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 cases.

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.

Some abbreviations:

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

DES di-ethyl-stilboestrol

hCG Human Chorionic Gonadotropin

IUD Intra Uterine Device

LH Luteinizing Hormone

LMP Last Menstrual Period

MAP Morning After Pill

PID Pelvic Infectious Disease

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