eMedicine Specialties > Obstetrics and Gynecology > General Gynecology

Elective Abortion: Differential Diagnoses & Workup

Author: Suzanne R Trupin, MD, Clinical Professor of Obstetrics and Gynecology, University of Illinois College of Medicine-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center
Contributor Information and Disclosures

Updated: Nov 16, 2009

Differential Diagnoses

Anemia
Cervicitis
Early Pregnancy Loss
Ectopic Pregnancy
Missed Abortion
Pelvic Inflammatory Disease

Other Problems to Be Considered

Bacterial vaginosis
Cervical dysplasia or neoplasia
Ovarian masses
Uterine fibroids
Uterine anomalies
Multifetal gestations
Fetal anomalies
Maternal illnesses
Maternal allergies
Bleeding or clotting disorders
Grand multiparity
Cervical incompetence
Sexual Assault
Psychological trauma
Bacterial endocarditis prophylaxis
Benign lesions of the uterine corpus
Gestational trophoblastic disease

Workup

Laboratory Studies

  • Preabortion workup
    • Pregnancy tests are used to confirm the presence of a pregnancy, and home tests are reliable enough that their results can be accepted in some cases.
    • Hemoglobin (Hb) or hematocrit (Hct) levels are always assessed. A full CBC count is optional but may be indicated if abnormal findings are detected with the Hb or Hct test.
    • STI screening typically includes a gonorrheal culture (GC) or chlamydial test (CT), and targeting those aged 25 years and younger is considered appropriate. Screening for other STIs, such as syphilis or HIV disease, is usually prohibitively expensive; however, patients with positive results from the GC or CT should be offered these tests.
    • Rh typing is always performed. ABO typing is optional.
  • Use of human chorionic gonadotropin titers
    • Human chorionic gonadotropin (hCG) titers are helpful in performing very early terminations, to establish the completeness of an abortion postoperatively in cases of persistent positive results from a urinary pregnancy test, or to establish the presence of an ectopic pregnancy. Prior to a medical abortion, ruling out ectopic pregnancy is mandatory. In medical abortion protocols, they can also be used to establish the arrest of viability of a pregnancy or to establish the completeness of a medical abortion.
    • Titer resolution is different between surgical and medical abortions. The titer should decrease to approximately 64% of its preabortion value within 24 hours of misoprostol being administered in medical abortion protocols. By 2 weeks, the titers should have dropped 99%.
    • If an abortion is being performed prior to 5 weeks from the LMP, obtaining titer values preoperatively can be very useful. Managing most abortion procedures without obtaining an hCG titer is within the standard of care.
  • Wet preparations
    • Vaginal wet preparations, pH testing, and/or urine dipstick analysis are usually performed for standard indications.
    • If a woman is discovered to have a concomitant infection, it may require treatment before she has an abortion.
    • Screen for common sexually transmitted diseases (eg, chlamydia, gonorrhea, HIV, hepatitis B) in geographic areas with high prevalence (eg, urban, inner city) and in age groups commonly at risk (women <25 y).
  • Additional testing is dictated by findings on history and physical examination.
    • Coagulation studies are indicated in patients with a history of bruising, abnormal bleeding, hemorrhage with previous surgical procedures, or petechiae on physical examination.
    • Liver function tests are indicated in patients with ethyl alcohol abuse, hepatitis, hepatomegaly, or jaundice.
    • Renal function tests are indicated in patients with a history of renal disease or dialysis.

Imaging Studies

Ultrasonography is invaluable but not always used in first-trimester terminations. The standard of care demands that second-trimester terminations be evaluated preoperatively with sonography. Documenting uterine abnormalities is important because failed terminations can occur in patients with double uterus or ectopic pregnancies.

  • First-trimester sonography: The results of the examination are what is typically expected for a first-trimester screening examination. The focus is on fetal number, the size and nature of the gestational sac, the placental location, the uterus, and the ovaries. Document the presence and nature of a yolk sac.
  • Second- and third-trimester sonography: For second- or third-trimester abortions, performing an ultrasound preoperatively is the standard of care. Conduct these examinations like other second-trimester screening examinations. If anomalies are detected, women should be offered a referral for targeted examinations that can delineate specific fetal disease conditions. Not unusually, women decline further investigation if their abortion decision does not hinge on the specific findings.

Other Tests

  • Papanicolaou tests (Pap smears) are optional specifically prior to the procedure, but patients should be informed of their need for Pap smears as part of their postabortion contraceptive care.
  • Genetic testing of an abnormal first-trimester pregnancy may be done either preoperatively or at the time of the abortion procedure. At the time of the procedure, either the fetus or the placenta may be tested, but these tests have to be prearranged and may be expensive.
  • Autopsy should be considered for all second-trimester anomalies. The combination of genetic sampling (either by amniocentesis or cytogenetic specimen from the fetus and placenta) and autopsy should be offered to these patients to provide as much diagnostic information for the patient to facilitate counseling for future pregnancies.

Histologic Findings

Pathologic analysis of tissue is typically performed for documentation purposes, but visual inspection of the products of conception postprocedure is mandatory. Washing the blood clots off the tissue obtained prior to visual inspection is helpful, and the presence of villi can be detected more reliably after back-lighting the specimen. In cases in which very little tissue is obtained, the use of colposcopy may reveal villi. 

