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Lecture Notes

Medical abortion (long known as RU-486 and marketed as Mifeprex) became available in the United States in 2000. Widely used in several European countries for over two decades, it has been shown to be safe, effective, and acceptable. It has become an increasingly common alternative to surgical procedures and constitutes 25% of induced early abortions.

 

Surgical methods include vacuum aspiration, and dilation and evacuation.

 

Vacuum aspiration is the method used for nearly all first-trimester abortions. This safe and simple method is performed under local anesthesia. The first step involves the rinsing of the vagina with an antiseptic solution. Next, the cervix is dilated with a series of graduated rods. Then a small tube attached to a vacuum is inserted through the cervix. The uterus is gently vacuumed, removing the conceptus, the placenta, and endometrial tissue.

 

Dilation and evacuation is usually performed during the second trimester of pregnancy. Local or general anesthesia is used. The cervix is dilated, and the fetus is removed by curettage or scraping. Because it is a second-trimester procedure, the D&E is somewhat riskier and often more traumatic than a first-trimester abortion.

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