, Fiala C, Hämäläinen JM, Heikinheimo O, Gemzell-Danielsson K. Medical abortion in lactating women–low levels of mifepristone in breast milk. Acta Obstet Gynecol Scand. 2010 May;89(5):618-22.

23.

Medicines in Pregnancy [internet]. The Royal Women’s Hospital: 2018. Available from: https://www.thewomens.org.au/images/uploads/fact-sheets/Medicines-in-pregnancy-140219.pdf.

24.

Department of Health, Therapeutic Goods Administration. Australian Public Good Assessment Report for mifepristone/misoprostol. [Internet]. Australian Government; 2014. Available from: https://www.tga.gov.au/sites/default/files/auspar-mifepristone-misoprostol-141013.pdf.

25.

Pocius K, Maurer R, Fortin J, Goldberg AB, Bartz D. Early serum human chorionic gonadotropin (hCG) trends after medication abortion. Contraception. 2015 Jun;91(6):503-6.

26.

Shannon C, Brother LP, Philip NM, Winikoff B. Infection after medical abortion: a review of the literature. Contraception. 2004;70(3):183-90.

27.

NPS Medicinewise. Mifepristone (Mifepristone Linepharma) followed by misoprostol (GyMiso) for medical termination of pregnancy of up to 49 days’ gestation. RADAR. 2013.

28.

Goldstone P, Walker C, Hawtin K. Efficacy and safety of mifepristone–buccal misoprostol for early medical abortion in an Australian clinical setting. Australian and New Zealand Journal of Obstetrics and Gynaecology. 2017;57(3).

29.

Marie Stopes Australia. Understanding your options: surgical abortion vs medical abortion [internet]. Marie Stopes Australia; 2016 [updated 2016 Oct 27]. Available from: https://www.mariestopes.org.au/.

30.

Horvath S, Schreiber CA. Unintended pregnancy, induced abortion, and mental health. Current psychiatry reports. 2017;19(11):77.

31.

Biggs M, Upadhyay UD, McCulloch CE, Foster DG. Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study. JAMA Psychiatry. 2017;74(2):169-78.

32.

Rocca C, Kimport K, Roberts SC, Gould H, Neuhaus J, Foster DG. Decision Rightness and Emotional Responses to Abortion in the United States: A Longitudinal Study. PLoS One. 2015;10(7):e0128832.

33.

Academy of Medical Royal Colleges by National Collaborating Centre for Mental Health. Induced abortion and mental health: A systematic review of the mental outcomes of induced abortion, including their prevalence and associated factors. [Internet]. London, England: AOMRC; 2011. Available from: https://www.aomrc.org.uk/wp-content/uploads/2016/05/Induced_Abortion_Mental_Health_1211.pdf.

34.

Department of Health. Medicare Benefits for Non-Directive Pregnancy Support Counselling Services. Australian Government; 2013. Available from: https://www1.health.gov.au/internet/main/publishing.nsf/content/4A80759F9ACB7106CA257BF0001D74C1/$File/FS-Pregnancy%20Support%20Counselling%2031-10-13.pdf.

35.

Bateson D, Stewart M, Goldstone P. Post-abortion contraception. O&G Magazine: Abortion. 2018 Winter;20(2).

36.

The Faculty of Sexual & Reproductive Healthcare (FSRH) Clinical Effectiveness Unit. FSRH Guideline: Contraception after pregnancy. [Internet]. England: FSRH; 2017. Available from: https://www.fsrh.org/standards-and-guidance/documents/contraception-after-pregnancy-guideline-january-2017/.

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Reproductive and Sexual Health Handbook

Chapter 10 – Pregnancy Options

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