Placental analysis typically reveals products of conception consistent with gestational age. Preoperative ultrasound typically reveals placental abnormalities, such as a molar gestation or choriocarcinoma, when present. However, results from the histologic analysis that reveal the presence of a partial molar pregnancy or an incomplete molar pregnancy are not uncommon. See eMedicine article Hydatidiform Mole.

Requirements for pathological examination of products of conception (POC) after surgical abortion are also determined by state regulations. Many states require examination of fetal tissue after abortion. Request pathological examination of tissue in the following circumstances, even if no state requirement exists:

  • Tissue obtained is less than expected based on gestational age.
  • Scant tissue is obtained. Pathologic confirmation should be available within 24 hours if an ectopic pregnancy is suggested or within a week to 10 days if no pathology is suggested.
  • Tissue is abnormal in appearance (eg, grapelike appearance consistent with molar pregnancy).
  • Ectopic pregnancy is suspected.
  • Sac, placental, or fetal tissue are not identifiable on gross examination in a first-trimester abortion.
  • Placental and/or fetal tissue are not identifiable on gross examination in a second-trimester abortion.
  • Many fetal anomalies can be detected upon anatomic inspection of the fetus, but only intact procedures or induction of labor reliably offer a fetal specimen that can be evaluated adequately.
  • Tissue inconsistent with POC is identified in the specimen (eg, fat).

More on Elective Abortion

Overview: Elective Abortion
Differential Diagnoses & Workup: Elective Abortion
Treatment & Medication: Elective Abortion
Follow-up: Elective Abortion
References
[ CLOSE WINDOW ]

References

  1. Kahn JG, Becker BJ, MacIsaa L, et al. The efficacy of medical abortion: a meta-analysis. Contraception. Jan 2000;61(1):29-40. [Medline].

  2. Koenig JD, Tapias MP, Hoff T, Stewart FH. Are US health professionals likely to prescribe mifepristone or methotrexate?. J Am Med Womens Assoc. 2000;55(3 Suppl):155-60. [Medline].

  3. [Best Evidence] Dickinson JE, Doherty DA. Optimization of third-stage management after second-trimester medical pregnancy termination. Am J Obstet Gynecol. Sep 2009;201(3):303.e1-7. [Medline].

  4. Perry KG Jr, Rinehart BK, Terrone DA, Martin RW, May WL, Roberts WE. Second-trimester uterine evacuation: A comparison of intra-amniotic (15S)-15-methyl-prostaglandin F2alpha and intravaginal misoprostol. Am J Obstet Gynecol. Nov 1999;181(5 Pt 1):1057-61. [Medline].

  5. Pridmore BR, Chambers DG. Uterine perforation during surgical abortion: a review of diagnosis, management and prevention. Aust N Z J Obstet Gynaecol. Aug 1999;39(3):349-53. [Medline].

  6. Hakim-Elahi E, Tovell HM, Burnhill MS. Complications of first-trimester abortion: a report of 170,000 cases. Obstet Gynecol. Jul 1990;76(1):129-35. [Medline].

  7. Kafrissen ME, Barke MW, Workman P, Schulz KF, Grimes DA. Coagulopathy and induced abortion methods: rates and relative risks. Am J Obstet Gynecol. Oct 1 1983;147(3):344-5. [Medline].

  8. Zhou W, Sorensen HT, Olsen J. Induced abortion and subsequent pregnancy duration. Obstet Gynecol. Dec 1999;94(6):948-53. [Medline].

  9. Hendricks MS, Chow YH, Bhagavath B, Singh K. Previous cesarean section and abortion as risk factors for developing placenta previa. J Obstet Gynaecol Res. Apr 1999;25(2):137-42. [Medline].

  10. Eras JL, Saftlas AF, Triche E, Hsu CD, Risch HA, Bracken MB. Abortion and its effect on risk of preeclampsia and transient hypertension. Epidemiology. Jan 2000;11(1):36-43. [Medline].

  11. Challis D, Gratacos E, Deprest JA. Cord occlusion techniques for selective termination in monochorionic twins. J Perinat Med. 1999;27(5):327-38. [Medline].

  12. Acharya PS, Gluckman SJ. Bacteremia following placement of intracervical laminaria tents. Clin Infect Dis. Sep 1999;29(3):695-7. [Medline].

  13. ACOG. ACOG practice bulletin. Clinical management guidelines of obstetrician-gynecologists. Number 67, October 2005. Medical management of abortion. Obstet Gynecol. Oct 2005;106(4):871-82. [Medline].

  14. ACOG. American College of Obstetricians and Gynecologists. Methods of Midtrimester Abortion. ACOG Technical Bulletin. 1987;109:602-05.

  15. ACOG Compendium of Selected Publications. American College of Obstetricians and Gynecologists. Abortion Policy. 2005;865-867.

  16. Aiyer AN, Ruiz G, Steinman A, Ho GY. Influence of physician attitudes on willingness to perform abortion. Obstet Gynecol. Apr 1999;93(4):576-80. [Medline].

  17. Ashok PW, Templeton A. Nonsurgical mid-trimester termination of pregnancy: a review of 500 consecutive cases. Br J Obstet Gynaecol. Jul 1999;106(7):706-10. [Medline].

