FIRST-TRIMESTER METHODS
Vacuum curettage (dilation and curettage [D&C]) (most common abortion
procedure in the United States at 90%) is performed before 13 weeks’
gestation. Prophylactic antibiotics are given to reduce the infection rate, and
conscious sedation and paracervical block local anesthetic are administered
for pain relief.
The cervical canal is dilated with tapered metal cervical dilators or
hygroscopic/osmotic dilators such as laminaria.
Complications are rare but include endometritis (treated with outpatient
antibiotics) and retained products of conception (POC) (treated with repeat
curettage).
Maternal mortality ratio: 1 per 100,000 women.
Medical abortion: Mifepristone has been marketed over the past decade as
an alternative to surgical abortion. Medical induction of abortion can be
induced using oral mifepristone (a progesterone antagonist) and oral
misoprostol (prostaglandin E1). Use is limited to the first 63 days of
amenorrhea.
Approximately 85% of patients will abort within three days. The earlier
the gestational age, the higher the success rate. About 2% of patients abort
incompletely and require vacuum curettage.
Rare cases of Clostridium sordellii sepsis have been reported.