Procedure

Induced Abortion

Editors: Michael S. Warren MD, MA; Esther Jolanda van Zuuren MD; Katharine DeGeorge MD, MS

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Background Information

Description

  • induced abortion is the intentional medical or surgical termination of pregnancy for any reason
    1
  • induced abortion should be distinguished from spontaneous abortion (SAB), which describes spontaneous pregnancy loss, typically in the first trimester, also known as miscarriage

Also Called

  • abortion
  • medical abortion
  • medication abortion
  • surgical abortion
  • surgical methods of abortion
  • therapeutic abortion

Definitions

  • medical abortion (medication abortion)
    1
    ,
    4
    • involves use of medication to terminate a pregnancy
    • the medication abortion regimen supported by major medical organizations nationally and internationally includes 2 medications
      • mifepristone
      • misoprostol
  • surgical abortion involves the use of transcervical procedures for terminating a pregnancy, which may include
    4
    • vacuum aspiration
    • dilation and evacuation
  • self-management of medical abortion (as part of a safe abortion) refers to the self-management of the entire process of medical abortion or ≥ 1 of its steps, such as
    4
    • self-assessment of eligibility for medical abortion
    • self-administration of drugs without direct supervision of healthcare professional
    • self-assessment of success of abortion process
  • PubMed19557834Prenatal diagnosisPrenat Diagn20090901299875-81875induced fetal demise refers to the use of a pharmacologic agent such as potassium chloride or digoxin administered via intracardiac, intra-amniotic, intraumbilical, or intrafetal route to ensure demise of fetus prior to evacuation and is performed to eliminate the possibility of transient fetal survival at time of passage of fetal tissue which can be psychologically and emotionally difficult for patient and others involved in care (Prenat Diagn 2009 Sep;29(9):875)
  • safe abortion care includes provision of information, abortion management, and postabortion care, including
    • provision of induced abortions performed by skilled professionals in a safe and clean facility
    • medical and/or surgical care that may be necessary for any complications or treatment after incomplete or unsafe abortions, fetal demise, or miscarriage
    • provision of psychological counseling, contraceptive care, family planning, and reproductive and other health services
    • Reference - World Health Organization (WHO) 2021 Nov
  • unsafe abortion involves steps taken to terminate an unwanted pregnancy by persons lacking the necessary skills or in an environment that does not meet minimal medical standards
    2
  • PubMed19609407Reviews in obstetrics & gynecologyRev Obstet Gynecol2009040122122-6122self-induced abortion (1 type of unsafe abortion) involves the ingestion of substances commonly available substances, overdoses of prescription medications, or physical methods such as insertion of a solid object into the uterus in an effort to terminate an unwanted pregnancy (Rev Obstet Gynecol 2009 Spring;2(2):122)
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DynaMed Levels of Evidence

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DynaMed provides easy-to-interpret Level of Evidence labels so users can quickly find and determine the quality of the best available evidence. Evidence may be labeled in one of three levels:

1Level 1 (likely reliable) Evidence
Representing research results addressing clinical outcomes and meeting an extensive set of quality criteria which minimizes bias.
There are two types of conclusions which can earn a Level 1 label: levels of evidence for conclusions derived from individual studies and levels of evidence for conclusions regarding a body of evidence.
2Level 2 (mid-level) Evidence
Representing research results addressing clinical outcomes, and using some method of scientific investigation, but not meeting the quality criteria to achieve Level 1 evidence labeling.
3Level 3 (lacking direct) Evidence
Representing reports that are not based on scientific analysis of clinical outcomes. Examples include case series, case reports, expert opinion, and conclusions extrapolated indirectly from scientific studies.

Grades of Recommendation

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