  18. Baird DT. Mode of action of medical methods of abortion. J Am Med Womens Assoc. 2000;55(3 Suppl):121-6. [Medline].

  19. Ballagh SA, Harris HA, Demasio K. Is curettage needed for uncomplicated incomplete spontaneous abortion?. Am J Obstet Gynecol. Nov 1998;179(5):1279-82. [Medline].

  20. Bartholomew LL, Grimes DA. The alleged association between induced abortion and risk of breast cancer: biology or bias?. Obstet Gynecol Surv. Nov 1998;53(11):708-14. [Medline].

  21. Begley AM. Preparation for practice in the new millennium: a discussion of the moral implications of multifetal pregnancy reduction. Nurs Ethics. Mar 2000;7(2):99-112. [Medline].

  22. Berer M. Making abortions safe: a matter of good public health policy and practice. Bull World Health Organ. 2000;78(5):580-92. [Medline].

  23. Bernick BA, Ufberg DD, Nemiroff R, Donnenfeld A, Tolosa JE. Success rate of cytogenetic analysis at the time of second-trimester dilation and evacuation. Am J Obstet Gynecol. Oct 1998;179(4):957-61. [Medline].

  24. Bernstein PS, Rosenfield A. Abortion and maternal health. Int J Gynaecol Obstet. Dec 1998;63 Suppl 1:S115-22. [Medline].

  25. Blanchard K, Winikoff B, Ellertson C. Misoprostol used alone for the termination of early pregnancy. A review of the evidence. Contraception. Apr 1999;59(4):209-17. [Medline].

  26. Borgatta L, Burnhill M, Haskell S, Nichols M, Leonhardt K. Instituting medical abortion services: changes in outcome and acceptability related to provider experience. J Am Med Womens Assoc. 2000;55(3 Suppl):173-6. [Medline].

  27. Borgatta L, Chen AY, Reid SK, Stubblefield PG, Christensen DD, Rashbaum WK. Pelvic embolization for treatment of hemorrhage related to spontaneous and induced abortion. Am J Obstet Gynecol. Sep 2001;185(3):530-6. [Medline].

  28. Borgmann CE, Jones BS. Legal issues in the provision of medical abortion. Am J Obstet Gynecol. Aug 2000;183(2 Suppl):S84-94. [Medline].

  29. Bourguignon A, Briscoe B, Nemzer L. Genetic abortion: considerations for patient care. J Perinat Neonatal Nurs. Sep 1999;13(2):47-58. [Medline].

  30. Breitbart V, Repass DC. The counseling component of medical abortion. J Am Med Womens Assoc. 2000;55(3 Suppl):164-6. [Medline].

  31. Cakir L, Dilbaz B, Caliskan E, Dede FS, Dilbaz S, Haberal A. Comparison of oral and vaginal misoprostol for cervical ripening before manual vacuum aspiration of first trimester pregnancy under local anesthesia: a randomized placebo-controlled study. Contraception. May 2005;71(5):337-42. [Medline].

  32. Castadot RG. Pregnancy termination: techniques, risks, and complications and their management. Fertil Steril. Jan 1986;45(1):5-17. [Medline].

  33. Cates W, Ellertson C. Contraceptive Technology. In: Hatcher RA, Trussel J, Stewart F, et al. Abortion. 17th ed. New York, NY: Ardent Media; 1998:682-697.

  34. Chapman SJ, Crispens M, Owen J, Savage K. Complications of midtrimester pregnancy termination: the effect of prior cesarean delivery. Am J Obstet Gynecol. Oct 1996;175(4 Pt 1):889-92. [Medline].

  35. Chasen ST, Kalish RB, Gupta M, Kaufman JE, Rashbaum WK, Chervenak FA. Dilation and evacuation at >or=20 weeks: comparison of operative techniques. Am J Obstet Gynecol. May 2004;190(5):1180-3. [Medline].

  36. Christin-Maitre S, Bouchard P, Spitz IM. Medical termination of pregnancy. N Engl J Med. Mar 30 2000;342(13):946-56. [Medline].

  37. Chung TK, Lee DT, Cheung LP, Haines CJ, Chang AM. Spontaneous abortion: a randomized, controlled trial comparing surgical evacuation with conservative management using misoprostol. Fertil Steril. Jun 1999;71(6):1054-9. [Medline].

  38. Clark S, Ellertson C, Winikoff B. Is medical abortion acceptable to all American women: the impact of sociodemographic characteristics on the acceptability of mifepristone-misoprostol abortion. J Am Med Womens Assoc. 2000;55(3 Suppl):177-82. [Medline].

  39. Cohen AL, Bhatnagar J, Reagan S, et al. Toxic shock associated with Clostridium sordellii and Clostridium perfringens after medical and spontaneous abortion. Obstet Gynecol. Nov 2007;110(5):1027-33. [Medline].

  40. Cole DS, Bruck LR. Anaphylaxis after laminaria insertion. Obstet Gynecol. Jun 2000;95(6 Pt 2):1025. [Medline].

  41. Cook RJ, Dickens BM. Human rights and abortion laws. Int J Gynaecol Obstet. Apr 1999;65(1):81-7. [Medline].

  42. Coyaji K. Early medical abortion in India: three studies and their implications for abortion services. J Am Med Womens Assoc. 2000;55(3 Suppl):191-4. [Medline].

