Techniques of induced abortion, their health implications and service aspects: a review of the literature

Abstract

This literature review indicates that menstrual regulation during the fifth to seventh week of pregnancy is not always as free from risk as has sometimes been claimed. In particular, it has a higher failure rate, in terms of continued pregnancy, than has abortion by suction in later stages of pregnancy.Vacuum aspiration is still the method of choice until the beginning of the eleventh week of pregnancy. After that, it seems to be slightly more hazardous than dilatation and curettage (D & C). Preoperative cervical dilatation seems to be beneficial after the tenth week, even though its effectiveness in preventing cervical tears and subsequent cervical incompetence in primigravidae remains to be definitely proven.For second trimester abortions, there is an urgent need for controlled studies, in the thirteenth to fifteenth week, to compare the increasingly popular modified D & C technique with various two-stage techniques, both in terms of safety and of cost-effectiveness. Prostaglandins for second trimester abortions have not quite fulfilled their promise as a relatively risk-free technique; they do, however, decrease the time interval between the administration of the abortifacient and the expulsion of the fetus.Aspects of abortion care other than the purely technical ones are much less well covered by research. For instance, very little is known about the acceptability of various abortion and anaesthetic techniques to either pregnant women or hospital staff. More studies are also needed on the interaction of pregnant women with the service providers at various levels and on how this affects their subsequent reproductive behaviour.