Reproductive Health Counseling & Pregnancy Testing

Pregnancy testing is a simple urine test that shows if a woman is pregnant. Pregnancy test for a hormone called human chorionic gonadotropin (HCG). HCG is released when a fertilized egg attaches to the lining of the uterus. HCG will be in a woman’s body if she is pregnant. You can either take a home pregnancy test or visit Expectations Women’s Center for a complimentary test. Home pregnancy tests are sold in most drugstores. If you take a home pregnancy test, it’s important to follow all of the instructions on the package. The results will be either positive — meaning pregnant — or negative — meaning not pregnant. Our pregnancy tests are accurate 99 out of 100 times, so the results are immediate and accurate. Health care providers can also test if you are pregnant by testing your blood. Blood pregnancy testing is rare and done only when a urine test is inconclusive.

You can take a pregnancy test as soon as your period is late. Be aware that tests become more accurate as you get closer to the date of your expected period. They are most effective once you have already missed your period. Only you can decide what is best for you when it comes to pregnancy. We are here to help and simply listen. A mentor or counselor can talk with you about all of your pregnancy-related concerns.

The method used depends on how long you have been pregnant – the number of days since the first day of your last period.

First Trimester Abortions Manual Vacuum Aspiration- MVA (Up to 10 weeks) Dilation and Suction Curretage- D&C (6-14 weeks)

Both methods use suction to remove the fetus and other products of conception from the uterus (womb). For very early surgical abortions, a manual syringe may be used. Otherwise, machine-operated suction is used. During the procedure the cervix or neck of the uterus must first be opened in order to accomplish the abortion. In the first 12 weeks of pregnancy, this is generally accomplished by sequentially inserting tapered rods of increasing width called “dilators.” Usually, the cervix needs to be opened no more than 1/4″-1/2″ in the first trimester. This can be done with anywhere between 1 to 8 dilator insertions, depending on the stage of the pregnancy and the resistance of the individual cervix, and will cause cramping (much like menstrual cramps). Once the cervix has been adequately dilated, the fetus is removed by inserting a hallow plastic tube called a “vacurette” and applying suction. Generally, the plastic tube is moved in and out or is rotated to enhance the suction force at the tip of the vacurette. This is sometimes followed by curetting (scraping) the walls of the uterus to ensure that no fetal tissue or parts are left behind that might cause subsequent problems.

Second Trimester Abortions Dilation and Evacuation- D&E (13-26 weeks)

Abortion performed in the middle months of pregnancy is a significantly different procedure from the first trimester. The procedures used require greater time and skill and entail somewhat greater risk. The essential difference is that the cervix must be dilated to increasing diameters as the fetus grows. The extent to which the cervix can be safely dilated with dilators varies, dependent upon the woman’s cervix. Most experienced physicians will avoid the use of mechanical dilators beyond the 14th week of pregnancy; some will avoid them after the 10th week. As a general rule, the method of choice for dilating the cervix beyond the 12th week involves the use of osmotic dilators. Osmotic dilators are stalks of material which absorb water and expand once placed inside the cervix, they are inserted and left overnight (this will cause cramping). The next morning, the cervix will have dilated and softened. The fetus and placenta are removed in parts with forceps. Suction is then used to scrape the uterus to ensure that no fetal parts remain. Sharp curettage may or may not be performed as a final step. This type of abortion is performed under sedation combined with local anesthesia.

* After 24 weeks of pregnancy, abortions are usually performed only for serious health reasons.

Possible Complications Following Surgical Abortions:

• Infection
• Incomplete abortion
• Heavy bleeding
• Damage to the uterus or nearby internal structures
• Cervical tears
• Continued pregnancy

(Up to 9 weeks, or 63 days)

Currently, the three drugs used for early non surgical abortions are Methotrexate, Mifepristone (formerly known as RU- 486) and Misoprostol. In this procedure, either Methotrexate or Mifepristone is taken first and Misoprostol is taken in a follow-up visit.

Methotrexate is a drug approved by the FDA for the treatment of cancer and certain chronic diseases. When being administered to induce an abortion, Methotrexate is given to the woman in the form of an injection or shot, the dose of which is determined by the woman’s height and weight. Methotrexate halts the implantation process that occurs during the first several weeks after conception. The most common side effects of a single dose include nausea, diarrhea, cramping and/or sores in the mouth. Less often, vomiting, headaches, dizziness, sleeplessness, and/or vaginal bleeding may occur.

Another medication that may be used is Mifepristone. Mifepristone was developed and tested specifically as an abortion-inducing agent. Mifepristone is taken orally, and works by blocking the hormone progesterone that is necessary to sustain pregnancy. Without progesterone, the lining of the uterus breaks down, the cervix softens, and bleeding begins.

With the use of either Methotrexate or Mifepristone, a second drug, Misoprostol, is administered in a follow-up visit. It is given as a single dose in the vagina (by suppository) 5-7 days after taking Methotrexate or 2 days after taking Mifepristone. Misoprostol acts on the uterus to create contractions and bleeding, similar to those of a spontaneous abortion or “miscarriage.” When taken after abortion-inducing drugs, it causes the uterus to expel the fetus. The contractions usually occur 2 to 4 hours after insertion of the suppositories. Heavy bleeding is expected at times, followed by severe abdominal cramps. Generally, cramping will be milder after the fetus has been expelled. The fetus and fetal tissue may be expelled at an unexpected time or place.

For most women who take the Mifepristone regimen, the abortion will be complete within four hours of taking Misoprostol. For others, bleeding begins in 24 hours. The whole process can take a week. About 50% of women who take the Methotrexate regimen have the abortion on the same day they take Misoprostol. For another 35-40%, it happens within a week. The whole process can take up to 14 days. A follow-up appointment is necessary to make sure that the abortion is complete and that there is no risk of infection. If the abortion was not complete, a surgical abortion must be performed to ensure that all the fetal tissue has been removed. U.S. trials of Mifepristone indicate that 2 in 25 women will have to follow up their medical abortion with a surgical abortion (Spitz, Irving, et al., New England Journal of Medicine, 1998).