Chemical abortion and surgical abortion

This article is also available in Italian.

The abortion pill Ru486 has arrived in Italy, already experienced in early 1980 and approved in France in 1988 and the U.S. in 2000.

Years of testing are many and this gives us a clear overview of the effects of the drug.

Are we decide our lives, whether it is right or not an abortion, but the fact that in Italy, together with the use of epidural, the RU486 be freely distributed in each hospital, it makes me think that this will prompt women to use. It was proposed a psychological post-abortion “I agree because it is a devastating choice that marks the psyche of a woman for life. But why not offer even before an abortion? A woman afraid of pregnancy, childbirth or what will come after, has the right to be supported above all by helping to overcome her fears. As indeed happens in many Scandinavian countries.

Now I will show you what are the differences between surgical abortion (dilation and scraping of the uterus, the aspiration and Hysterotomy), and the chemical abortion, namely the use of the pill RU486, the so-called painless but, as you will see, it is not absolutely painless.

Ru486

The active ingredient of Ru486 is called mifepristone and is a synthetic steroid with strong abortifacient very effective when used in the early weeks of gestation and before the 49th day (seventh week). Ru486 has no link with the morning-after pill, whose active ingredient is called levonorgestrel, which is used to block ovulation and should be taken during the 72 hours after sexual intercourse.

What is the procedure?

The whole procedure lasts three days. Just this pill is administered, it acts by stopping the feeding to the embryo and bringing it to death within 24 hours. 48 hours after the pill, is given the prostaglandins, a drug that in 3 or 4 hours causes strong uterine contractions, often very painful, leading to the expulsion of the embryo died.

After 14 days there will be a check in the hospital to monitor the effect of drugs on the body of the woman, the fact remains mifepristone circulating for 10-15 days after intake.

Complications derived from the use of Ru486 pill, even with minimum use of 200 mg may be:

• heavy and prolonged bleeding,

• fainting,
• increased blood pressure,
• nausea,
• vomiting,
• abdominal pain and cramps,
• Endometriosis,
• incomplete abortion (in 5% of cases, it is necessary to resort to abortion surgery),
• if the abortion fails and the pregnancy continues, there is a considerable increase of major malformations in the fetus,
• will jeopardize future pregnancies with: extrauterine pregnancies increases, closure of a tuba, natural abortion, severe bleeding and infertility,
• increases the production of cortisol, which affects the immune system, often causing pelvic or genital infections such as Chlamydiosis and gonorrhea and women living with HIV and AIDS risk of death.

Does not end here, in 2005 the CDC published an article where it leads back to the abortion pill, cases of death caused by Toxic Shock Syndrome associated with the bacterium Clostridium Sordellii to which are added effects such as tachycardia, hypotension, edema, blood stickiness and deep leukocytosis.

Vacuum aspiration

Often is used to suction through dilation and evacuation, to abort a pregnancy between 10 and 12 weeks.
The most commonly used method of abortion in the UK, used in over 80 per cent of abortion is vacuun aspiration under a general anaesthetic or, more rarely, with a local preparation apllied to the cervix. Women who are given a general anaesthetic will be unconscious for around ten minutes during which time they will be unable to feel anything and have no memories or feelings. A cannula is passed up the vagina and carefully into the womb and vacuum aspiration is used to remove the pregnancy. This process takes 10 minutes.

This method also carries some risks such as:

• perforation of the walls of the uterus,

• infection,
• haemorrhage.

The situation becomes more complicated if the operation is not performed carefully, and some parts of the fetus remains attached to the uterus.

Dilation and evacuation

This method is generally performed during the second trimester (from 13 to 20 weeks gestation).

The cervix is dilated with laminaria and the procedure performed under paracervical block or general anaesthesia.
Greater dilation of the cervix is required and a cannula of greater diameter (12-21 mm) is directed into the womb. The foetus is larger, the placenta formed and evacuating forceps are used as well as suction to complete the process. The cervix needs to be carefully dilated to avoid cervical tears. When a pregnancy is over ten weeks in first pregnancies and in all pregnancies over twelve weeks, various cervical preparations can be used prior to the abortion to dilate the cervix, materials that swell with moisture or mifepristone by mouth. This technique requires skill and is seen as being technically and aesthetically difficult.

The complications are similar to those of vacuum aspiration.

Hysterotomy

When you reach the 13th week of pregnancy, the uterus becomes more delicate and sensitive and a technique of scraping or aspiration increases the risk of severe bleeding, broken uteri and the fetus is too large to exit. For these reasons we use to do a surgical extraction of the fetus called Hysterotomy; an operation similar to a caesarean section, the only difference is that the fetus does not come out alive. Labor can be induced pharmacologically by replacing a portion of the amniotic fluid with saline or prostaglandin substance. The fetus and placenta are expelled quickly and the next day you can go home.

Even this technique is not immune to complications like severe bleeding or placental retention. But precisely, the effects of administration of the saline can be:

• disorders of the liver or kidneys,

• cardiac disorders,
• hypertension,
• sickle cell anemia.

While it is not recommended the use of prostaglandin for women who have had episodes of convulsions, epilepsy, or suffer from asthma.

With this technique the fetus could be born alive and died of suffocation because the lungs are not yet formed. For this reason, the isterotomia, the use of saline or prostaglandin substance are not very practiced.

I am not in favor of abortion, we are talking about difficult choices to be addressed, and no one can know with certainty how the deal until we are directly involved, but certainly we can not say that the Ru486 pill is painless compared to another technique abortion.

I appeal to all women who have to make a choice like this: I beseech you, think well and talk to someone who can help.

Bibliography:

• “Lo Specchio Di Venere”, by Giorgio Camporese – 2008
• “Pillole che uccidono. Quello che nessuno ti dice sulla contraccezione”, by Vittorio Baldini – Giorgio Maria Carbone – 2006
• “Pregnancy and Abortion Counselling”‎, by Joanna Brien, Ida Fairbairn – 1996