Overview

Canada

In Canada, legally, abortion can occur up to the point of birth. abortions are provided 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 anomalies.

History

Abortions were made illegal in 1869. From 1926-1947, 4000-6000 women died of illegal abortions in Canada. In 1969, abortions were decriminalized under restrictive conditions. In 1988, the 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.

In 1989, Bill C-43 was introduced to amend criminal code prohibiting abortion unless threat to women's physical, mental health. It was passed by House of Commons but defeated by Senate.

Medical Abortions

• 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

Manual vacuum aspiration and menstrual extraction

• can be done in physican's office up to 7 weeks
• uses a large syringe with a special cannula
• up to 12% failure rate
• critical to ensure chorionic villi/gestational sac removed

Machine Vacuum Aspiration

• up to 12 weeks
• gold standard and most common
• outpatient procedure
• done under local anaesthetic with cervical block and sometimes sedation
• cervix dilated to appropriate size
• suction machine used to empty uterus: 6-10 minutes
• tissue examined to ensure completeness
• patient observed 30-60 minutes

Dilatation and Evacuation

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

• 1-2 days osmotic dilation of the cervix required
• instruments used to remove fetal parts

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