OJOG  Vol.4 No.15 , November 2014
Methods of Abortion in First and Second Trimester
Background: Medical and surgical methods are available for abortions in both the first and second trimester. Aim: To review the evidence base and current recommendations for available methods of abortions in first and second trimesters. Methods: Extensive literature search and review of available guidelines were done. Results: In the first trimester, medical methods are recommended below 7 weeks gestation while vacuum aspiration is an appropriate method between 7 to 12 weeks gestation. In the second trimester, the three methods of abortion available are dilatation and evacuation, intrauterine instillation of abortifacients and administration of systemic abortifacients. Conclusion: The choice of techniques depends on many factors including uterine volume, operator experience, patient preference, medical history and indication for abortion.

Cite this paper
Lim, L. and Singh, K. (2014) Methods of Abortion in First and Second Trimester. Open Journal of Obstetrics and Gynecology, 4, 924-929. doi: 10.4236/ojog.2014.415130.
[1]   Sedgh, G., Singh, S., Shah, I.H., et al. (2012) Induced Abortion: Incidence and Trends Worldwide from 1995 to 2008. The Lancet, 379, 625-632. http://dx.doi.org/10.1016/S0140-6736(11)61786-8

[2]   Singh, K. and Fong, Y.F. (2000) Preparation of the Cervix for Surgical Termination of Pregnancy in the First Trimester. Human Reproduction Update, 6, 442-448. http://dx.doi.org/10.1093/humupd/6.5.442

[3]   Royal College of Obstetricians and Gynaecologists (2011) The Care of Women Requesting Induced Abortion. Evidence-Based Clinical Guideline Number 7, RCOG, London.

[4]   American College of Obstetricians and Gynecologists (2014) Practice Bulletin No. 143: Medical Management of First-Trimester Abortion. Obstetrics & Gynecology, 123, 676-692.

[5]   Swahn, M.L. and Bygdeman, M. (1988) The Effect of the Antiprogestin RU 486 on Uterine Contractility and Sensitivity to Prostaglandin and Oxytocin. British Journal of Obstetrics and Gynaecology, 95, 126-134. http://dx.doi.org/10.1111/j.1471-0528.1988.tb06840.x

[6]   El-Refaey, H., Rajasekar, D., Abdalla, M., et al. (1995) Induction of Abortion with Mifepristone (RU 486) and Oral or Vaginal Misoprostol. The New England Journal of Medicine, 332, 983-987.

[7]   Spitz, I.M., Bardin, C.W., Benton, L. and Robbins, A. (1998) Early Pregnancy Termination with Mifepristone and Misoprostol in the United States. The New England Journal of Medicine, 338, 1241-1247. http://dx.doi.org/10.1056/NEJM199804303381801

[8]   Kulier, R., Kapp, N., Gülmezoglu, A.M., Hofmeyr, G.J., Cheng, L. and Campana, A. (2011) Medical Methods for First Trimester Abortion (Review). Cochrane Database of Systematic Reviews, 11, Article ID: CD002855.

[9]   Schaff, E.A. (2010) Mifepristone: Ten Years Later. Contraception, 81, 1-7.

[10]   Creinin, M.D., Fox, M.C., Teal, S., Chen, A., Schaff, E.A. and Meyn, L.A. (2004) MOD Study Trial Group. A Randomized Comparison of Misoprostol 6 to 8 Hours versus 24 Hours after Mifepristone for Abortion. Obstetrics & Gynecology, 103, 851-859.

[11]   Singh, K., Fong, Y.F. and Dong, F. (2003) A Viable Alternative to Surgical Vacuum Aspiration: Repeated Doses of Intravaginal Misoprostol over 9 Hours for Medical Termination of Pregnancies up to Eight Weeks. BJOG: An International Journal of Obstetrics & Gynaecology, 110, 175-180. http://dx.doi.org/10.1046/j.1471-0528.2003.02225.x

[12]   Jain, J.K., Dutton, C., Harwood, B., Meckstroth, K.R. and Mishell Jr., D.R. (2002) A Prospective Randomized, Double-Blinded, Placebo-Controlled Trial Comparing Mifepristone and Vaginal Misoprostol to Vaginal Misoprostol Alone for Elective Termination of Early Pregnancy. Human Reproduction, 17, 1477-1482. http://dx.doi.org/10.1093/humrep/17.6.1477

[13]   Say, L., Kulier, R., Gülmezoglu, M. and Campana, A. (2005) Medical versus Surgical Methods for First Trimester Termination of Pregnancy. Cochrane Database of Systematic Reviews, Published Online.

[14]   Singh, K. and Fong, Y.F. (2000) Preparation of the Cervix for Surgical Termination of Pregnancy in the First Trimester. Human Reproduction Update, 6, 442-448. http://dx.doi.org/10.1093/humupd/6.5.442

[15]   Dey, M. (2013) Oral Misoprostol Is an Effective and Acceptable Alternative to Vaginal Administration for Cervical Priming before First Trimester Pregnancy Termination. Medical Journal Armed Forces India, 69, 27-30. http://dx.doi.org/10.1016/j.mjafi.2012.07.014

[16]   Singh, K., Fong, Y.F., Prasad, R.N. and Dong, F. (1999) Evacuation Interval after Vaginal Misoprostol for Preabortion Cervical Priming: A Randomized Trial. Obstetrics & Gynecology, 94, 431-434.

