Abortion

Introduction

Abortion is a term connoting the termination of pregnancy that leads to the mortality of the embryo or the fetus. An abortion can either be spontaneous or induced(Podell, 1990). Spontaneous abortions, also universally referred to as miscarriages, often occur without any interventions(Gnad& Post Abortion Trauma Healing Service Charitable Trust, 2008). Embryos aborted through this method are frequently abnormal and are expelled through the body’s natural processes. Nevertheless, research shows that there is a linkage between spontaneous abortions and occupational exposure to chemicals and bacteria agents (Lindbohm et al.,1991, p 1029-1033). A case in point is the relationship between total mercury levels in hair of exposed females and accounts of menstrual cycle disorders and reproductive failure. Findings of human and animal studies conducted in the past indicate that the toxicity effects of chemicals such as ethylene oxide, which is often used as sterilizers in hospital settings, result in homeostatic imbalance during pregnancy(Rowland et al.,1996, p 363-368). As a result, nurses who handle antiseptic drugs at some stage in the first pregnancy trimester record higher rates of fetal loss. Studies conducted in laboratory animal research reinforce these conclusions. In point of fact, solvents like benzene and its products are verified disrupters of homeostasis and have demonstrated spontaneous abortions in rabbits. Other solvents, including methylmercuric chloride, lead to chromosome stickiness, clumping in fetal tissues, and reduced mitotic divisions which further triggerincreased thepost-implantation loss.

On the other hand, induced abortions involve deliberate termination of pregnancies by disruption of homeostatic balance,either for birth control or therapeutic purposes(Tietze, 1983).Birth control abortions make a larger part of induced abortions and are often a counteractionagainst unplanned pregnancies. In therapeutic abortion procedures, physicians terminate the pregnancy to save the mother’s life or to eliminate a grossly abnormal embryo. Most abortions conducted in the course of the first three months of pregnancy (first trimester abortions) are carried out by administering drugs that discontinue the pregnancy and induce the ejection of the embryo. For instance, the drug RU-496 (mifepristone) attaches competitively to progesterone receptors in the uterus without activating them(Brooks, 1993, p 261). This inhibits the normal functions of the progesterone which results in the breakdown ofendometrium and uterine contractions. Physicians can also execute abortions by use of a suction method; this involves the dilation of the cervix and subsequent evacuation of the embryo along with other contents by use of a suction aspirator.

As much as there are many legal issues concerning abortion, there are also numerous biological complications surrounding it. The central focus lies on disruption of the body’s homeostasis with regard to hormonal balance, normal menstrual functioning, and organ functioning.Notably, abortion disrupts the normal adaptation of the body to pregnancy, which is part of the body’sstandard homeostatic balance.This alterationresults in various tissue adjustments, metabolic changes, and adverse consequential outcomes(Johnstone, 2001). The following section will explore several organs that abortion is likely to affect as well as how they are disturbed.

Background

Abortion and procedures of abortion affect various parts of the body including vital structures and tissues(Tortora & Derrickson, 2015). For example, chemical abortions have, in the past, resulted inhemorrhage and distortion of undiagnosed ectopic pregnancieswhile surgical ones have led to endometritis, sepsis, pelvic inflammatory disease, uterine and bladder perforations, cervical lacerations, as well as other infections related to the female reproductive system. Altogether, these complications are bound to adversely distress the following organs:

Cervix

Abortions, especially induced ones, can potentially cause cervical damages and shock. Induced abortions often involve dilation of the normally-tightly-closed cervix to launchthe suction cannula and other instruments into the uterus. This weakens the cervix and may lead to preterm labor and miscarriages brought about by the preceding pressure and weight during a future pregnancy’s progression. Although the cervix may not show any damages, theinjury is usually microscopic, often ranging from minor tears of the cervical muscle to serious injuries of the uterine wall. Other effects include cervical laceration,cancer, and incompetence. These are often a result of the unnatural disruption of hormonal changes that accompany pregnancy and abortion.

Ovaries

Abortion often causes the development of womb infections which may adversely affect the normal functioning of the ovaries. In such cases, the organs are damaged and may fail to function normally in future. Repeated abortions also increase risks of ovarian cancer in old age(Gnad& Post Abortion Trauma Healing Service Charitable Trust, 2008).

Uterus

Common injuries inflicted on the uterus by abortion involve uterine perforations. In fact, between 2% and 3% of all abortion patients experience perforations. However, unless physicians perform laparoscopic visualization, many of these injuries often remain undiagnosed(Gnad& Post Abortion Trauma Healing Service Charitable Trust, 2008). Uterine damage results to complications in future pregnancies, the need to perform ahysterectomy, worse medical conditions like osteoporosis, where the patient suffers brittle and fragile bones, and loss of tissue from the preceding hormonal changes.

Other organs

Abortions are occasionally accompanied by a septic shock. This occurs due to sudden changes in the body and, particularly, low blood pressure. Besides leaving the body susceptible to the infection, abortion with septic shock can lead to organ failure(Gnad& Post Abortion Trauma Healing Service Charitable Trust, 2008). Typical complications affect kidneys, lungs, liver, and the heart, and can lead to fatalities. Abortions can also result in other multifaceted complications resulting from a series of reactions that offset the process of homeostasis. For example, long-term effects of spontaneous and induced abortions can leadto nonalcoholic fatty liver disease, according to Liu et al. (2013, p119-123).

