PREGNANCY TERMINATION

What is abortion?

An abortion is the medical process of ending a pregnancy so it does not result in the birth of a baby.

It is also sometimes known as a 'termination' or a 'termination of pregnancy'. This is different to “miscarriage” as the latter is the natural loss or end of the pregnancy.

 

What does the Greek law about abortions state?

In Greece, abortion is permitted under specific circumstances. The Penal Code (article 304) allows abortion (induced termination of pregnancy) only after the woman's consent and only conducted by a qualified obstetrician- gynecologist with the participation of an anesthesiologist in an organised medical unit in case of:

  • All pregnancies in the first 12 weeks of gestation.
  • Pregnancies up to 19 weeks, if the pregnancy was a result of rape, seduction of minor, consanguination or abuse of a powerless to resist woman.
  • Pregnancies up to 24 weeks of gestation, if there are serious indications of a fetal anomaly that will have as a consequence the birth of an abnormal baby.
  • Without any time restriction, if there is inevitable danger of the woman's life or danger of serious and permanent physical or mental health injury injury, certified by a specialised physician.

 

How is an abortion done?

Depending on how many weeks you have been pregnant, the pregnancy is ended either by taking medication or by having a surgical procedure.

Before the abortion

When you go for your first appointment, we will discuss about your situation. You'll be informed about the different methods of abortion, and which method is suitable for your stage of pregnancy. You will also be advised about any related risks and complications.

We will then take your medical history to make sure the type of abortion you are offered is suitable for you. You'll have a blood test to find out your blood group to see if you're anaemic. If there is any genital infection, you may also need to be treated beforehand in order to avoid a womb infection.

Before having an abortion, you may also need to have:

  • an ultrasound scan (if there is any doubt about how many weeks pregnant you are)
  • a vaginal (internal) examination
  • a cervical screening test for infections (if appropriate)

In case you are interested, we may also discuss about which method of contraception to use after the abortion.

 

What are the various methods of abortion?

There are a number of different methods of abortion. The method recommended for you will depend on how many weeks pregnant you are, any reasons excluding the use of one method and your personal preferences. The gestational week is usually calculated either by counting the number of weeks from the first day of your last period or by the estimation of your week by ultrasound. Broadly speaking there are two types of abortion – medical and surgical. A medical abortion is carried out using medication while a surgical abortion involves a minor operation.

 

Early medical abortion (earlier than nine weeks of pregnancy)

An early medical abortion involves taking two different medicines 24-36 hours apart. The effect of the medication will be similar to having an early natural miscarriage – this means you will have some bleeding and some pain when the abortion happens.

In details, the first medicine that needs to be taken is mifepristone, a substance that blocks progesterone, the hormone that keeps the inner lining of the womb fertile. After taking the first tablet, you will be able to go home and continue your normal everyday activities.

Very little will happen while you are waiting for the second part of the treatment. A few women will have mild cramps and a little bleeding, but most will not. If you have heavier bleeding or significant pain, you should contact us immediately.

After approximately 36 hours, you will have to take the second medication, a prostaglandin. Within four to six hours of taking prostaglandin, your womb lining will break down and be lost, along with the embryo, through bleeding from your vagina. This part of the process can be painful, but you can take painkillers. Medicines used during an early medical abortion may make you feel sick and you may have diarrhoea.

 

Vacuum aspiration or suction termination (from seven to 14 weeks of pregnancy)

Vacuum aspiration, or suction termination, is a procedure that uses gentle suction to remove the foetus from the womb. The procedure usually takes five to 10 minutes and can be carried out under light sedation.

Your cervix (opening of the womb) will be dilated (widened) to make accessing your womb easier. To ease the process, medication will be given to you a few hours before the abortion to soften your cervix and make it easier to open. Afterwards, a small, suction tube connected to a pump will then be inserted into your womb and used to remove the foetus and surrounding tissue.

After having a vacuum aspiration abortion, you will usually be able to go home the same day. You need to know that you will have some bleeding for several days (and in a few cases for a few weeks). Bleeding usually lasts for 10 days and is more severe the first two to three days before settling down. Some women only bleed for three to four days in total. You may experience mild or moderate cramps for which you can take simple painkillers.

