JOURNAL OF WOMEN'S HEALTH Volume 7, Number 8, 1998 Mary Ann Liebert, Inc. Review Update on Early Medical and Surgical Abortion JOHN M. WESTFALL, M.D., M.P.H., ANN O'BRIEN-GONZALES, Ph.D., and GWYN BARLEY, Ph.D. ABSTRACT Abortion is one of the most common surgical procedures in the United States. Recent inno- vations in medicine make early pregnancy termination safe and effective. Our purpose is to review advances in early detection and confirmation of intrauterine pregnancy and discuss medical and surgical techniques for elective termination early in pregnancy. Manual vacuum aspiration is a safe and effective method for pregnancy termination through 10 weeks' ges- tation. Medical abortion using methotrexate or mifepristone with misoprostol is safe and ef- fective for early pregnancy termination through 7 weeks' gestation. INTRODUCTION Half of the nearly 6 million annual preg- nancies in the United States are un- planned.1 As a result, elective abortion is one of the most common surgical procedures in the United States, with an estimated 1.4 million abortions each year. Approximately 45% of all women in the United States will have at least one abortion during their lifetime. Several medical advances allow for abortion very early in pregnancy. The purpose of this article is to provide a current review of early first trimester abortion. Historically, first trimester abortion has been limited to 8-13 weeks of pregnancy. Except for a limited number of practitioners providing menstrual extraction, abortion was not per- formed before the 8th week of pregnancy.2'3 Early pregnancy tests lacked the sensitivity to detect pregnancy before this time, and early transabdominal ultrasonography was not ac- curate enough to confirm and date an in- trauterine pregnancy. With the advent of sen- sitive urine pregnancy tests and transvaginal ultrasound, confirmation of an intrauterine pregnancy can be made reliably at 4 weeks' gestation or within 1 week of the expected on- set of menses.4 There are multiple definitions of abortion, several of which often confuse the issues sur- rounding abortion. Spontaneous abortion, threatened abortion, missed abortion, and in- complete abortion all refer to the involuntary loss of a pregnancy during the first 20 weeks of gestation. Therapeutic abortion is a particu- larly confusing term. For some, therapeutic abortion means an elective abortion; for others, it means abortion for maternal health reasons or fetal anomaly. A better term is elective or in- Department of Family Practice, University of Colorado Health Sciences Center, Denver, Colorado. 991