  43. Creinin MD. Conception rates after abortion with methotrexate and misoprostol. Int J Gynaecol Obstet. May 1999;65(2):183-8. [Medline].

  44. Creinin MD. Medical abortion regimens: historical context and overview. Am J Obstet Gynecol. Aug 2000;183(2 Suppl):S3-9. [Medline].

  45. Creinin MD, Fox MC, Teal S, Chen A, Schaff EA, Meyn LA. A randomized comparison of misoprostol 6 to 8 hours versus 24 hours after mifepristone for abortion. Obstet Gynecol. May 2004;103(5 Pt 1):851-9. [Medline].

  46. Creinin MD, Jerald H. Success rates and estimation of gestational age for medical abortion vary with transvaginal ultrasonographic criteria. Am J Obstet Gynecol. Jan 1999;180(1 Pt 1):35-41. [Medline].

  47. Creinin MD, Pymar HC. Medical abortion alternatives to mifepristone. J Am Med Womens Assoc. 2000;55(3 Suppl):127-32, 150. [Medline].

  48. Creinin MD, Spitz IM. Use of various ultrasonographic criteria to evaluate the efficacy of mifepristone and misoprostol for medical abortion. Am J Obstet Gynecol. Dec 1999;181(6):1419-24. [Medline].

  49. Creinin MD, Wiebe E, Gold M. Methotrexate and misoprostol for early abortion in adolescent women. J Pediatr Adolesc Gynecol. May 1999;12(2):71-7. [Medline].

  50. Cunningham GF, MacDonald PC, Gant NF. Abortion. In: Williams Obstetrics. 19th ed. 1993:661-90.

  51. Daling JR, Emanuel I. Induced abortion and subsequent outcome of pregnancy. A matched cohort study. Lancet. Jul 26 1975;2(7926):170-3. [Medline].

  52. Davis A, Westhoff C, De Nonno L. Bleeding patterns after early abortion with mifepristone and misoprostol or manual vacuum aspiration. J Am Med Womens Assoc. 2000;55(3 Suppl):141-4. [Medline].

  53. Dean G, Cardenas L, Darney P, Goldberg A. Acceptability of manual versus electric aspiration for first trimester abortion: a randomized trial. Contraception. Mar 2003;67(3):201-6. [Medline].

  54. Delfs E, Katayama KP. Surgical Management of Reproductive Failure and Abortion. Te Linde's Operative Gynecology. Fifth Edition. 1977:429-451.

  55. Dobie SA, Hart LG, Glusker A, Madigan D, Larson EH, Rosenblatt RA. Abortion services in rural Washington State, 1983-1984 to 1993-1994: availability and outcomes. Fam Plann Perspect. Sep-Oct 1999;31(5):241-5. [Medline].

  56. Drey EA, Thomas LJ, Benowitz NL, Goldschlager N, Darney PD. Safety of intra-amniotic digoxin administration before late second-trimester abortion by dilation and evacuation. Am J Obstet Gynecol. May 2000;182(5):1063-6. [Medline].

  57. Edmondson AS, Cooke EM. The development and assessment of a bacteriocin typing method for Klebsiella. J Hyg (Lond). Apr 1979;82(2):207-23. [Medline].

  58. Elimian A, Verma U, Tejani N. Effect of causing fetal cardiac asystole on second-trimester abortion. Obstet Gynecol. Jul 1999;94(1):139-41. [Medline].

  59. Elul B, Ellertson C, Winikoff B, Coyaji K. Side effects of mifepristone-misoprostol abortion versus surgical abortion. Data from a trial in China, Cuba, and India. Contraception. Feb 1999;59(2):107-14. [Medline].

  60. Elul B, Pearlman E, Sorhaindo A, Simonds W, Westhoff C. In-depth interviews with medical abortion clients: thoughts on the method and home administration of misoprostol. J Am Med Womens Assoc. 2000;55(3 Suppl):169-72. [Medline].

  61. Epner JE, Jonas HS, Seckinger DL. Late-term abortion. JAMA. Aug 26 1998;280(8):724-9. [Medline].

  62. Evans MI, Goldberg JD, Horenstein J, et al. Selective termination for structural, chromosomal, and mendelian anomalies: international experience. Am J Obstet Gynecol. Oct 1999;181(4):893-7. [Medline].

  63. Fitzpatrick KM, Wilson M. Exposure to violence and posttraumatic stress symptomatology among abortion clinic workers. J Trauma Stress. Apr 1999;12(2):227-42. [Medline].

  64. Fong YF, Singh K, Prasad RN. Severe hyperthermia following use of vaginal misoprostol for pre-operative cervical priming. Int J Gynaecol Obstet. Jan 1999;64(1):73-4. [Medline].

  65. Frank PI, McNamee R, Hannaford PC, Kay CR, Hirsch S. The effect of induced abortion on subsequent pregnancy outcome. Br J Obstet Gynaecol. Oct 1991;98(10):1015-24. [Medline].

  66. Geva E, Fait G, Yovel I, et al. Second-trimester multifetal pregnancy reduction facilitates prenatal diagnosis before the procedure. Fertil Steril. Mar 2000;73(3):505-8. [Medline].

