Clinical Practice
A Request for Abortion
Allan Templeton, M.D., and David A. Grimes, M.D.
N Engl J Med 2011; 365:2198-2204December 8, 2011
A 22-year-old student presents to her primary care physician with an unintended pregnancy at 9 weeks of gestation and requests an abortion. She is aware of both medical (drug-induced) and surgical methods of terminating a pregnancy and wants to know which approach would be recommended. She also asks whether either method will affect her future reproductive health. What would you advise?
The Clinical Problem
Induced abortion is one of the most common medical interventions. In the United States, approximately 1.2 million abortions were performed in 2008.1 In the United Kingdom, more than 200,000 abortions are recorded annually.2,3 About one of three women will have had an induced abortion by the time she reaches menopause.
Approximately 90% of abortions are performed in the first trimester because the pregnancy is unintended or unwanted. A small but important proportion (1 to 2%) of abortions are performed later because of a fetal abnormality (e.g., anencephaly, trisomy, or myelomeningocele)4 or serious illness (e.g., cancer or pulmonary hypertension) in the woman.
Until recently, the main method of abortion was surgical, but since 1992 in the United Kingdom and since 2000 in the United States, medical abortion has become increasingly available. Medical abortion involves the combined use of the progesterone antagonist RU-486 (now known as mifepristone), which initiates the abortion, and a prostaglandin, which causes uterine contractions and empties the uterus.5 Of all abortions, medical abortions account for approximately 10% in the United States, 40% in England, and 70% in Scotland. (Figure 1)
Cont. >> http://www.nejm.org/doi/full/10.1056/NEJMcp1103639?query=BUL
