Medical abortion

Mifepriston (Mifegyne®) combined with misoprostol (Cytotec®) is the treatment option that is usually chosen in the Netherlands for women who opt for the ‘abortion pill’. Up to a gestational age of 9 weeks and 0 days of amenorrhoea, women can choose between the abortion pill and suction curettage. The physician will, however, be the one who makes the ultimate decision as to whether or not a woman is suited for the abortion pill. 

The gestational age will be established at the clinic through an ultrasound scan. If the woman has complied with the mandatory cooling-off period stipulated by law, she can be administered the abortion pill immediately after the consultation with the physician. This means that the woman will take Mifegyne® at the clinic and be given 4 tablets of Cytotec® for her to administer vaginally 2 days later. Mifegyne® generally causes little to no side effects. This drug is a competitive progesterone receptor blocker that ensures in 96% of cases that the products of conception stop growing. It also elevates sensitivity to prostaglandins. Cytotec® is a synthetic analog of prostaglandin E1 that triggers uterine contractions that lead to foetal expulsion.   

Potential side effects include gastrointestinal discomfort, shivering, and severe blood loss. An analgesic that the woman could take is NSAID.  

The abortion pill is often compared to spontaneous abortion. Medical abortion may involve more cramps and blood loss than after suction curettage. 

 

Suction curettage

Suction curettage is available as an abortion option up to 12-13 weeks of amenorrhoea. The woman can choose between a local anaesthetic or full sedation. Suction curettage is a procedure where the cervical canal is dilated slightly to be able to insert a disposable plastic curette that is used to remove the products of conception and subsequently curette the uterus. As a result, there is generally little blood loss after the procedure. The procedure takes around 10 to 15 minutes. Prior to the procedure, the cervix is primed using prostaglandins.  

If the woman has opted for sedation, she will not be allowed to drive a car or ride a motorcycle or bike for 24 hours.  

  

The Zanzu website contains extensive information for women about medical abortion and suction curettage. 

 

Dilation & Evacuation (D&E) with prostaglandin priming  

If the pregnancy is further along than 12-13 weeks of amenorrhoea, the D&E procedure is used to abort the pregnancy. D&E is a method where the products of conception are removed surgically, followed by a curettage of the uterus. To create sufficient access for the surgical instruments, this procedure, too, requires priming of the cervix with prostaglandins. Gynaikon Klinieken performs this procedure up to a biparietal diameter (BPM) of 42mm. 

If the woman has opted for sedation, she will not be allowed to drive a car or ride a motorcycle or bike for 24 hours. 

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Local anaesthetic or sedation 

If a women opts for a local anaesthetic, she will get a (para)cervical block, not an epidural. If the woman is tense, the procedure may be experienced as painful.  

Sedation is administered by registered anaesthetists. If the woman has undergone a procedure under sedation, she will not be allowed to drive a car or ride a motorcycle or bike for 24 hours.