  67. Gouk EV, Lincoln K, Khair A, Haslock J, Knight J, Cruickshank DJ. Medical termination of pregnancy at 63 to 83 days gestation. Br J Obstet Gynaecol. Jun 1999;106(6):535-9. [Medline].

  68. Grimes D, Schulz K, Stanwood N. Immediate post-abortal insertion of intrauterine devices. Cochrane Database Syst Rev. 2000;CD001777. [Medline].

  69. Grimes DA. A 26-year-old woman seeking an abortion. JAMA. Sep 22-29 1999;282(12):1169-75. [Medline].

  70. Grimes DA. The continuing need for late abortions. JAMA. Aug 26 1998;280(8):747-50. [Medline].

  71. Grimes DA. Unsafe abortion: the silent scourge. Br Med Bull. 2003;67:99-113. [Medline].

  72. Grimes DA, Schulz KF. Morbidity and mortality from second-trimester abortions. J Reprod Med. Jul 1985;30(7):505-14. [Medline].

  73. Hamoda H, Ashok PW, Flett GM, Templeton A. A randomised controlled trial of mifepristone in combination with misoprostol administered sublingually or vaginally for medical abortion up to 13 weeks of gestation. BJOG. Aug 2005;112(8):1102-8. [Medline].

  74. Hamoda H, Ashok PW, Flett GM, Templeton A. Medical abortion at 64 to 91 days of gestation: a review of 483 consecutive cases. Am J Obstet Gynecol. May 2003;188(5):1315-9. [Medline].

  75. Hamoda H, Ashok PW, Flett GM, Templeton A. Medical abortion at 9-13 weeks' gestation: a review of 1076 consecutive cases. Contraception. May 2005;71(5):327-32. [Medline].

  76. Heath V, Chadwick V, Cooke I, Manek S, MacKenzie IZ. Should tissue from pregnancy termination and uterine evacuation routinely be examined histologically?. BJOG. Jun 2000;107(6):727-30. [Medline].

  77. Hellberg D, Mogilevkina I, Mardh PA. Sexually transmitted diseases and gynecologic symptoms and signs in women with a history of induced abortion. Sex Transm Dis. Apr 1999;26(4):197-200. [Medline].

  78. Henshaw SK. Abortion incidence and services in the United States, 1995-1996. Fam Plann Perspect. Nov-Dec 1998;30(6):263-70, 287. [Medline].

  79. Hern WM. Second-trimester surgical abortions. In: Sciarra JJ. Gynecology and Obstetrics. Philadelphia, PA: JB Lippincott Co; 2002.

  80. Isley MM, Blumenthal P. Medical Abortion What's Old, what's new?. Contemporary OB GYN. Apr 15 2008;30-38.

  81. Jackson RA, Teplin VL, Drey EA, Thomas LJ, Darney PD. Digoxin to facilitate late second-trimester abortion: a randomized, masked, placebo-controlled trial. Obstet Gynecol. Mar 2001;97(3):471-6. [Medline].

  82. Jain JK, Kuo J, Mishell DR Jr. A comparison of two dosing regimens of intravaginal misoprostol for second-trimester pregnancy termination. Obstet Gynecol. Apr 1999;93(4):571-5. [Medline].

  83. Jain JK, Meckstroth KR, Mishell DR Jr. Early pregnancy termination with intravaginally administered sodium chloride solution-moistened misoprostol tablets: historical comparison with mifepristone and oral misoprostol. Am J Obstet Gynecol. Dec 1999;181(6):1386-91. [Medline].

  84. Jain JK, Meckstroth KR, Park M, Mishell DR Jr. A comparison of tamoxifen and misoprostol to misoprostol alone for early pregnancy termination. Contraception. Dec 1999;60(6):353-6. [Medline].

  85. Jensen JT, Harvey SM, Beckman LJ. Acceptability of suction curettage and mifepristone abortion in the United States: a prospective comparison study. Am J Obstet Gynecol. Jun 2000;182(6):1292-9. [Medline].

  86. Jensen MP, Miller L, Fisher LD. Assessment of pain during medical procedures: a comparison of three scales. Clin J Pain. Dec 1998;14(4):343-9. [Medline].

  87. Jermy K, Oyelese O, Bourne T. Uterine anomalies and failed surgical termination of pregnancy: the role of routine preoperative transvaginal sonography. Ultrasound Obstet Gynecol. Dec 1999;14(6):431-3. [Medline].

  88. Jones BS, Heller S. Providing medical abortion: legal issues of relevance to providers. J Am Med Womens Assoc. 2000;55(3 Suppl):145-50. [Medline].

  89. Joyce T, Kaestner R. The impact of Mississippi's mandatory delay law on the timing of abortion. Fam Plann Perspect. Jan-Feb 2000;32(1):4-13. [Medline].

  90. Kafrissen ME, Grimes DA, Hogue CJ, Sacks JJ. Cluster of abortion deaths at a single facility. Obstet Gynecol. Sep 1986;68(3):387-9. [Medline].

  91. Kalish RB, Chasen ST, Rosenzweig LB, Rashbaum WK, Chervenak FA. Impact of midtrimester dilation and evacuation on subsequent pregnancy outcome. Am J Obstet Gynecol. Oct 2002;187(4):882-5. [Medline].

