Gestational age The number of weeks of pregnancy that has lapsed since the first day of the last menstrual period (LMP). This is not a literal calculation since pregnancy actually starts at the time of conception but is common terminology.
Surgical abortion refers to the procedure performed by a doctor to remove the pregnancy from the uterus. It does not actually involve any cutting or sewing. In early pregnancy the cervix (opening of the uterus) is enlarged with small metal dilators and the abortion is done by vacuum aspiration. The procedure is completed in 10 – 15 minutes. In later pregnancies (typically after 12 weeks) cervical dilation may require insertion of passive dilators (over-night) or use of a prostaglandin medication.
Medical abortion An abortion performed by a series of medications which cause the pregnancy to stop growing and then be expelled from the uterus without instrumentation by a physician. Most commonly medications used are RU486 (Mifiprex) and misoprostol (Cytotec).
Ectopic pregnancy A pregnancy that has implanted outside of the uterus. Usually in the fallopian tube.
Early second trimester abortion (13-14 weeks) Vacuum aspiration or D&E. Requires more cervical dilation than first trimester vacuum aspiration.
D&E short for Dilation and Evacuation. This is the procedure used for abortions after the 13th week of gestation when the pregnancy is too far to be removed by vacuum and the doctor removes the pregnancy with special uterine forceps.
Late second trimester abortion (19-24 weeks) D&E
D&X short for Dilation and Extraction. A procedure whereby a fetus is removed from the uterus intact. For situations in which the fetus needs to be examined by a pathologist or by the skeletal dysplasia registry for purpose of accurate diagnosis of an abnormality. Details of this procedure will be discussed in person by the doctor on an individual basis.
Abortion after the second trimester For cases of fetal abnormalities. Available only with referral from a perinatologist or maternal-fetal-medicine specialist. Dr Seletz is one of the few doctors in the United States who has experience doing these procedures.
Prostaglandin A class of medications which cause softening of the cervix and uterine contractions. The most commonly used prostaglandin in the United States is a synthetic prostaglandin called misoprostol (Brand name Cytotec)
Laminaria Rods or tents the size of a toothpick or a large matchstick (6 cm long, 4 mm diameter). Laminaria are osmotic which means they enlarge slowly over several hours as they absorb moisture from the body. For safe cervical dilation, multiple laminaria are placed the day before an early second trimester abortion or on two sequential days for later second trimester or third trimester abortions. Laminaria are either synthetic or are naturally occurring seaweed from the sea of Japan or the sea of Norway. They are sterilized for medical use.
Local anesthesia for abortion is a paracervical block. (Paracervical = around the cervix). This is similar to what a dentist gives when working in your mouth. An injection of lidocaine is given through the vagina to numb the nerves which supply the cervix. The pros of an abortion under local are that the patient may drive herself for the procedure as the local does not cause sedation. The cons are that there is no effect on anxiety and that the injection does not numb the vagina so pressure of the speculum is not diminished at all. This type of anesthesia is better tolerated in women who have already experienced natural childbirth.
Speculum An instrument used by obstetricians and gynecologists to keep the vaginal walls open so that visualization and instrumentation of the uterine cervix is possible. Many women find this uncomfortable.
Ultrasound is a form of imaging commonly used in obstetrics and gynecology for the past 30 years. It allows the physician to visualize the uterus, the ovaries, and the fetus. Measurements taken with ultrasound is the most accurate way to determine gestational age.
LMP Last Menstrual Period. Prior to the advent of ultrasound, medical professionals determined gestational age by the LMP since most women knew the first date of their last period but did not know the date of conception. This terminology is still in common use. That is why gestational age is still calculated by the LMP instead of ultrasound measurement. The LMP is usually 2 weeks prior to the date of conception. Many women do know the date of conception and are puzzled why we refer to a pregnancy as 6 weeks if they conceived 4 weeks prior. If a woman has irregular menstrual cycles, was on depo-provera, or is post-partum then the LMP does NOT accurately coincide with the gestational age and the gestational age needs to be adjusted. Also, some women experience some uterine bleeding even though they are already pregnant and mistake this bleeding for a menstrual period so are actually father along than the LMP would indicate
RU486/abortion pill- first patented in France which blocks the effect of the hormone progesterone. In the United States this medication is patented as Mifeprex. This is the first of two medications that are typically used for the medical abortion. Also known as ‘the abortion pill’. It is not the same medication used for emergency contraception. RU486 causes interference with placental attachment in the uterus and is not effective if the pregnancy is ectopic.
Methrotrexate A drug which interferes with the action of folic acid. Used to treat early ectopic pregnancy.
Cervix The part of the uterus which opens into the vagina. The cervix is part smooth muscle and part elastic tissue. Labor is all about getting the cervix to open. The cervix dilates to 10 cm during labor to allow expulsion of the fetus. For an early first trimester abortion dilation to 8 mm ( 0.3 inch diameter) is sufficient. This can be accomplished with small metal dilators in less than a minute. More advanced pregnancies require more dilatation. In general, the cervix becomes easier to dilate after a woman has had a full term vaginal birth and may be more difficult to dilate is she has had prior cervical procedures such as cryotherapy, laser, or LEEP – common procedures done for abnormal Pap smears. Some women are born with a very small cervical opening. In order to achieve safe and adequate cervical dilation, preparation with either prostaglandin medication and/or laminaria is required for most pregnancies over 12 weeks gestation. The further along in pregnancy, the more cervical dilation is required. Attempting to mechanically dilate the cervix very quickly can result in serious complications. My first mentor used to say “The cervix is sovergn.”