Abortions in the First Trimester

Every woman faced with an unforeseen pregnancy will choose to react in whatever way she feels is best. She may choose to keep her child and learn to care for her child. She may remain pregnant but give the newborn up for adoption. Or she may decide to terminate the pregnancy medically. Many reasons are given for why one might choose to terminate her pregnancy. Financial trouble or social issues compel many women to abort. For some, there are medical complications which put the life of the mother at risk. Still others are victims of sexual violence and cannot bear the thought of having produced offspring with their assailants. A number of women use abortion as a form of birth control. Rather than taking a daily pill, wearing a patch, or using some other form of prevention, they wait until after intercourse and eliminate their seed following conception. Because of their immediate results, induced abortions have become routine among women of all ages and are most commonly performed during the first trimester

© Alex & Kathy Plasencia
© Alex & Kathy Plasencia

The first trimester begins on the first day of a woman’s last monthly period (LMP). Conception usually occurs at approximately two weeks LMP. After a couple has had intercourse, the sperm and egg unite within the fallopian tube to form a single-celled organism called a zygote, which contains all the genetic material necessary to determine the human’s sex, physical features, and personality. The zygote then travels toward the uterus, all the while dividing into a raspberry-like cluster of cells. Once at the uterus, these 300 cells now form a blastocyst. During week three, implantation occurs. This is when the blastocyst buries itself into the uterine wall. By the second week after conception, four weeks LMP, the blastocyst has become an embryo and has the beginnings of a central nervous system and most internal organs. By now the average woman begins to experience physical symptoms that lead her to believe she may be pregnant. She will probably purchase a home-test kit and, thanks to modern science, her fears are often confirmed or refuted within a few minutes after opening the package. This is the moment when many will consider having an abortion.


Once a woman has chosen to terminate her pregnancy, she will need to decide what type of abortion she would like to undergo. She must first consider the gestational age of the pregnancy, since some procedures must be implemented during specific time frames. Medicinal abortions, for example, should be administered only up to 9 weeks LMP, while surgical procedures are possible (though not always legal) until pregnancy reaches its full term.

Vacuum aspiration is most commonly used to terminate a pregnancy between five and twelve weeks LMP. In this procedure, the pregnant woman lies in the same position used for a pelvic exam. Using a speculum, the practitioner will clean the area with an antiseptic solution and inject a local anesthetic into the cervix. The patient may also be given a sedative, or, in rare cases, a general anesthetic may be used. A metal instrument is inserted to dilate the cervix, followed by a tube which reaches into the uterus. In some cases, an instrument will be used to keep the uterus immobile throughout the procedure. Using a syringe or a machine vacuum, the practitioner will suction out the fetal and placental matter. If any of the uterine contents fail to emerge, a dilation and curettage procedure (D&C) is done.

When performing a D&C, a loop-shaped knife is used to break up and scrape out the remaining tissue. During these procedures, the patient will experience uterine contractions and is likely to feel lightheaded or nauseous. The contractions should diminish shortly after the abortion is completed. Normal recovery includes cramping that can last several days, light to moderate bleeding, and emotional ups and downs caused by the sudden hormonal change. Possible complications of a vacuum aspiration abortion increase with gestational age. They include, but are not limited to:

  1. Sepsis, a widespread infection

  2. Perforation, tearing or scarring of the uterus or cervix

  3. Severe blood loss, sometimes requiring a transfusion

  4. Embolism

  5. Anemia

  6. Depression

  7. Incomplete abortion, requiring another procedure

  8. Death (approximately 1 in 160,000)

The United States Food and Drug Administration approved mifepristone in 2000 as an alternative to surgical abortion. Also known as the “abortion pill” or “RU486,” this drug is used in combination with artificial prostaglandins such as misoprostol to terminate a confirmed pregnancy up until the ninth week LMP. “Mifepristone blocks the action of the hormone progesterone, which is needed to sustain a pregnancy. This results in changes of the uterine lining and detachment of the pregnancy, softening and opening of the cervix, [and] increased uterine sensitivity to prostaglandin” (National Abortion Federation, 2008). It is followed by the administration of chemically-produced prostaglandin analogue –either orally or vaginally – about two days later. An alternative to misefpristone is methotrexate, which is given by injection but otherwise works in the same way. The National Abortion Federation recommends that the physician should provide a surgical abortion if the medicinal approach does not succeed. According to Healthwise, normal side effects of a medicinal abortion include moderate to heavy bleeding, nausea, vomiting, diarrhea, headache, dizziness, chills or hot flashes, and fatigue. The complications of a medicinal abortion are comparable to those of a surgical abortion, with the death rate somewhat elevated at 1 in 100,000.

