Pregnancy Termination

History of Abortions in Canada

abortions were made illegal in 1869
from 1926-1947, 4000-6000 women died of illegal abortions in Canada
1969 - abortions decriminalized under restrictive conditions
1970-1976 - Morgentaler's charges, convictions, and eventual dropping of charges
1988 - Supreme Court ruled that abortion's illegality violated the Charter of Rights and Freedoms by infringing on a woman's right to life, liberty and security
1989: C-43 introduced to amend criminal code prohibiting abortion uless threat to women's physical, mental health
- passed by House of COmmons in 1989 but defeated by Senate

Right now it is abortion on demand; some provinces require physican referral
Services are provided up to 16 weeks in hospitals and up to 20 weeks if there are genetic/congenital anomolies
if provinces don't fund abortions, the feds will hold transfers
in New Brunswick, only funded if performed by a gynecologist, with two physician referrals
legally, abortion can occur up to the point of birth

abortions are preferable under 24 weeks for non-lethal chromosomal abnormalities
if there is a lethal abnormality, they will go at any time

usually offered only up to 7 weeks
in Canada, methotrexate used as one dose IM or orally; misoprostol (PGE1) given 5-7 days later
76% complete within 12 hours, 15-20% complete in 1-3 weeks
require followup, 5% need surgical evacuation
side effects include pain from contractions, nausea, vomiting, diarrhea, occasionally heavy bleeding
can be done from 7-9 weeks, but higher failure rate; suction curettage usually used

RU-486 (Mifepristone) more efficatious than MTX; also followed by misoprostol day 1-3
not licensed for use in Canada, but clincial trials are underway
requires reliable follow-up

12-16 weeks

classically a 2 day procedure, with day one being an osmotic dilator placed in the cervix
- treatment with misoprostol makes it a one day procedure
machine suction then used

16-x weeks

can also inject fetus (intracardiac or intraamniotic) with saline or urea to kill it
labour can then be induced with misoprostol, PGE2, or syntocinon
requires hospital admissionand has higher complicationrate than D and E