Medication vs. Surgical Abortion: Safety and Concerns

Please explain the differences between medical abortion and surgical abortion?

Yesterday, we confirmed my girlfriend's pregnancy at the hospital.
The doctor mentioned that the embryo is very small, so small that there are two shadows on the ultrasound and they couldn't confirm which one is which.
However, they did confirm that she is pregnant, but they didn't specify how many weeks along she is.
The doctor asked if we wanted to proceed with the pregnancy, but we had already discussed that this is not the right time for us.
My girlfriend is also worried about her family finding out, and although she is unmarried, she is over twenty.
She has done some research online about medical abortion and surgical abortion methods.
The doctor mentioned that we could return on Wednesday to confirm and that she could take medication for a medical abortion.
Since we are both over twenty, we want to ensure that we go to a qualified physician and hospital.
However, my girlfriend has previously been diagnosed with iron deficiency anemia, and she is very concerned about whether it is safe to undergo a medical abortion.
Is there a higher risk of complications, such as sudden heavy bleeding or fainting? If we opt for a surgical abortion, is it generally safer? The doctor said the embryo is too small to confirm; can you estimate how many weeks along it might be? The doctor used an invasive ultrasound rather than a transabdominal one.
Additionally, what is the cost difference between the two procedures? We are also worried about the possibility of a medical abortion being incomplete, which would require surgery and could cause more harm to her body.
We hope to minimize any potential harm.
Thank you for your answers, doctor.

Lan Tu, 20~29 year old female. Ask Date: 2015/11/14

Dr. Lin Wenbin reply Obstetrics and Gynecology

1.
Medical abortion does not necessarily result in heavier bleeding.
If there are any abnormalities, including bleeding issues, some physicians may consider switching to surgical abortion.
Other physicians may have a higher tolerance and prefer to continue with medical abortion, as surgery also carries risks such as anesthesia complications, which may lead to increased bleeding.
However, physicians generally prioritize safety.
Therefore, it is essential to discuss your options with your physician, as different approaches can yield different outcomes.

2.
The cost also depends on the hospital's policies.
Generally, elective abortions are not covered by health insurance.
Charges vary from one hospital to another.
Insurance coverage for abortion is limited to situations where the pregnancy cannot continue or when there are dangerous symptoms such as bleeding.
3.
The gestational age must be assessed through an ultrasound examination to determine its size accurately.
Please consult a physician for this evaluation.

Reply Date: 2015/11/14

More Info

When considering the options for terminating a pregnancy, it's essential to weigh the safety and potential risks associated with both medication (medical abortion) and surgical abortion. Each method has its own advantages and disadvantages, and understanding these can help you and your girlfriend make an informed decision.

Medical Abortion (Medication Abortion)
Medical abortion typically involves taking two different medications: mifepristone and misoprostol. This method is generally safe and effective, especially in the early weeks of pregnancy (up to 10 weeks). However, since your girlfriend has been diagnosed with iron deficiency anemia, there are specific considerations to keep in mind:
1. Risk of Heavy Bleeding: One of the primary concerns with medical abortion is the potential for heavy bleeding. Women with anemia may already have a lower blood volume, which can make them more susceptible to complications from significant blood loss. It's crucial for her to be monitored closely during this process, and she should have access to medical care if she experiences excessive bleeding.

2. Symptoms to Watch For: If your girlfriend experiences severe cramping, heavy bleeding (soaking through two or more pads in an hour), dizziness, or fainting, she should seek immediate medical attention. These could be signs of complications that need to be addressed promptly.

3. Follow-Up Care: After a medical abortion, a follow-up appointment is usually necessary to ensure that the abortion is complete. If there are any remnants of the pregnancy tissue, a surgical procedure may be required to remove it, which can increase the risk of complications.

Surgical Abortion
Surgical abortion is another option that can be performed through various methods, such as suction aspiration or dilation and curettage (D&C). Here are some points to consider:
1. Safety and Efficacy: Surgical abortion is generally considered safe and can be performed up to 24 weeks of pregnancy, depending on local laws and regulations. It is often quicker and may be preferred if there are concerns about incomplete abortion with medication.

2. Less Risk of Heavy Bleeding: For women with anemia, surgical abortion may pose a lower risk of heavy bleeding compared to medical abortion, as the procedure is performed in a controlled environment with immediate access to medical intervention if complications arise.

3. Confirmation of Gestational Age: Since your girlfriend's pregnancy is still early and the doctor mentioned uncertainty about the gestational age, a follow-up ultrasound may be necessary to determine how far along she is. This information is crucial for deciding the appropriate method of abortion.

Cost Considerations
The cost of medical versus surgical abortion can vary significantly based on location, healthcare provider, and whether insurance covers the procedure. Generally, medical abortions may be less expensive than surgical ones, but this can depend on the specific circumstances and healthcare facilities involved.

Conclusion
Ultimately, the decision between medical and surgical abortion should be made collaboratively between your girlfriend and her healthcare provider, considering her medical history, current health status, and personal preferences. Given her iron deficiency anemia, it may be prudent to discuss the potential risks of medical abortion with her doctor and consider the surgical option if there are significant concerns about her health and safety.

It's essential to ensure that she receives care from qualified healthcare professionals who can provide the necessary support and monitoring throughout the process. Open communication with her healthcare provider will help address any concerns and ensure that she feels safe and informed about her choices.

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