Abortion

Abstract

In 1990 abortion literature was characterized by articles relating to 1) the safety of surgical abortion procedures, 2) advances in knowledge and experience with medical abortifacients such as mifepristone (RU 486), and 3) reviews of psychologic and ethical considerations. Although technical methods differ greatly between countries and continents, there is increasing similarity between termination protocols in the United States, the United Kingdom, and Europe. The advent of mifepristone will make this even more so. Surgically, although dilatation and evacuation procedures are far more common in the United States than in other countries, the literature reflects a fine-tuning of analysis and technique, with safety the major consideration. Knowledge about the effectiveness of mifepristone continues to grow, and the effective dose for early first-trimester termination appears established. There is increasing evidence that at least in the short term, the negative psychologic sequelae of abortion are infrequent and are inconsequential as a public health issue.

PIP: The recent literature on abortion reflects a refinement of technique and an increased concern with safety. Safety is an especially important concern in developing countries, where abortion-related deaths account for 40-90% of maternal mortality. Dilatation and evacuation has become the method of choice for terminations up to 18 weeks of gestation. The major safety concern associated with this technique is uterine perforation. Preoperative preparation of the cervix with an osmotic or pharmacologic agent is recommended to reduce this risk and sufficient time should be allowed for cervical ripening to reduce the need for mechanical dilatation. Much current research is centered on the use of mifepristone as a cervical ripening method or abortifacient agent. An appropriate dose of mifepristone at an appropriate gestational age in combination with a prostaglandin is an effective means of early pregnancy termination, but the type and dosage of the prostaglandin require further definition. In developing countries, where prostaglandins are costly or unavailable, ethacridine should be investigated as an alternative to mifepristone. The major disadvantage of this agent is the time required to achieve fetal expulsion. Other areas under research include the management of cases in which fertility-enhancing procedures result in a multifetal pregnancy and the value of routine histologic examination of aborted fetal tissue. Finally, studies on the psychological sequelae of induced abortion suggest that social support, especially from the male partner, is the critical factor in outcome.