What is Abortion?

*** This is a general resource and is NOT meant to serve as medical advice or guidance. For a comprehensive resource on how provide abortion care, please visit the following resources:

First Trimester Termination

Medication AbortionSurgical Abortion 
General Description Using medications to induce similar processes as a miscarriage. Used up to 11 weeks gestation15 minute in-office procedure with local anesthesia or sedation. Used up to 14 weeks gestation. 
Pre-Procedure PreparationNoneProphylactic antibiotics, typically doxycycline 
NSAIDS 30-60min before procedure 
Procedure DescriptionMifepristone plus misoprostol 
If Mifepristone is not accessible, solely using misoprostol can also be effective
Mechanical cervical dilation 
Aspiration of uterine contents 
Warn patients: The machine can be loud 
Recovery 20-30min 
Pain ManagementNSAIDsNSAIDS 30-60min before procedure 
Paracervical block with local anesthetic 
Oral/IV sedation 
Lorazepam 0.5 to 2mg 30min prior 
Opioid optional, no proven benefit 
If IV: fentanyl 100mcg and midazolam 2mg 
Post-ProcedureAbdominal pain and cramps
Vaginal bleeding typically heavier than a menstrual period, but not excessive 
Mean duration of bleeding is 8 to 17 days. 
Abdominal pain and cramps 
Light bleeding, like a menstrual cycle. Occasionally passage of small clots 

Some patients will be followed with serial hCG if products of conception are not fully visualized during the procedure – expect a short-term elevation with return to undetectable levels varies widely from 7-60 days 
ComplicationsMajor Complications 0.31%
Minor Complications 4.88%

Hemorrhage – secondary to uterine atony, retained tissue, infection, uterine AV malformation, placenta accreta spectrum, coagulopathy 

Ongoing pregnancy

Infection or Retained products of conception 

Maternal mortality – far less than maternal mortality rates among live births in the U.S., but does increase with gestational age.
Comparable to other procedures such as plastic surgery or dental procedures 
Major Complications 0.16%
Minor Complications 1.1%

Overall complication rate: 9.05 per 1000, with major complications (perforation, ectopic pregnancy, hemorrhage, sepsis) very rare, 0.71 per 1000. 

Complications include:
Cervical laceration
Uterine perforation 
Postabortal endometritis 
Retained products of conception
Ongoing Pregnancy
Mortality risks: infection, anesthesia complications, hemorrhage 
ContraindicationsHbg <9, hemorrhagic disorders, suspected ectopic pregnancy, chronic adrenal failure, long-term steroid use, porphyrias

Note: Asthma is NOT a contraindication (misoprostol is a prostaglandin, but acts as a bronchodilator
fibroid restricting access to uterine cavity
ProsCan receive medications through telehealth services and delivery to home (in available locations) 
No surgical procedure/anesthesia 
May feel “more natural” to patients 
More control as patient can take medications privately at home 
No need for repeat visits 
Fast Procedure 
Failure is rare – More common at early <7 weeks gestation because it can be harder to see on ultrasound 
Vaginal bleeding post-procedure
Cons Increased bleeding that can be unpredictable 
Takes longer to completely evacuate the uterus 
Can be difficult if privacy is an issue (adolescent, domestic violence, etc.)
Slightly lower efficacy 
Greater awareness of blood loss/passage of pregnancy tissue
If it fails, will require a surgical abortion
Surgical procedure with associated risks
Reason to Follow Up Severe abdominal pain that persists after pregnancy tissue passes, or if pain persists and no bleeding/tissue has passed

Bleeding that not decreased after pregnancy tissue is passed or soaking 2 maxi pads per hour for 2 consecutive hours.
Vaginal bleeding >2 maxi pads per hour for than 2 hours in a row

Cramps persistent/worsens despite pain medications

Temp >101
Future FertilityNot shown to be decreased
May have increased risk of future preterm births, low birth weights or small for gestational age
Not shown to be decreased
May have increased risk of future preterm births, low birth weights or small for gestational age



Second Trimester Terminations (14-20 week gestation)

Dilation and EvacuationInduction
General DescriptionSurgical procedure to evacuate uterine cavityInduce labor and deliver fetus
LocationsOutpatient or Inpatient surgical centerLabor and Delivery floor 
Pre-ProcedureCervical preparation: osmotic, pharmacologic (misoprostol/mifepristone) and/or mechanical dilators 

Osmotic dilators often placed a couple hours to days before procedure to open cervix 

Prophylactic antibiotics: doxycycline or azithromycin
Pain ManagementNSAIDS
Paracervical Block 
IV sedation
ProcedureDilation of cervix 
Uterine evacuation with combination of suction, extraction with forceps and curettage
Fetus and placenta entirely removed
Occasionally an intact D&E will be utilized in which entire fetus removed intact
Induction with misoprostol and mifepristone 

Oxytocin is NOT used as there is decreased efficacy due to the uterus having fewer oxytocin receptors at <20 weeks gestation.
Post-ProcedureAbdominal cramps, mild bleeding Normal post-delivery care
ComplicationsUterine perforation <1%
– Increased risk with increasing gestational age, cervical abnormalities, multiparity or inexperienced provider

Retained products of conception <1% 

Cervical laceration <3% 

Infection up to 4% 
Hemorrhage 0-0.3%

Risk with uterine atony, retained products of conception, coagulopathy, abnormal placentation, uterine or cervical injury, prior caesarean.

Anesthesia-related complications
Nausea, vomiting 
Retained placenta needing surgical removal (2-10%)
Incomplete abortion more common than in D&E (1-7 vs 0%)
Uterine rupture 
Considerations ForGreater control over timing 
Less experience of the procedure 
Decreased procedure duration 
Decreased cost 
Helpful for patients who have medical conditions that require controlled timing 
Outpatient setting 
Avoidance of surgery 
Experience intact fetus 
Consideration Against Surgical procedure with associated risks and complicationsMore discomfort 
Awareness of events happening
Larger blood loss
Potential for need of surgical intervention