A 19-year-old woman presents for elective termination of pregnancy at 8 weeks’ gestation. She previously had regular menses every 28 days. Pregnancy is confirmed by β-human chorionic gonadotropin (β-hCG), and ultrasound confirms expected gestational age.
Which of the following techniques for termination of pregnancy would be safe and effective in this patient at this time?
A. Dilation and evacuation (D&E)Surgical abortion is a safe and effective method for pregnancy termination, with a serious complication rate in the first trimester of less than 1%. It is the most common form of termination for pregnancies less than 14 weeks. Outpatient medical abortion is a safe and acceptable alternative to surgical abortion in select women with pregnancies less than 10 weeks’ gestation. Three medications have been used. These are: mifepristone (antiprogestin), methotrexate (antimetabolite), and misoprostol (prostaglandin). Various regimens have been found to be effective. Usually mifepristone or methotrexate is initially administered followed by misoprostol. Intra-amniotic injection of hypertonic saline is no longer used regularly, because it has a much higher incidence of serious complications, including death, hyperosmolar crisis, cardiac failure, peritonitis, hemorrhage, and coagulation abnormalities. D&E is a surgical procedure similar in concept to a D&C. However, instead of curettage (scraping) to remove the products of conception, various forceps are placed into the uterine cavity to remove the products of conception. D&E is performed for termination of later pregnancies, generally those in the second trimester. Hysterotomy is a surgical procedure in which the uterus is opened transabdominally and the contents evacuated. It is a procedure done for termination of more advanced pregnancies when all other methods of termination are unsuccessful or contraindicated.