7 Weeks Gestation
7 Weeks Gestation

By the time the first trimester ends eleven weeks after conception, or thirteen weeks LMP, the embryo and its host have gone through many changes. During week five, while it is still no larger than the tip of a number two pencil, the embryo’s heart beats for the first time, setting the circulatory system in action. Just days later, at six weeks LMP, facial features are forming and the digestive and respiratory structures are in order. The umbilical cord becomes visible in week seven. This is also when the nostrils appear and spinal fluid begins circulating. By week eight the embryo is about one-half inch long. Its digits, joints and eyelids are recognizable. Week nine LMP marks the creature’s first voluntary movements, and by the following week its tiny brain processes 250,000 neurons per minute. It is in week eleven that the embryo is no longer an embryo. Now called a fetus, this intricate being has all its gender parts in place. About the time the pregnant woman begins to “show,” the three-inch-long fetus within her will respond to any poking or prodding by squirming or clenching its fingers and toes. Perhaps this swift and elaborate development is the cause of the greatly increased probability that a woman will suffer from one of the rare complications of a medical abortion should she prolong her decision, thus postponing the procedure until the second or third trimester.

Alternatives to parenting are becoming all the time more readily available to those who do not wish to have a child. Incidences of adoption are rising in number, and induced abortions are increasingly effortless to obtain. While medical abortions in the first trimester are becoming more generally accepted, evidence does show the intentional termination of a pregnancy to have physical and psychological consequences. As these procedures are so widely propagated t is every woman’s prerogative to make her own decision after carefully taking into consideration the advantages and disadvantages of terminating her pregnancy.

References

Dudley, S., Kruse, B. (December 2006). Safety of abortion. National Abortion Federation. Retrieved May 22, 2009, from http://www.prochoice.org/about_abortion/facts/safety_of_abortion.html

Guttmacher Institute. (July 2008). Facts on induced abortion in the United States. Retrieved May 18, 2009, from http://www.guttmacher.org/pubs/fb_induced_abortion.html

Healthwise Medical Writer. (September 29, 2008). Abortion – topic overview. WebMD. Retrieved April 10, 2009, from http://women.webmd.com/tc/abortion-topic-overview

Healthwise Medical Writer. (September 29, 2008). Abortion – what to think about. WebMD. Retrieved April 10, 2009, from http://women.webmd.com/tc/abortion-what-to-think-about

Healthwise Medical Writer. (September 29, 2008). Manual and vacuum aspiration for abortion. WebMD. Retrieved April 10, 2009, from http://women.webmd.com/manual-and-vacuum-aspiration-for-abortion#tw1081

Healthwise Medical Writer. (September 29, 2008). Methotrexate and misoprostol for abortion. WebMD. Retrieved April 10, 2009, from http://women.webmd.com/methotrexate-and-misoprostol-for-abortion

Mayo Clinic Staff. (July 25, 2007). Fetal development: what happens during the first trimester? Retrieved May 20, 2009, from http://www.mayoclinic.com/health/prenatal-care/PR00112/METHOD=print

Murkoff, H., Eisenber, A. & Hathaway, S. (2002). What to expect when you’re expecting. New York: Workman Publishing.

National Abortion Federation. (2009). Abortion facts. Retrieved May 22, 2009, from http://www.prochoice.org/about_abortion/facts/index.html

National Right to Life Committee. (2009). Abortion: medical facts. Retrieved April 11, 2009, from http://www.nrlc.org/abortion/index.html

Parents Magazine. (2009). Fetal development. Retrieved May 16, 2009, fromhttp://www.parents.com/pregnancy/stages/fetal-development/


*All images from http://graphicstock.com unless otherwise noted

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