A medical abortion at 6 weeks of pregnancy

If you are 6 weeks or 42 days pregnant as per the ultrasound and the pregnancy has been localized intrauterine, in general there are two options to get abortion process.

First Option - Medical termination.

• In medical abortion, you will given a set of medicines namely Mifepristone and Misoprostol in a set protocol.
• The medicine will be effective to disallow further growth of pregnancy by stopping the cytotrophoblastic invasion into the endometrium (through Mifepristone) and then initiating uterine contractions and placental separation (through Misoprostol).
• The procedure for drug protocol lasts till max 2000 mcg of Misoprostol has been given in a set protocol till the pregnancy has been aborted.
• The success rates are 93%-96%, but the disadvantage is that it may lead to prolong bleeding for up to two weeks before all the products of conception can be actually aborted.
• Sometimes, the bleeding just continues for long and one may have to resort to surgical curettage to remove the remaining decidua in utero.

2.  Surgical evacuation with suction and evacuation.

• Surgical evacuation is a day care procedure where a suction canal is introduced inside the uterus through the cervix, with patient under anesthesia or a paracervical block and the products of conception are suctioned out completely.
• If I have to suggest you then start with the ultrasound guided procedure, because the success rates of this procedure is 100 percent and major advantage is, you can leave for work after 6 hours (till the anesthesia effect passes of if general anesthesia or after 2 hours in case of post paracervical block).
• The remote chances of Asherman syndrome or intrauterine adhesions have been documented in 1% of women who underwent surgical evacuation where adhesions were formed inside the uterus leading to secondary infertility. But, a controlled, ultrasound guided dilation and curettage under an experienced hand is safe.
• I would suggest her to opt for medical abortion if the pregnancy is unplanned or accidental as this would be a natural way of aborting and moreover pregnancy being less than 7 weeks, can be easily aborted.
• A repeat ultrasound pelvis to check for completion of abortion shall be necessary after the procedure is undertaken. The mild bleeding and discharge may or may not continue for long, it depends from woman to woman.
• If this fails, then of course you have a surgical option to look at. Then you have to completely avoid pregnancy for the next four months of post procedure as that is the time required by uterus and pelvic organs to return back to their pre-pregnant state.