Is Abortion Medically Necessary?
Nicholas Colgrove, Bruce P. Blackshaw, Daniel Rodger in Agency, Pregnancy and Persons, 2023
Abortions performed in the first trimester of pregnancy are divided into medication abortions and aspiration abortions. Medication abortions involve the administration of drugs: typically the antiprogesterone drug mifepristone, which causes decidual necrosis, myometrial contraction, and the detachment of the early fetus from the womb, is followed by the prostaglandin analogue, misoprostol, to expel the contents of the uterus (Bartz and Blumenthal 2021; Chen et al. 2014). In aspiration abortions, the cervix is mechanically dilated, and a cannula attached to an aspirator is inserted into the uterus to evacuate its contents (Shie and Wallace 2021). Second-trimester abortions can be performed by induction abortion or by dilation and evacuation. Induction abortion requires the administration of the same drugs as a medication abortion, often preceded by a feticidal injection (Hammond 2021a). Dilation and evacuation entails emptying the uterine contents with suction, forceps, and curettage (Hammond 2021b), not usually preceded by feticidal injection (Sfakianaki et al. 2019). Abortions performed in the late second or third trimester are performed using one of these two techniques, usually the former.
Contraception and abortion
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
After 14 weeks, the surgical technique of choice is dilation and evacuation. In skilled hands, this procedure has a low complication rate and is highly acceptable to women. It is widely used in North America, but is less common in Europe. It is necessary to achieve good cervical dilation before the procedure (up to 20 mm) in order to remove larger fetal parts. This is achieved using one or a combination of either osmotic dilators (hygroscopic sticks placed in the cervix several hours preprocedure that absorb fluid from surrounding tissues, causing them to swell and bring about cervical dilation), or misoprostol (vaginal or sublingual) or mifepristone (oral). At surgery, the cervix is then further dilated using graduated dilators and the contents of the uterus removed by a combination of aspiration and extraction of fetal tissue using appropriate instruments; ultrasound is performed to confirm complete evacuation.
Is it Wrong to Abort a Person?
Christopher Kaczor in The Ethics of Abortion, 2023
To answer this question requires us to examine the various ways abortions are performed. What are the methods of abortion commonly used? Stephanie D. Schmutz has given a description of the most commonly used methods of abortion, namely: suction curettage, dilation and evacuation, and induction:Suction curettage. Vacuum aspiration abortion or suction curettage is the most common form of surgical abortion in the first trimester of pregnancy and normally involves either local or general anesthesia. After dilating the cervix, the physician uses a powerful suction machine to remove part by part the contents of the uterus, until the human fetus and placenta are entirely outside the womb.Dilation and evacuation. D & E is the most common method for second trimester abortions and involves an overnight dilation of the cervix, using seaweed to slowly open the entrance to the uterus. Following the dilation of the cervix, the doctor evacuates the contents of the uterus using suction and forceps to dismember the developing human being in order to remove the human fetus more easily from the uterus.Induction. Used in the second and third trimester, induction involves injecting the amniotic cavity in the uterus with a hypertonic solution of urea, prostaglandin, or saline. These solutions kill the human fetus and induce contractions, which result in delivery.(Schmutz 2002, p. 552)
Intrauterine Fetal Demise Associated with Vascular Malperfusion and Multiple Uterine Leiomyomata: A Report of Two Cases
Published in Fetal and Pediatric Pathology, 2023
Tess E. K. Cersonsky, Megan Lord, Halit Pinar
The patient was counseled on options for uterine evacuation. Pelvic examination confirmed the presence of a large uterine leiomyoma in the lower uterine segment, and it was unclear if the fetus would be able to pass through the pelvis. A hysterotomy for uterine evacuation would likely require incision into the contractile portion of the uterus. Given the size and location of the leiomyoma, there was also concern for uterine atony following hysterotomy, potentially resulting in hysterectomy. At the time of admission, attempted dilation and evacuation (D&E) in the operating room was not felt to be feasible given the patient’s advanced gestational age. Mildly elevated blood pressures were noted during induction on hospital day 2; serum creatinine and other end-organ laboratory values were normal at this time. The patient was mildly febrile and was started on gentamicin and clindamycin for possible intraamniotic infection.
Prenatal genetic diagnosis of Neu-Laxova syndrome
Published in Journal of Obstetrics and Gynaecology, 2018
Amber M. Wood, Amy T. Mottola, Eleanor H. Rhee, Jeffrey A. Kuller
The 18-week ultrasound revealed a thickened nuchal fold and facial oedema. There was no apparent cavum septum pellucidum. Minimal foetal movement was noted, concerning for foetal akinesia. The upper extremities appeared short and fixed, with contracted hands and the lower legs were also fixed in a crossed position. A significant growth lag and microcephaly was noted, with foetal measurements 3 weeks behind expected. Genetic analysis from the CVS returned at this time and the foetus was found to be homozygous for the familial variant c.399 G > A in the PHGDH gene, consistent with a diagnosis of NLS1. The pregnancy was terminated by dilation and evacuation. Autopsy was not performed.
Interpregnancy interval and subsequent pregnancy outcomes after dilation and evacuation
Published in Journal of Obstetrics and Gynaecology, 2018
Melissa Kuwahara, Kelly Yamasato, Mary Tschann, Bliss Kaneshiro
Pregnancy termination is a common procedure in the United States with approximately 926,200 abortions performed each year. Of these abortions, approximately 8.4% are completed by dilation and evacuation (D&E) (Jatlaoui et al. 2016; Jones and Jerman 2017). D&E is associated with a low rate of intra- and post-operative complications (Kapp et al. 2013; Jones and Jerman 2017). Termination of pregnancy for foetal abnormalities is often performed by D&E because patients often wait for the results of definitive diagnostic testing to be obtained. When the indication for termination of pregnancy is a foetal abnormality, patients often desire a new pregnancy as soon as possible.
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