  92. Keder LM. Best practices in surgical abortion. Am J Obstet Gynecol. Aug 2003;189(2):418-22. [Medline].

  93. Kero A, Hogberg U, Lalos A. Wellbeing and mental growth-long-term effects of legal abortion. Soc Sci Med. Jun 2004;58(12):2559-69. [Medline].

  94. Kero A. Wellbeing and mental growth - long term effects of legal abortion.

  95. Kjems E, Krag C. Melanoma and pregnancy. A review. Acta Oncol. 1993;32(4):371-8. [Medline].

  96. Koonin LM. Abortion reporting in the era of medical procedures: why is it important?. J Am Med Womens Assoc. 2000;55(3 Suppl):203-4. [Medline].

  97. Kruse B. Advanced practice clinicians and medical abortion: increasing access to care. J Am Med Womens Assoc. 2000;55(3 Suppl):167-8. [Medline].

  98. Kruse B, Poppema S, Creinin MD, Paul M. Management of side effects and complications in medical abortion. Am J Obstet Gynecol. Aug 2000;183(2 Suppl):S65-75. [Medline].

  99. Lahteenmaki P, Luukkainen T. Return of ovarian function after abortion. Clin Endocrinol (Oxf). Feb 1978;8(2):123-32. [Medline].

  100. Larsson PG, Platz-Christensen JJ, Dalaker K, et al. Treatment with 2% clindamycin vaginal cream prior to first trimester surgical abortion to reduce signs of postoperative infection: a prospective, double-blinded, placebo-controlled, multicenter study. Acta Obstet Gynecol Scand. May 2000;79(5):390-6. [Medline].

  101. Lazovich D, Thompson JA, Mink PJ, Sellers TA, Anderson KE. Induced abortion and breast cancer risk. Epidemiology. Jan 2000;11(1):76-80. [Medline].

  102. Levgur M, Abadi MA, Tucker A. Adenomyosis: symptoms, histology, and pregnancy terminations. Obstet Gynecol. May 2000;95(5):688-91. [Medline].

  103. Lichtenberg ES, Shott S. A randomized clinical trial of prophylaxis for vacuum abortion: 3 versus 7 days of doxycycline. Obstet Gynecol. Apr 2003;101(4):726-31. [Medline].

  104. Linn S, Schoenbaum SC, Monson RR, Rosner B, Stubblefield PG, Ryan KJ. The relationship between induced abortion and outcome of subsequent pregnancies. Am J Obstet Gynecol. May 15 1983;146(2):136-40. [Medline].

  105. Macisaac L, Darney P. Early surgical abortion: an alternative to and backup for medical abortion. Am J Obstet Gynecol. Aug 2000;183(2 Suppl):S76-83. [Medline].

  106. MacIsaac L, Grossman D, Balistreri E, Darney P. A randomized controlled trial of laminaria, oral misoprostol, and vaginal misoprostol before abortion. Obstet Gynecol. May 1999;93(5 Pt 1):766-70. [Medline].

  107. Major B, Gramzow RH. Abortion as stigma: cognitive and emotional implications of concealment. J Pers Soc Psychol. Oct 1999;77(4):735-45. [Medline].

  108. Mansfield C, Hopfer S, Marteau TM. Termination rates after prenatal diagnosis of Down syndrome, spina bifida, anencephaly, and Turner and Klinefelter syndromes: a systematic literature review. European Concerted Action: DADA (Decision-making After the Diagnosis of a fetal Abnormality). Prenat Diagn. Sep 1999;19(9):808-12. [Medline].

  109. Martin CW, Brown AH, Baird DT. A pilot study of the effect of methotrexate or combined oral contraceptive on bleeding patterns after induction of abortion with mifepristone and a prostaglandin pessary. Contraception. Aug 1998;58(2):99-103. [Medline].

  110. Mayr NA, Wen BC, Saw CB. Radiation therapy during pregnancy. Obstet Gynecol Clin North Am. Jun 1998;25(2):301-21. [Medline].

  111. Mcfarlane DR. Induced abortion: an historical overview. Am J Gynecol Health. May-Jun 1993;7(3):77-82. [Medline].

  112. Medich DS, Fazio VW. Hemorrhoids, anal fissure, and carcinoma of the colon, rectum, and anus during pregnancy. Surg Clin North Am. Feb 1995;75(1):77-88. [Medline].

  113. Miller VL, Ransom SB, Shalhoub A, Sokol RJ, Evans MI. Multifetal pregnancy reduction: perinatal and fiscal outcomes. Am J Obstet Gynecol. Jun 2000;182(6):1575-80. [Medline].

  114. Nielsen S, Hahlin M, Platz-Christensen J. Randomised trial comparing expectant with medical management for first trimester miscarriages. Br J Obstet Gynaecol. Aug 1999;106(8):804-7. [Medline].

  115. Oteri O, Hopkins R. Second trimester therapeutic abortion using mifepristone and oral misoprostol in a woman with two previous caesarean sections and a cone biopsy. J Matern Fetal Med. Nov-Dec 1999;8(6):300-1. [Medline].

  116. Owen J, Hauth JC. Vaginal misoprostol vs. concentrated oxytocin plus low-dose prostaglandin E2 for second trimester pregnancy termination. J Matern Fetal Med. Mar-Apr 1999;8(2):48-50. [Medline].

