Abortion

1. Abortion An abortion is the termination of a pregnancy by the removal or expulsion from the uterus of a fetus/embryo, resulting in or caused by its death.

2. What is Abortion? • An abortion can occur spontaneously due to complications during pregnancy or can be induced, in humans and other species. • In the context of human pregnancies, an abortion induced to preserve the health of the gravid (pregnant female) is termed a therapeutic abortion, while an abortion induced for any other reason is termed an elective abortion. • The term abortion most commonly refers to the induced abortion of a human pregnancy, while spontaneous abortions are usually termed miscarriages.

3. Spontaneous abortion • Spontaneous abortion (also known as miscarriage) is the expulsion of an embryo or fetus due to accidental trauma or natural causes before approximately the 20th week of gestation; the definition by gestational age varies by country. • Most miscarriages are due to incorrect replication of chromosomes; they can also be caused by environmental factors. • A pregnancy that ends before 37 weeks of gestation resulting in a live-born infant is known as a "premature birth". • When a fetus dies in utero after about 20 weeks, or during delivery, it is usually termed "stillborn". Premature births and stillbirths are generally not considered to be miscarriages although usage of these terms can sometimes overlap.

4. Miscarriage • Between 10% and 50% of pregnancies end in clinically apparent miscarriage, depending upon the age and health of the pregnant woman. • Most miscarriages occur very early in pregnancy, in most cases, they occur so early in the pregnancy that the woman is not even aware that she was pregnant. One study testing hormones for ovulation and pregnancy found that 61.9% of pregnancies were lost prior to 12 weeks, and 91.7% of these losses occurred without the knowledge of the once pregnant woman. • The risk of spontaneous abortion decreases sharply after the 10th week from the last menstrual period (LMP).One study of 232 pregnant women showed "virtually complete [pregnancy loss] by the end of the embryonic period" (10 weeks LMP) with a pregnancy loss rate of only 2 percent after 8.5 weeks LMP. • The most common cause of spontaneous abortion during the first trimester is chromosomal abnormalities of the embryo/fetus, accounting for at least 50% of sampled early pregnancy losses. Other causes include vascular disease (such as lupus), diabetes, other hormonal problems, infection, and abnormalities of the uterus.Advancing maternal age and a patient history of previous spontaneous abortions are the two leading factors associated with a greater risk of spontaneous abortion. A spontaneous abortion can also be caused by accidental trauma; intentional trauma or stress to cause miscarriage is considered induced abortion or feticide.

5. Induced abortion • A pregnancy can be intentionally aborted in many ways. The manner selected depends chiefly upon the gestational age of the embryo or fetus, which increases in size as it ages.[Specific procedures may also be selected due to legality, regional availability, and doctor-patient preference. Reasons for procuring induced abortions are typically characterized as either therapeutic or elective. An abortion is medically referred to as therapeutic when it is performed to: • save the life of the pregnant woman; • preserve the woman's physical or mental health; • terminate pregnancy that would result in a child born with a congenital disorder that would be fatal or associated with significant morbidity; or • selectively reduce the number of fetuses to lessen health risks associated with multiple pregnancy. • An abortion is referred to as elective when it is performed at the request of the woman "for reasons other than maternal health or fetal disease."

6. Abortion methods • Medical • Surgical • Other

7. Medical Abortions • "Medicalabortions" are non-surgical abortions that use pharmaceutical drugs, and are only effective in the first trimester of pregnancy. Medical abortions comprise 10% of all abortions in the United Statesand Europe.Combined regimens include methotraxate or mifepristone, followed by a prostaglandin (either misoprostol or gemeprost: misoprostol is used in the U.S.; gemeprost is used in the UK and Sweden.) • When used within 49 days gestation, approximately 92% of women undergoing medical abortion with a combined regimen completed it without surgical intervention.

8. Surgical Abortions • In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method.Manual Vacuum aspiration (MVA) abortion consists of removing the fetus or embryo, placenta and membranes by suction using a manual syringe, while electric vacuum aspiration (EVA) abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. MVA, also known as "mini-suction" and "menstrual extraction", can be used in very early pregnancy, and does not require cervical dilation. • Surgical techniques are sometimes referred to as 'Suction (or surgical) Termination Of Pregnancy' (STOP). From the 15th week until approximately the 26th, dilation and evacuation (D&E) is used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction.

