| Method | Advantages | Disadvantages and Side Effects |
|---|
| First-Trimester Procedures |
| Early uterine evacuation (EUE)—aspiration of endometrium through undilated cervix | - Performed for women who have not yet missed a menstrual period
| - Cervical trauma may occur and may lead to incompetent cervix
|
- 100% effective if implantation site is not missed
| |
 RU 486 (mifepristone)—a progesterone antagonist; taken up to 7 weeks’ gestation (56 days LMP); taken orally | - Prevents implantation of fertilized egg
| - Slight nausea and fatigue during period of bleeding
|
- Most effective in early gestation, during luteal phase, within 10 days of first missed period
| |
| Misoprostol (Cytotec)—initiates uterine contractions; given intravaginally | - Softens cervix and aids in expelling products of conception
| |
| Uterine aspiration (vacuum or suction curettage)—cannula suction under local anesthesia, following cervical dilatation, usually with laminaria tent | - Relatively few complications—minimal bleeding, minimal discomfort
| - Performed after one or two missed menstrual periods
|
| - Cervical or endometrial trauma possible
|
| Surgical dilation and curettage (D & C)—cervix dilated with laminaria tents; endometrium scraped with metal curette or flexible aspiration tip, under local anesthesia (paracervical block) | - After cervix is dilated, procedure takes about 15 minutes
| - Performed after one or two missed periods
|
| - Possible but rare; cervical trauma, uterine perforation infection, hemorrhage
|
- Relatively few complications (≤1%): bleeding like a heavy period, some cramping
| |
| Second-Trimester Procedures |
| D & E (dilation and evacuation)—extends D & C and vacuum curettage up to 20 weeks’ gestation | Woman does not experience labor | Requires 3 days for laminaria to dilate cervix; procedure done on third day |
| Second- and Third-Trimester Procedures |
| Hysterotomy—cesarean delivery | - Available for gestations more than 14–16 weeks
| - After: major surgery complications—hemorrhage and infection possible
|
- Preferred method if woman wishes a tubal ligation or hysterectomy to follow
| - Fetus may be born alive, causing ethical, moral, religious, and legal problems
|