  117. Pakarinen P, Toivonen J, Luukkainen T. Randomized comparison of levonorgestrel- and copper-releasing intrauterine systems immediately after abortion, with 5 years' follow-up. Contraception. Jul 2003;68(1):31-4. [Medline].

  118. Papiernik E, Grange G, Zeitlin J. Should multifetal pregnancy reduction be used for prevention of preterm deliveries in triplet or higher order multiple pregnancies?. J Perinat Med. 1998;26(5):365-70. [Medline].

  119. Paul M. Office management of early induced abortion. Clin Obstet Gynecol. Jun 1999;42(2):290-305. [Medline].

  120. Paul M, Lichtenberg ES, Borgatta L. A Clinician's Guide to Medical and Surgical Abortion. New York, NY: Churchill Livingstone; 1999.

  121. Paul M, Schaff E, Nichols M. The roles of clinical assessment, human chorionic gonadotropin assays, and ultrasonography in medical abortion practice. Am J Obstet Gynecol. Aug 2000;183(2 Suppl):S34-43. [Medline].

  122. Paul ME, Mitchell CM, Rogers AJ, Fox MC, Lackie EG. Early surgical abortion: efficacy and safety. Am J Obstet Gynecol. Aug 2002;187(2):407-11. [Medline].

  123. Penfield AJ. Gynecologic Surgery Under Local Anesthesia. Baltimore, Md: Urban & Schwarzenburg; 1986:65-94.

  124. Perry KG Jr, Rinehart BK, Terrone DA, Martin RW, May WL, Roberts WE. Second-trimester uterine evacuation: A comparison of intra-amniotic (15S)-15-methyl-prostaglandin F2alpha and intravaginal misoprostol. Am J Obstet Gynecol. Nov 1999;181(5 Pt 1):1057-61. [Medline].

  125. Pope LM, Adler NE, Tschann JM. Postabortion psychological adjustment: are minors at increased risk?. J Adolesc Health. Jul 2001;29(1):2-11. [Medline].

  126. Reeves MF, Lohr PA, Harwood BJ, Creinin MD. Ultrasonographic endometrial thickness after medical and surgical management of early pregnancy failure. Obstet Gynecol. Jan 2008;111(1):106-12. [Medline].

  127. Rosenblatt RA, Robinson KB, Larson EH, Dobie SA. Medical students' attitudes toward abortion and other reproductive health services. Fam Med. Mar 1999;31(3):195-9. [Medline].

  128. Sandstrom O, Brooks L, Schantz A, Grinsted J, Grinsted L, Jacobsen JD. Interruption of early pregnancy with mifepristone in combination with gemeprost. Acta Obstet Gynecol Scand. Oct 1999;78(9):806-9. [Medline].

  129. Sawaya GF, Grady D, Kerlikowske K, Grimes DA. Antibiotics at the time of induced abortion: the case for universal prophylaxis based on a meta-analysis. Obstet Gynecol. May 1996;87(5 Pt 2):884-90. [Medline].

  130. Schaff EA, Fielding SL. A comparison of the Abortion Rights Mobilization and Population Council trials. J Am Med Womens Assoc. 2000;55(3 Suppl):137-40. [Medline].

  131. Schaff EA, Fielding SL, Eisinger SH, Stadalius LS, Fuller L. Low-dose mifepristone followed by vaginal misoprostol at 48 hours for abortion up to 63 days. Contraception. Jan 2000;61(1):41-6. [Medline].

  132. Schaff EA, Fielding SL, Westhoff C, et al. Vaginal misoprostol administered 1, 2, or 3 days after mifepristone for early medical abortion: A randomized trial. JAMA. Oct 18 2000;284(15):1948-53. [Medline].

  133. Schüler L, Pastuszak A, Sanseverino TV, et al. Pregnancy outcome after exposure to misoprostol in Brazil: a prospective, controlled study. Reprod Toxicol. Mar-Apr 1999;13(2):147-51. [Medline].

  134. Selam B, Lembet A, Stone J, Lapinski R, Berkowitz RL. Pregnancy complications and neonatal outcomes in multifetal pregnancies reduced to twins compared with nonreduced twin pregnancies. Am J Perinatol. 1999;16(2):65-71. [Medline].

  135. Selam B, Torok O, Lembet A, Stone J, Lapinski R, Berkowitz RL. Genetic amniocentesis after multifetal pregnancy reduction. Am J Obstet Gynecol. Jan 1999;180(1 Pt 1):226-30. [Medline].

  136. Shanahan MA, Metheny WP, Star J, Peipert JF. Induced abortion. Physician training and practice patterns. J Reprod Med. May 1999;44(5):428-32. [Medline].

  137. Singh K, Ratnam SS. The influence of abortion legislation on maternal mortality. Int J Gynaecol Obstet. Dec 1998;63 Suppl 1:S123-9.

  138. Sorosky JI, Scott-Conner CE. Breast disease complicating pregnancy. Obstet Gynecol Clin North Am. Jun 1998;25(2):353-63. [Medline].

  139. Stephen JA, Timor-Tritsch IE, Lerner JP, Monteagudo A, Alonso CM. Amniocentesis after multifetal pregnancy reduction: is it safe?. Am J Obstet Gynecol. Apr 2000;182(4):962-5. [Medline].