9. Vacuum Aspiration

10. Surgical Abortions • Dilation and curettage (D&C), the second most common method of abortion, is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. Curettage refers to cleaning the walls of the uterus with a curette. The World Health Organization recommends this procedure, also called sharp curettage, only when MVA is unavailable. • Other techniques must be used to induce abortion in the second trimester. Premature delivery can be induced with prostaglandin; this can be coupled with injecting the amniotic fluid with hypertonic solutions containing saline or urea. After the 16th week of gestation, abortions can be induced by intact dilation and extraction (IDX) (also called intrauterine cranial decompression), which requires surgical decompression of the fetus' head before evacuation. IDX is sometimes called "partial-birth abortion," which has been federally banned in the United States. A hysterectomy abortion is a procedure similar to a caesarean section and is performed under general anesthesia. It requires a smaller incision than a caesarean section and is used during later stages of pregnancy. • From the 20th to 23rd week of gestation, an injection to stop the fetal heart can be used as the first phase of the surgical abortion procedureto ensure that the fetus is not born alive.

11. Other Methods • Historically, a number of herbs reputed to possess abortion properties have been used in folk medicine: tansy, pennyroyal, black cohosh. The use of herbs in such a manner can cause serious—even lethal—side effects, such as multiple organ failure, and is not recommended by physicians. • Abortion is sometimes attempted by causing trauma to the abdomen. The degree of force, if severe, can cause serious internal injuries without necessarily succeeding in inducing miscarriage. Both accidental and deliberate abortions of this kind can be subject to criminal liability in many countries. In Southeast Asia, there is an ancient tradition of attempting abortion through forceful abdominal massage. One of the bas reliefs decorating the temple of Angkor Wat in Cambodia depicts a demon performing such an abortion upon a woman who has been sent to the underworld. • Reported methods of unsafe, self-induced abortion include misuse of misoprostol, and insertion of non-surgical implements such as knitting needles and clothes hangers into the uterus. These methods are rarely seen in developed countries where surgical abortion is legal and available.

13. Health Risks and Considerations • Early-term surgical abortion is a simple procedure which is safer than childbirth when performed before the 16th week. • The APA revised and updated its findings in August 2008 to account for the accumulation of new evidence, and again concluded that induced abortion did not lead to increased mental health problems. • A 2008 review by a group from the Johns Hopkins Bloomberg School of Public Health concluded that the highest quality studies found few, if any, mental health differences between women who had abortions and their comparison groups, whereas studies with the most flaws reported negative mental health consequences of abortion.al health is an area of controversy.

14. Health Risks and Considerations • Pain and/or cramping • Nausea • Vomiting • Diarrhea • Reaction to local anesthetic • Infection – many physicians prescribe antibiotics to prevent infections, serious infection occurs in 3% of women • Heavy Bleeding – 1-2% of women will have serious bleeding (more than a normal menstrual period) • Continued Pregnancy – may occur if pregnancy is tubal or ectopic (a fertilized egg has implanted outside the uterus), requires major surgery • Retained Tissue – requires a repeat of the suction procedure • Perforation or puncture of the uterus – rare, but requires surgical repair • Sterility – very rare, may occur due to serious infection, bleeding, or damage to the uterus • Death – extremely rare

15. Abortion Laws- Pennsylvania • ILLEGAL: • 1) Failure to obtain informed consent of woman; (2) failure to meet standards for legal abortion; (3) using any means to cause the death of an unborn child but not meaning use of intrauterine device or the birth control pill; (4) solely for the reason of the child's sex; (5) without making diagnosis of gestational age; (6) use of public funds, facilities, or officials

16. PA LAWS • Except for medical emergency, physician must give information to mother at least 24 hours before abortion; if mother under 18 years and not emancipated, both mother's and one parent/guardian's informed consent required-court may authorize M.D. to perform abortion. If the woman is married, she must provide signed statement that she has notified her spouse of the abortion (Spousal consent found unconstitutional in Planned Parenthood of Southeastern Pennsylvania V. Casey, but remain in PA's statute nonetheless)