[17]   Fong, Y.F., Singh, K. and Prasad, R.N. (1998) A Comparative Study Using Two Dose Regimens (200 Microg or 400 Microg) of Vaginal Misoprostol for Pre-Operative Cervical Dilatation in First Trimester Nulliparae. BJOG: An International Journal of Obstetrics & Gynaecology, 105, 413-417.

[18]   Singh, K., Fong, Y.F., Prasad, R.N. and Dong, F. (1999) Vaginal Misoprostol for Pre-Abortion Cervical Priming: Is There an Optimal Evacuation Time Interval? BJOG: An International Journal of Obstetrics & Gynaecology, 106, 266-269. http://dx.doi.org/10.1111/j.1471-0528.1999.tb08241.x

[19]   Singh, K., Fong, Y.F., Prasad, R.N. and Dong, F. (1998) Randomized Trial to Determine Optimal Dose of Vaginal Misoprostol for Preabortion Cervical Priming. Obstetrics & Gynecology, 92, 795-798. http://dx.doi.org/10.1016/S0029-7844(98)00281-6

[20]   Fong, Y.F., Singh, K. and Prasad, R.N. (1999) Severe Hyperthermia Following Use of Vaginal Misoprostol for PreOperative Cervical Priming. International Journal of Gynecology and Obstetrics, 64, 73-74. http://dx.doi.org/10.1016/S0020-7292(98)00151-9

[21]   Wen, J., Cai, Q.Y., Deng, F. and Li, Y.P. (2008) Manual versus Electric Vacuum Aspiration for First-Trimester Abortion: A Systematic Review. BJOG: An International Journal of Obstetrics & Gynaecology, 115, 5-13. http://dx.doi.org/10.1111/j.1471-0528.2007.01572.x

[22]   Verkuyl, D.A. and Crowther, C.A. (1993) Suction v. Conventional Curettage in Incomplete Abortion. A Randomised Controlled Trial. South African Medical Journal, 83, 13-15.

[23]   Ngo, T.D., Park, M.H. and Free, C. (2013) Safety and Effectiveness of Termination Services Performed by Doctors versus Midlevel Providers: A Systematic Review and Analysis. International Journal of Women’s Health, 5, 9-17. http://dx.doi.org/10.2147/IJWH.S39627

[24]   Stubblefield, P.G., Carr-Ellis, S. and Borgatta, L. (2004) Methods for Induced Abortion. Obstetrics & Gynecology, 104, 174-185. http://dx.doi.org/10.1097/01.AOG.0000130842.21897.53

[25]   Kafrissen, M.E., Schulz, K.F., Grimes, D.A. and Cates Jr., W. (1984) Midtrimester Abortion. Intra-Amniotic Instillation of Hyperosmolar Urea and Prostaglandin F2α v Dilatation and Evacuation. JAMA, 251, 916-919. http://dx.doi.org/10.1001/jama.1984.03340310030014

[26]   American College of Obstetricians and Gynecologists (2013) Practice Bulletin No. 135: Second-Trimester Abortion. Obstetrics & Gynecology, 121, 1394-1406.

[27]   Kapp, N., Borgatta, L., Stubblefield, P., Vragovic, O. and Moreno, N. (2007) Mifepristone in Second-Trimester Medical Abortion: A Randomized Controlled Trial. Obstetrics & Gynecology, 110, 1304-1310. http://dx.doi.org/10.1097/01.AOG.0000289577.32274.a5

[28]   Ashok, P.W., Templeton, A., Wagaarachchi, P.T. and Flett, G.M. (2004) Midtrimester Medical Termination of Pregnancy: A Review of 1002 Consecutive Cases. Contraception, 69, 51-58.

[29]   Wong, K.S., Ngai, C.S., Yeo, E.L., Tang, L.C.H. and Ho, P.C. (2000) A Comparison of Two Regimens of Intravaginal Misoprostol for Termination of Second Trimester Pregnancy: A Randomized Comparative Trial. Human Reproduction, 15, 709-712. http://dx.doi.org/10.1093/humrep/15.3.709

[30]   Dickinson, J.E. and Evans, S.F. (2003) A Comparison of Oral Misoprostol with Vaginal Misoprostol Administration in Second-Trimester Pregnancy Termination for Fetal Abnormality. Obstetrics & Gynecology, 101, 1294-1299. http://dx.doi.org/10.1016/S0029-7844(03)00357-0

[31]   Su, L.L., Biswas, A., Choolani, M., Kalaichelvan, V. and Singh, K. (2005) A Prospective, Randomized Comparison of Vaginal Misoprostol versus Intra-Amniotic Prostaglandins for Midtrimester Termination of Pregnancy. American Journal of Obstetrics & Gynecology, 193, 1410-1414.

[32]   Peterson, W.F., Berry, F.N., Grace, M.R. and Gulbranson, C.L. (1983) Second-Trimester Abortion by Dilatation and Evacuation: An Analysis of 11,747 Cases. Obstetrics & Gynecology, 62, 185-190.

[33]   Embrey, M.P. and Hillier, K. (1971) Therapeutic Abortion by Intrauterine Instillation of Prostaglandins. British Medical Journal, 1, 588-590. http://dx.doi.org/10.1136/bmj.1.5749.588