  140. Stotland NL. The myth of the abortion trauma syndrome. JAMA. Oct 21 1992;268(15):2078-9. [Medline].

  141. Strauss LT, Herndon J, Chang J, Parker WY, Levy DA, Bowens SB. Abortion surveillance--United States, 2001. MMWR Surveill Summ. Nov 26 2004;53(9):1-32. [Medline].

  142. Trussell J, Ellertson C. Estimating the efficacy of medical abortion. Contraception. Sep 1999;60(3):119-35. [Medline].

  143. Ventura SJ, Mosher WD, Curtin SC, Abma JC, Henshaw S. Trends in pregnancies and pregnancy rates by outcome: estimates for the United States, 1976-96. Vital Health Stat 21. Jan 2000;(56):1-47. [Medline].

  144. Vintzileos AM, Ananth CV, Smulian JC, Beazoglou T, Knuppel RA. Routine second-trimester ultrasonography in the United States: a cost-benefit analysis. Am J Obstet Gynecol. Mar 2000;182(3):655-60. [Medline].

  145. Westfall JM, Sophocles A, Burggraf H, Ellis S. Manual vacuum aspiration for first-trimester abortion. Arch Fam Med. Nov-Dec 1998;7(6):559-62. [Medline].

  146. Wiebe E, Guilbert E, Jacot F, Shannon C, Winikoff B. A fatal case of Clostridium sordellii septic shock syndrome associated with medical abortion. Obstet Gynecol. Nov 2004;104(5 Pt 2):1142-4. [Medline].

  147. Wiebe ER. Comparing abortion induced with methotrexate and misoprostol to methotrexate alone. Contraception. Jan 1999;59(1):7-10. [Medline].

  148. Wiebe ER. Tamoxifen compared to methotrexate when used with misoprostol for abortion. Contraception. Apr 1999;59(4):265-70. [Medline].

  149. World Health Organization. Comparison of two doses of mifepristone in combination with misoprostol for early medical abortion: a randomised trial. World Health Organisation Task Force on Post-ovulatory Methods of Fertility Regulation. BJOG. Apr 2000;107(4):524-30. [Medline].

  150. Wu S. Medical abortion in China. J Am Med Womens Assoc. 2000;55(3 Suppl):197-9, 204. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

abortion, surgical termination of pregnancy, elective termination of pregnancy, medical termination of pregnancy, voluntary abortion, therapeutic abortion, menstrual extraction, fetal reduction, pregnancy termination, partial birth abortion, Roe v Wade, intact dilatation and extraction, late-term abortion, elective induced abortion, surgical abortion, medical abortion, dilatation and suction curettage procedure, dilatation and evacuation procedure, labor induction, prostaglandin labor induction, saline infusion, hysterotomy, dilatation and extraction, medication-induced elective abortion, misoprostol, mifepristone, RU-486, incomplete abortion, complete abortion, therapeutic abortion, prostaglandin-induced second-trimester abortion, saline-induced abortion, dilatation and curettage

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Suzanne R Trupin, MD, Clinical Professor of Obstetrics and Gynecology, University of Illinois College of Medicine-Champaign; CEO and Owner, Women's Health Practice; CEO and Owner, Hada Cosmetic Medicine and Midwest Surgical Center
Suzanne R Trupin, MD is a member of the following medical societies: American Association of Gynecologic Laparoscopists, American College of Obstetricians and Gynecologists, American Institute of Ultrasound in Medicine, American Medical Association, Association of Reproductive Health Professionals, International Society for Clinical Densitometry, and North American Menopause Society
Disclosure: Nothing to disclose.

Medical Editor

Steven David Spandorfer, MD, Assistant Professor, Department of Obstetrics and Gynecology, New York Presbyterian Hospital, Weill Medical College-Cornell University
Steven David Spandorfer, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Society for Reproductive Medicine, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

A David Barnes, MD, PhD, MPH, FACOG, Consulting Staff, Department of Obstetrics and Gynecology, Mammoth Hospital (Mammoth Lakes, California), Pioneer Valley Hospital (Salt Lake City, Utah), Warren General Hospital (Warren, Pennsylvania), and Mountain West Hospital (Tooele, Utah)
A David Barnes, MD, PhD, MPH, FACOG is a member of the following medical societies: American College of Forensic Examiners, American College of Obstetricians and Gynecologists, American Medical Association, Association of Military Surgeons of the US, and Utah Medical Association
Disclosure: Nothing to disclose.

CME Editor

Frederick B Gaupp, MD, Consulting Staff, Department of Family Practice, Hancock Medical Center
Frederick B Gaupp, MD is a member of the following medical societies: American Academy of Family Physicians
Disclosure: Nothing to disclose.

Chief Editor

Michel E Rivlin, MD, Professor, Coordinator of Quality Assurance/Quality Improvement, Department of Obstetrics and Gynecology, University of Mississippi School of Medicine
Michel E Rivlin, MD is a member of the following medical societies: American College of Obstetricians and Gynecologists, American Medical Association, Mississippi State Medical Association, and Royal College of Surgeons of Edinburgh
Disclosure: Nothing to disclose.

RELATED EMEDICINE ARTICLES
RELATED MEDSCAPE ARTICLES
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.