1. Medical Abortion
A medical abortion involves taking medications to terminate a pregnancy. This method is usually offered up to 10–12 weeks of gestation, depending on local laws and medical guidelines.
Medications Used:
Mifepristone:
- Blocks the hormone progesterone, which is necessary to maintain the pregnancy.
- Causes the uterine lining to break down, detaching the embryo or fetus.
Misoprostol:
- Taken 24–48 hours after mifepristone.
- Induces uterine contractions, expelling the pregnancy tissue.
hCG Monitoring in Medical Abortion:
Before the Procedure:
- Baseline hCG levels are measured to confirm pregnancy and estimate gestational age.
- Ultrasound may be used alongside hCG levels for more precise dating.
After the Procedure:
- hCG Decline: hCG levels should decrease by at least 80–90% within 7–14 days.
- A follow-up visit typically occurs 1–2 weeks after the abortion to confirm completion using either:
- hCG testing: Blood or urine tests can confirm declining levels.
- Ultrasound: Confirms that the uterus is empty.
Incomplete Abortion:
- If hCG levels decline slowly or plateau, it may indicate retained pregnancy tissue, requiring additional doses of misoprostol or surgical intervention.
2. Surgical Abortion
Surgical abortion involves a procedure to remove the pregnancy from the uterus. It is typically performed during the first or second trimester, depending on gestational age and circumstances.
Methods Used:
- Manual Vacuum Aspiration (MVA):
- A handheld suction device is used to empty the uterus.
- Performed up to 12–14 weeks of pregnancy.
- Dilation and Curettage (D&C):
- A surgical instrument is used to scrape the uterine lining.
- Often used in first-trimester or early second-trimester abortions.
Dilation and Evacuation (D&E):
- Combines suction and surgical instruments to remove pregnancy tissue.
- Used for second-trimester abortions (13–24 weeks).
hCG Monitoring in Surgical Abortion:
Before the Procedure:
- hCG levels confirm pregnancy.
- Ultrasound is often used to determine gestational age and rule out complications like ectopic pregnancy.
After the Procedure:
- In most cases, no further hCG monitoring is required if the abortion is performed by a skilled provider and complications are absent.
- Follow-up is recommended only if symptoms like heavy bleeding, fever, or persistent pregnancy signs occur.
Retained Tissue:
- Rarely, some pregnancy tissue may remain, causing hCG levels to decline slowly. This can result in persistent bleeding or infection and may require additional intervention.
Key Differences in hCG Management Between Medical and Surgical Abortion
Aspect | Medical Abortion | Surgical Abortion |
Initial hCG Testing | Often required to confirm eligibility and baseline. | Used mainly to confirm pregnancy. |
Follow-up Testing | Necessary to ensure hCG levels decline sufficiently. | Rarely needed unless complications arise. |
Monitoring Timeline | hCG levels monitored over 1–2 weeks. | Typically no prolonged hCG tracking required. |
3. Other Considerations
Ectopic Pregnancy:
- An ectopic pregnancy occurs when a fertilized egg implants outside the uterus, often in the fallopian tubes.
- hCG levels rise more slowly than in a normal pregnancy and may not double every 48–72 hours.
- Medical or surgical intervention is necessary to manage the condition, and hCG levels are closely monitored until they return to zero.
Molar Pregnancy:
- A molar pregnancy is a rare complication where abnormal tissue grows inside the uterus instead of a normal pregnancy.
- hCG levels are unusually high and persist after the tissue is removed.
- Long-term monitoring ensures no malignant tissue remains.
Self-Managed Abortion:
- For women managing abortion outside clinical settings, monitoring hCG levels can help confirm completion.
- Home urine pregnancy tests can detect residual hCG, but they are less precise than blood tests.
Key Points for hCG Monitoring
- hCG levels should decline steadily after a successful abortion or miscarriage.
- Persistent or slowly declining levels may indicate retained tissue, ectopic pregnancy, or ongoing pregnancy.
- Follow-up care is essential to prevent complications and ensure complete resolution.
