Abortion. - Preparation and counselling

Abortion Preparation

History

Most abortions are performed after your health care professional takes a brief and targeted medical history. You will be asked questions about prior pregnancies and any treatment or care during the current pregnancy. You will be asked about any diseases or conditions that affect your reproductive organs, such assexually transmitted infections.

The health care professional will ask whether you have a history of diabetes,high blood pressure, heart disease,anemia, bleeding disorders, or surgery (on your ovaries or uterus, for example). If you have active medical problems, you may need to be stabilized before an abortion or have the procedure performed in a facility that can handle special medical problems.

• If there are known problems with the fetus, such as severe brain abnormalities that will either not allow the fetus to live, and if these problems are known through diagnostic testing, the woman may choose to end the pregnancy with abortion.

• The most common problems with the fetus encountered in abortion counseling include major system development failures and problems that cannot be repaired dealing with the heart, nervous system, spine, brain, abdomen, kidneys, and breathing and digestive systems.

Physical

A brief physical examination is usually performed before an abortion. The focus is on determining when your pregnancy began and checking for sexually transmitted disease and whether you are healthy enough to undergo the procedure.

Lab tests

Pregnancy tests are used to confirm that you are pregnant. Home tests are reliable, so providers will accept these results in some cases. Blood will be tested forsexually transmitted diseases and forhepatitis. Urine may be checked to see if you have a urinary tract infection.

Imaging studies

An ultrasound is virtually always dome for pregnancy confirmation and dating. Doctors are looking for how many fetuses may be developing, the size of the fetus or fetuses, a picture of the uterus and ovaries, and to rule out a problem such as an ectopic pregnancy (a life-threatening condition in which the fetus develops outside the uterus).

Medications

Your health care professional may give you antibiotics as a precaution against infection. Antibiotic use for the procedure is usually given the day of the procedure and for the next day or two.

Abortion Counseling

Most abortion counseling focuses on the decision-making process, the options for continuing the pregnancy, medical issues of the pregnancy, information regarding the pregnancy itself, full disclosure of the risks of continuing the pregnancy to deliver a baby, information and options for the abortion procedure, and, finally, information regarding a birth control decision. The risks and benefits of both medical and surgical abortions are often reviewed.

• The counseling process is aimed primarily at the woman herself but may also include other people she chooses to be involved. Studies indicate that men are involved in more than 40% of the decisions, but only scant research has been performed on male involvement in the process. Some women can reach a decision quickly. Others take longer to decide. The counseling process may provide referrals if you need ongoing support.
• You should not feel pressured to make a decision. Take time to consider your options.
• During the counseling, you may be asked questions designed to encourage meaningful discussion of the issues as they pertain to you. You will have many emotions. Counseling may take a day or longer.

Some state laws may apply to the counseling process. Some states have mandatory waiting times between the information session and the actual abortion. Other states require family or parental notification, and some states mandate that certain subjects be covered during abortion counceling.

Explanation of the Procedures

Once your pregnancy has been confirmed, and the doctor knows how many weeks along the pregnancy is, and you have decided to end the pregnancy, the procedure offered typically reflects your stage of gestation. Early abortions can be accomplished medically or surgically, but most facilities do not have the protocols established or personnel with the technical ability to offer medical abortions (with pills). Therefore, most abortions are performed surgically.

• Women often travel far for their abortion procedure and feel comfortable completing the preoperative preparation in a short office visit. In states where laws require waiting periods, this can be done in stages.
• The assessment process involves only a targeted history, physical examination, laboratory work, and ultrasound (including dating of the pregnancy, if indicated) followed by a counseling session.
• Second-trimester abortion preparation is more difficult. Preparing the cervix in less than 24 hours is almost impossible, but the basic assessment process is identical.
• Ultrasound examinations may be used to look specifically for obvious problems with the fetus.
• Some centers also offer an intra-amniotic injection of the drug digoxin, which stop heart activity in the fetus before a second-trimester abortion.