Which of the following are methods used for induced abortion? Select all that apply.

Vacuum aspiration is a surgical method used for early pregnancy termination. It involves suction evacuation of uterine contents using a manual or electric vacuum source. It is most effective between 5 to 12 weeks gestation. The procedure requires cervical dilation, carries low risk of infection, and has a complication rate below 1%. It is contraindicated in ectopic pregnancy, coagulopathy, and severe pelvic infection. Compared to medical abortion, vacuum aspiration offers immediate completion and tissue confirmation.

Rationale for correct answer

1. Vacuum aspiration is most commonly used in the first trimester, specifically between 5 to 12 weeks gestation. At this stage, the uterine contents are soft and easily evacuated by suction. The question asks for the most common use, which aligns with early gestational termination where vacuum aspiration is standard.

Rationale for incorrect answers

2. In the second trimester, fetal size and ossification increase, making vacuum aspiration less effective. Dilation and evacuation (D&E) becomes the preferred method due to the need for forceps and ultrasound guidance. Vacuum aspiration is not routinely used beyond 12 weeks due to incomplete evacuation risks.

3. During the third trimester, termination is rare and legally restricted. Methods include induction abortion or cesarean delivery, not vacuum aspiration. The fetal size and viability make suction techniques inappropriate and unsafe. Vacuum aspiration is contraindicated due to high risk of uterine rupture and maternal morbidity.

4. Post-term pregnancy refers to gestation beyond 42 weeks, where termination is managed by labor induction or cesarean section. Vacuum aspiration has no role in post-term management. The uterus is large, the fetus is viable, and suction evacuation is neither effective nor safe.

Take home points

• Vacuum aspiration is preferred for abortion between 5 to 12 weeks gestation.
• D&E is used for second trimester termination due to fetal size.
• Third trimester termination requires induction or cesarean delivery.
• Post-term pregnancy is not managed with vacuum aspiration.

Induced abortion involves the deliberate termination of a pregnancy using medical or surgical techniques. The uterine contents are evacuated through either pharmacologic agents or mechanical procedures. Common methods include vacuum aspiration, medical induction, and dilation and curettage, depending on gestational age. Prostaglandins like misoprostol stimulate uterine contractions, while surgical methods physically remove products of conception. Indications include maternal health risks, fetal anomalies, or personal choice. Gestational age determines method: medical induction is preferred before 12 weeks, while D&C and vacuum aspiration are used up to 14 weeks. Complications include hemorrhage, infection, and uterine perforation.

Rationale for correct answers

1. Vacuum aspiration is a standard surgical method for induced abortion, especially effective between 6 and 14 weeks gestation. It uses suction to evacuate the uterine contents. It is associated with low complication rates and is widely used due to its efficacy and safety.

3. Medical induction with prostaglandins, such as misoprostol or mifepristone, is a recognized method for early abortion. These agents cause cervical softening and uterine contractions, leading to expulsion of the embryo or fetus. It is preferred in pregnancies under 12 weeks and is non-invasive.

4. Dilation and curettage (D&C) is a surgical abortion technique involving cervical dilation followed by scraping of the uterine lining. It is used for first-trimester abortions and post-abortion retained products. It provides direct visual control and is effective in complete evacuation.

Rationale for incorrect answers

2. Expectant management is not a method of induced abortion. It refers to watchful waiting in cases of spontaneous abortion or miscarriage, allowing the body to expel the products of conception naturally. It lacks active intervention and is inappropriate for elective termination.

5. Cerclage placement is a procedure used to prevent miscarriage or preterm birth in cases of cervical insufficiency. It involves placing a suture around the cervix to keep it closed. It is a pregnancy-preserving intervention, not a termination method, and contraindicated in abortion.

Take home points

• Induced abortion methods include medical and surgical approaches based on gestational age.
• Vacuum aspiration and D&C are surgical techniques used in early pregnancy termination.
• Prostaglandins like misoprostol are used for medical induction of abortion.