Medical vs. surgical abortion

OB/GYN News, April 15, 2005 by Hans Freistadt

The principal advantage of medical abortion over the surgical procedure is that it is performed in a physician's office and offers a greater guarantee of privacy ("Limit Medical Abortions," Letters, Feb. 15, p. 6).

This issue is so important to some women that a slight increase in risk would be acceptable. The need for privacy, as opposed to intramural pregnancy or large cervical fibroids, is the main reason why medical abortion is used. Unfortunately, the guarantee of privacy is not always absolute. If the doctor has his own ultrasound equipment, that is probably enough to follow the patient post abortion. Otherwise, at least two quantitative HCG tests will be needed and will thus involve a laboratory technician. However, a woman belonging to a prolife church group, who, without any formal change in her intellectual position, feels that she simply must abort her accidental pregnancy, would feel more exposed at an abortion clinic than in the doctor's office.

As for surgical abortion, which Dr. E. Hakim-Elahi extols, it is usually safe. So is medical abortion, but it also has its risk--chiefly perforation, which if unrecognized may have catastrophic consequences. There also are cases of infection, excessive bleeding, and hematometrium (the "redo" syndrome). Surgical abortion, when done in a clinic with 10 cc's of local anesthesia, is generally very painful, though only for a short period of time. In-hospital surgical abortion under general anesthesia is not widely available, although it is part of my own practice.

Medical abortion by the methotrexatemisoprostol method is probably safer and more reliable than the commonly used mifepristone. I appreciate Dr. HakimElahi's concern about possible storage of methotrexate in kidney and liver tissue. However, this objection is largely theoretical. To my knowledge, there is not a single case of deformity in a subsequent pregnancy associated with the methotrexate-misoprostol technique.

In my private practice, I prefer surgical abortion under general anesthesia or at least heavy sedation with complete intracervical block, as being more definitive and probably less traumatic to the patient than the medical procedure. However, women are fortunate to have the medical alternative available, especially by the methotrexate-misoprostol technique, for the sake of privacy and secondarily for convenience and economy.

Hans Freistadt, M.D.

Oroville, Calif.