 

Late medical abortion (from nine to 20 weeks of pregnancy)

As well as being used for early abortion (before 9 weeks), mifepristone and prostaglandin can also be used for abortion later in pregnancy. However, the abortion will take longer and more than one dose of prostaglandin may be needed. This type of abortion is similar to having a late natural miscarriage. After having a late medical abortion, you will usually be able to return home on the same day. However, the more advanced the pregnancy is, the more common is severe bleeding and staying overnight to the clinic to happen. Similarly increased is the risk for the placenta not to pass. In this case, you may need to have a small operation under a general anaesthetic to remove the placenta. In general, in the second trimester, the medical method causes more complications than the surgical one.

 

Surgical dilation and evacuation (from 15 weeks of pregnancy)

Surgical dilation and evacuation (D&E) is a procedure carried out under mild general anesthesia. Cervical preparation is useful here as well, so the process becomes easier.Your cervix will be gently stretched and dilated and forceps and a suction tube will be used to remove the foetus and tissue within the womb.

This process usually takes 10-20 minutes to perform and, if you are feeling well, you may be able to return home the same day. If thought safer, we will advise you to stay overnight in the clinic. As with vacuum aspiration, you may experience some bleeding for up to a few weeks.

 

Late abortion (20-24 weeks)

When the pregnancy is so advanced, staying overnight in the clinic is necessary. Moreover, when the pregnancy has exceeded 22 weeks, fetocide has to be performed because otherwise, the fetus would have been born alive.

Medically induced abortion. This is similar to a late natural miscarriage and involves administration of the medicine, prostaglandin which provokes contractions of the womb (as in labour). Contractions can last six to 12 hours. When the fetus is expelled, D&E most probably will be used to ensure the womb is completely empty.

Surgical abortion. In the second trimester, complications are more frequent with the medical method than the surgical one. In the surgical method, the cervix has to be prepared beforehand so that the risk of injury minimises. Subsequently, the cervix will be gently stretched and the fetus will be gently removed using forceps and a curette to scrape the inner lining of the womb. Suction might be used as well. The curette is used in order to make sure that no pregnancy tissue is left behind. If possible, intact expulsion of the fetus is preferable, so no instruments are used. Curettage then follows.

 

When should I seek medical assistance?

You should contact us immediately if, after having an abortion, you:

  • experience heavy bleeding
  • are in severe pain
  • have a high temperature

An abortion is not the same as a miscarriage, which is where the pregnancy is lost or ends naturally. The loss starts without medical intervention, although medical or surgical treatment may be needed after a miscarriage has started to help empty the womb.

 

Why an abortion may be needed

There are many reasons why a woman might decide to have an abortion, including:

  • personal circumstances, including risk to the wellbeing of existing children
  • a health risk to the mother than poses her to life risk.
  • a high chance the baby will have a serious abnormality/ handicap, either genetic or physical

Generally, an abortion should be carried out as early in the pregnancy as possible, usually before 12 weeks and ideally before 9 weeks where possible.

 

What are the risks of having an abortion?

No clinical procedure is entirely risk free, but abortion poses few risks to a woman's physical health, particularly when carried out as early as possible in the pregnancy (preferably during the first 12 weeks). Having an abortion will not usually affect your chances of becoming pregnant and having normal pregnancies in future. The risk of complications occurring during an abortion is low. But increases the later it is done.

The risks associated with abortions are:

  • haemorrhage (excessive bleeding), that occurs in about one in every 1,000 abortion
  • damage to the cervix (the entrance of the womb) that occurs in less than 1 in every 100 abortions
  • damage to the womb (including the formation of adhesions), that occurs in up to four in every 1,000 abortions during surgical abortion, and less than one in 1,000 medical abortions.

Psychological impact

Pregnancy termination is a very difficult choice for every woman that has to take that decision. The abortion experience, understandably, is stressful, unsettling and unpleasant. Feelings experienced during the decision and actual abortion time, vary widely. Sometimes, in the long term, feelings of sadness, regret and guilt may ensue. Every woman that chooses to terminate a pregnancy, should decide having weighed the circumstances and facts before. Having done so, will ensure that she will be certain that she made the best choice.