The word Abortion means a failure and is therefore more
appropriate for a spontaneous abortion then for an abortion arte
provocatus. The much used term Interruption of Pregnancy is not
correct, since interruption implies later continuation. The proper
term is Termination of Pregnancy. In de UK the operation is indicated
as VTOP (Voluntary termination of pregnancy). In Holland the official
term is A.A.P.:Abortus Arte Provocatus.
Termination of pregnancy is not a modern invention. In all times
and in all cultures methods to terminate a pregnancy have been
practised with more or less success (mostly less), and with more or
less complications (mostly more). There are many ways to do a
termination. Some only disturb the pregnancy so that a spontaneous
abortion follows, others remove the products of pregnancy and
completely evacuate the uterus. The latter prevent the inherent
discomfort and possible complications of the spontaneous abortion.
The ideal method of termination evacuates the uterus completely in a
matter of minutes, has no complications, does not require anaesthesia
and causes no discomfort for the patient. The modern method known as
aspiration comes closest to these requirements and is
therefore to be considered the method of choice.
For second trimester abortions aspiration can be done with larger tubes. Some physicians even use a 16 mm tube. The method of choice is the method which gives the operator the best results. Normally for second trimester abortions a procedure called D & E is used.
Besides surgical abortion,
medical abortion is practiced. This may have advantages in some
With suction curettage a first trimester pregnancy is terminated
in about 2-7 minutes, the advanced pregnancy in 10 - 20 minutes. If
the pregnancy is correctly and accurately diagnosed and certain
conditions which may make the procedure difficult are well
understood, the incidence of complications is about the lowest of all
medical procedures. Indeed this incidence is so low that termination
is less dangerous than continuation of pregnancy.
The history in the Netherlands proves that terminations of
pregnancy are best done in dedicated clinics rather than general
hospitals. Dedicated staff is contracted so that there is no
difficulty with staff refusing cooperation for ethical or religeous
reasons. An optimal routine can be established which does not
interfere with hospital theatre routines. All patients come for the
same. They are not confronted with maternity patients and babies.
Appendix 1 describes the
situation in the Netherlands
The figures in Appendix
8 show that 90% of all first trimester terminations and 98% of
all second trimester terminations are done in Abortion Clinics. All
clinics and hospitals report their results and complications to the
Ministry of Health. It appears that the incidence of complications in
clinics is 0.2%, (two in every thousand terminations), in hospitals
2.3%, more than ten times as much. However, although complications
are extremely rare, for an adequate handling of them a well organised
cooperation with a nearby hospital is essential.
In all cases where not stated explicitly, duration of pregnancy
is given in weeks of amenorrhoea, calculated from the first day of
the last menstrual period. Medicines are generally mentioned by their
generic name. Appendix 3 (page 51) provides a list of these medicines
with their MIMS classification and the available specialities.
AAP Abortus Arte Provocatus
BPD Bi-Parietal Diameter in ultrasound scan
CR Crown Rump distance in ultrasound scan
DIC Disseminated Intravascular Coagulation
D&C Dilation and Curettage
D&E Dilation and Evacuation
hCG Human Chorionic Gonadotropin
IUD Intra Uterine Device
LH Luteinizing Hormone
LMP Last Menstrual Period
MAP Morning After Pill
PID Pelvic Infectious Disease
Joeri van den