17. Federal Abortion Law • Roe v. Wade • The 1973 Supreme Court decision in Roe v. Wade made it possible for women to get safe, legal abortions from well-trained medical practitioners. This led to dramatic decreases in pregnancy-related injury and death. • The Roe case arose out of a Texas law that prohibited legal abortion except to save a woman's life. At that time, most other states had laws similar to the one in Texas. Those laws forced large numbers of women to resort to illegal abortions. • Jane Roe, a 21-year-old pregnant woman, represented all women who wanted abortions but could not get them legally and safely. Henry Wade was the Texas Attorney General who defended the law that made abortions illegal. • After hearing the case, the Supreme Court ruled that Americans' right to privacy included the right of a woman to decide whether to have children, and the right of a woman and her doctor to make that decision without state interference.

18. Abortion laws in the United States prior to Roe vs. Wade  RED  Illegal.  PURPLE Legal in cases of rape.  BLUE Legal in cases of danger to woman's health.  GREEN Legal in cases of danger to woman's health, rape or incest, or likely damaged fetus. YELLOW Legal

19. The U.S. Supreme Court has ruled that the term "partial-birth abortion" in the act pertains to a procedure that is medically called intact dilation and extraction. Under this law, "Any physician who, in or affecting interstate or foreign commerce, knowingly performs a partial-birth abortion and thereby kills a human fetus shall be fined under this title or imprisoned not more than 2 years, or both." The law was enacted in 2003, and in 2007 its constitutionality was upheld by the U.S. Supreme Court.

20. Reasons for abortions • In 2000, cases of rape or incest accounted for 1% of abortions. • Another study, in 1998, revealed that in 1987-1988 women reported the following reasons for choosing an abortion: • 25.5% Want to postpone childbearing • 21.3% Cannot afford a baby • 14.1% Has relationship problem or partner does not want pregnancy • 12.2% Too young; parent(s) or other(s) object to pregnancy • 10.8% Having a child will disrupt education or job • 7.9% Want no (more) children • 3.3% Risk to fetal health • 2.8% Risk to maternal health • 2.1% Other

21. Reasons for LATE abortions • According to a study that included specific data about late abortions (i.e. abortions “at 16 or more weeks' gestation”), women reported that various reasons contributed to their having a late abortion: • 71% Woman didn't recognize she was pregnant or misjudged gestation • 48% Woman found it hard to make arrangements for abortion • 33% Woman was afraid to tell her partner or parents • 24% Woman took time to decide to have an abortion • 8% Woman waited for her relationship to change • 8% Someone pressured woman not to have abortion • 6% Something changed after woman became pregnant • 6% Woman didn't know timing is important • 5% Woman didn't know she could get an abortion • 2% A fetal problem was diagnosed late in pregnancy • 11% Other

22. POLLS

23. COSTS • The cost of an abortion varies depending on factors such as location, facility, timing, and type of procedure. In 2005, a nonhospital abortion at 10 weeks’ gestation ranged from $90 to $1,800 (average: $430), whereas an abortion at 20 weeks’ gestation ranged from $350 to $4,520 (average: $1,260). Costs are higher for a medical abortion than a first-trimester surgical abortion.

24. Abortion Clinics • Found through www.plannedparenthood.com • Pittsburgh • Allentown • Philadelphia • Buffalo, NY • Cleveland, OH

25. Pro Life • http://www.youtube.com/watch?v=BYRpIf2F9NA • http://www.youtube.com/watch?v=s_W75zh1j2I&feature=related • http://www.youtube.com/watch?v=UTJes1rHQ30&feature=related • http://www.youtube.com/watch?v=th6Njr-qkq0

26. Pro-Choice • http://www.youtube.com/watch?v=qHzn2pNzijw • http://www.youtube.com/watch?v=y4SaD-fEwJs&feature=related • http://www.youtube.com/watch?v=lsknXsm2eHo&feature=fvw