Mechanism of Action

Many complications that shape adverse aftermaths of abortion are a result of disruption of homeostasis. This may involve one or more of the six homeostatic systems of the body: electrolytic, metabolic, immune, endocrine, circulatory, and nervous systems. Although all these systems are involved in one way or another, themajority ofmaternal physiological changes that are extensive in pregnancy are usually metabolic, renal, cardiovascular, respiratory, and hematologic. These bodily adjustments by the mother play a big role in accommodating the fetus and the embryo, as well as ensuring that each is well provided for depending on the stage of pregnancy(Brewer, 2011).

Changes of the endocrine system are particularly vital to the survival of the fetus or the embryo. During pregnancy, endocrine glandsenlarge, and the following hormones begin to have major effects on the body: relaxin, progesterone, and estrogen. First, Relaxin reduces uterine activity to protect the fetus. Second, progesterone reduces the muscle tone to prevent the expulsion of the uterus and its contents. Andthird, estrogen initiates enlargement of breasts for lactation and growth of the uterus to accommodate the baby. Hence,any toxin that gets into thebloodstream of the mother and affects the balance of these hormones lead to disruption of their function, and subsequently, and abortion. Many drug-induced abortions interrupt the normal functioning of hormones, which leads to a miscarriage(Brewer, 2011).

Other systems that increase or improve functioning to accommodate the needs of the fetus are respiratory, cardiovascular, and urinary. Although the space in the lungs decreases to accommodate the uterus, lung function amplifies by up to 40% to 50% to compensate for the extra requirements of the fetus. Similarly, the heart function increases by 40% to 50% to increase the amount of blood needed to carry nutrients and oxygen to the fetus(Brewer, 2011). The heart, in turn, gets bigger to cope with the workload. Similarly, metabolic functions accelerate to meet the requirements of the growing uterus.Disruption of these mechanisms can lead to decreased transportation of nutrients leading complications and eventual abortion.

Symptoms, Diagnosis, and Treatment

Symptoms of an impending miscarriage or a threatened abortion include vaginal bleeding during early stages of pregnancy.Common symptoms include loss of pregnancy symptoms, lower back pains, abdominal cramp, passing clots, and positive/negative pregnancy tests. Some of these symptoms might continue to manifest even after the abortion.

Physicians often carry out a variety of tests for diagnosis including chromosomal tests, tissue tests, ultrasound, blood tests, and pelvic exams. Chromosomal tests are carried out when a person has had previous miscarriages in the past. Here, both the woman and the man are involved in testing. In tissue and blood tests, the doctor might look for the level of pregnancy hormones and compare the results to earlier measurements. Abnormal patterns of change in the presence ofhuman chorionic gonadotropin (HCG) and cases of passed tissueoften indicate the likelihood ofabortion (Chartier et al., 1979, p 134-137). Inultrasound diagnosis, the healthcare provider measures and detects the presence of the embryo’s heartbeat to determine if there is normal growth. Failure of the first tests may result to another one in the next seven days. Lastly, pelvic exams involve the examination of the cervix to test for dilation.

Possible diagnosis include (1) threatened abortion, where bleeding occurs but the cervix does not show any signs of dilation, (2)inevitable abortion,where cases of bleeding, cramping, and cervical dilation are evident, (3) incompleteabortion,where the woman passes part of the fetal material while the rest is left in the uterus, (4) missed miscarriage, where a dead embryo or embryonic tissues remain in the uterus, (5) complete miscarriage, where all the pregnancy tissue has been passed, and (6) septic miscarriage, where the uterus develops infections (Ankum et al.,2001, p 1343-1346). Treatment options dependon thediagnosis. Many cases of abortion are not treatable, however, and only include treatment of the side effects. For example, complete miscarriages, missed miscarriages, incomplete abortions, inevitable miscarriages, and some cases of all other diagnosis are not treatable. Common treatment options include medical therapy to prevent infections, surgery, prehospital and emergency care, as well as monitoring of activity and diet.

Prevalence

Although medical reporting of abortion is not entirely reliable because of stigma, surveys have shown that it is much prevalent in the modern-day society compared to the 19th century. In recent years, however, the number of abortions has remained stable globally. In 2003,the number of abortions was 41.6 million likened to 2008’s figure of 43.8 million. (Sedgh, 2012, p 625-632). The abortion percentage between the two periods was 21%. Incidence was smaller in developing countries (20%) compared to that of developed countries (26%).

In the U.S., there were just over 660,000 abortions reported to Centers for Disease Control and prevention (CDC) from 49 reporting areas in 2013 alone. The abortion rate was 12.5/1000 women between the ages of 14-20 years among Americans in the same year. Compared the previous years, the rate decreased by 5% whilethe number of overall abortions decreased from 20% to 17% from2004 through2013.While 22% of all abortions were medically induced, themajoritywere carried out by women in their 20s during early periods of gestations.

On a global scale, the prevalence of abortion is averagely similar in countries with liberal access to abortion and those with restrictive abortion laws(Sedgh et al., 2007, p 1338-1345). Nevertheless, stringent abortion regulations are frequently related to increased incidences of unsafe abortions.  Although the rates vary broadly with geographic locations, statistics are more often than not deemed scientifically incomplete (Sedgh et al., 2007, p 1338-1345).The most universally reported reason for abortion is family planning (Cleland, 2006, p 1810-1827). The second one encompasses socio-economic concerns like the disruption of employment and education, poverty, lack of support from the other parent, unemployment, and inability to provide for the additionalnewborns. Moreover, relationship problems can lead to the mother opting for abortion to end any ties with the father (Sheldon, 2003, p 175-194). The logic behind higher prevalence in young women links to women’s varying characteristics of age. With few exceptions older females are less likely to point out ‘limitation of childbearing’ as the motive for abortion.


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