Abortion [supervised by a physician]

Prenatal diagnosis and abortion

An unavoidable question when undergoing prenatal diagnosis is whether or not to have an abortion in the unlikely event that the result is positive.

It is very important to learn the correct information about abortion in advance and to discuss with your spouse what to do in case of an emergency.

Make sure to study hard so that you don’t panic when that time comes.

What is induced abortion?

Induced abortion is the artificial termination of a pregnancy through surgery.

In Japan, abortion is basically a crime under the penal code, and abortion without permission is prohibited.

In exceptional cases, such as when the mother is in danger, abortion is permitted under the Maternal Protection Act, but the conditions and period under which abortion can be performed are strictly stipulated.

When can you have an induced abortion?

As of July 2021, the period in which abortion can be performed in Japan is limited to 21 weeks and 6 days of pregnancy.

Conditions for induced abortion

As of July 2021, only the following two reasons are recognized as valid reasons for abortion under the Maternal Protection Act.

•   Continuation of pregnancy or childbirth may seriously harm the health of the mother due to physical or economic reasons.
•   Pregnant by assault or intimidation or by adultery while unable to resist or refuse

As of July 2021, abortions based on fetal illness are not permitted, so when abortions are performed based on the results of prenatal diagnosis, economic reasons are most often cited.

Basically, the consent of the woman and her spouse (partner, father of the unborn child) is required for performing an abortion.

Only “designated doctors” designated by the Maternal Protection Act can perform abortions.

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Abortion with oral medication

Previously, the only option for abortion was surgery, but in 2023, the oral abortion drug “Mephigo Pack” was approved by the Ministry of Health, Labor and Welfare.

Regarding efficacy and safety

1. Regarding efficacy,
　in the domestic phase III study, the primary endpoint was that 93.3% (112/120 cases) of subjects successfully induced abortion within 24 hours after administration of misoprostol. This clinical study confirmed the effectiveness of abortion. 

2 Regarding safety,
　the incidence of adverse events in the domestic phase III study was 57.5% (69/120 patients), and the main adverse events were lower abdominal pain (30.0%) and vomiting (20.8%). Serious side effects reported include severe uterine bleeding (0.8%) and infection (incidence unknown). This clinical study evaluated the safety of abortion.

If your pregnancy is less than 9 weeks and 0 days old, you can now have an abortion simply by taking the drug orally. There is a possibility that methods that put less stress on the mother’s body will increase in the future.

Induced abortions can only be performed at medical institutions affiliated with doctors designated by the Maternal Protection Act.
This drug cannot be purchased at pharmacies or on the Internet, as it is sold only through the route of pharmaceutical manufacturers, wholesalers, and registered medical institutions.

Abortion surgery method

The method of induced abortion varies greatly depending on the gestational age.

Abortion in the first trimester involves mechanically removing the fetus from the uterus.

A second-trimester abortion is performed in the same way as a normal delivery.

Neither method will be covered by health insurance.

By the way, in some countries overseas, medical abortion is possible, but in Japan, its use is not allowed due to the risks.

Abortion before 12 weeks of pregnancy

Abortion in the early stages of pregnancy involves a method called uterine evacuation, in which the contents of the uterus, including the fetus, are forcibly removed.

There are two methods: curettage (using a small spoon-like device to scrape out the contents of the uterus) and aspiration (using a suction device to suck out the contents of the uterus).

In both methods, the cervix is ​​opened and the contents of the uterus are removed under intravenous anesthesia.

The surgery usually takes about 10 to 15 minutes.

There is little pain or bleeding, so if you check the progress for a few hours and there are no problems, you can go home the same day.

The cost for an abortion in the early stages of pregnancy is approximately 100,000 to 150,000 yen, including test and surgery fees.

Abortion between 12 weeks and less than 22 weeks of pregnancy

Abortion in the second trimester is performed by a method called induced abortion, in which the cervix is ​​opened, the cervix is ​​opened, and the fetus is forcibly induced by medication to force the delivery of the fetus.

Because it is physically taxing, hospitalization for several days is usually required.

Stillborn fetuses born after the 12th week of pregnancy must be cremated as corpses according to the Cemetery Burial Law.

Therefore, after an abortion, a stillbirth notification and a burial permit are required.

The cost of an abortion in the second trimester is expensive, around 400,000 to 600,000 yen.

This is because in addition to surgery and hospitalization costs, cremation costs are also required.

However, since an abortion in the second trimester is treated as childbirth, you may be entitled to a lump-sum birth allowance (approximately 400,000 yen).

Effects of abortion surgery on the mother’s body

Induced abortion surgery is basically a safe surgery.

Once the surgery is complete and the time is right, your uterus will return to its pre-pregnancy state.

The next period usually comes about a month after the abortion procedure.

However, in rare cases, hormonal balance is disrupted due to complications from the abortion procedure or the mental burden of having an abortion, resulting in infertility.

Complications of the abortion procedure itself

Complications of abortion surgery include the fetus or placenta remaining in the uterus, and uterine perforation, which creates a hole in the uterus.

If the uterus perforates, bacteria may leak into the abdomen and cause peritonitis, which may require emergency surgery.

According to clinical studies, the frequency of these complications is extremely rare.

How abortion affects subsequent pregnancies

Complications from an abortion can affect subsequent pregnancies.

However, the probability of complications occurring is extremely low, and unless there are major complications during surgery, there is almost no chance of becoming infertile.

However, even if there are no complications, adhesions occur after multiple abortions, which in rare cases can cause infertility.

Relationship between prenatal diagnosis and abortion

As the number of children born at older ages increases, the number of children born with congenital diseases is also increasing.

In particular, the incidence of autosomal numerical abnormalities, mainly Down syndrome (trisomy 21) , increases dramatically when the mother’s age is over 40, so the number of people undergoing prenatal diagnosis is also increasing significantly.

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Types of prenatal diagnosis

Prenatal diagnosis includes non-invasive tests such as NIPT (New Prenatal Diagnosis) and invasive tests (definitive diagnosis) such as amniocentesis and chorionic villus biopsy. Clinical studies have examined in detail the effectiveness and timing of these testing methods.

Generally, NIPT (New Prenatal Testing) can be performed from 10 weeks and 0 days of pregnancy, but if it is determined that there is a high possibility of a congenital disease, a definitive diagnosis such as amniocentesis is recommended.

However, amniocentesis can only be performed after 15 to 16 weeks of pregnancy, and chorionic villus analysis can only be performed after 11 to 14 weeks of pregnancy, both of which cannot be performed until the second trimester.

However, at Hiro Clinic, we currently perform NIPT from approximately 6 weeks into pregnancy (when pregnancy is confirmed by ultrasound examination). By getting results faster you will have more time to decide how to proceed.

It is also important to note that amniocentesis and chorionic villus testing themselves have a 0.2 to 1% chance of miscarriage. Clinical studies have provided detailed information about these risks. 

Percentage of people who choose abortion based on prenatal diagnosis results

According to a tally compiled by the NIPT Consortium, a joint research organization that conducted clinical research on new prenatal diagnostic tests, 142 (1.8%) of the 7,740 people tested in the one year period starting April 2013 were found to have chromosomal abnormalities. Tested suspiciously positive.

Of these, 113 had chromosomal abnormalities confirmed by amniocentesis.

As a result, 110 out of 113 women (97%) chose induced abortion.

It has been announced that two of the remaining three children had miscarriages, and the other child was found to have Down syndrome , but they decided to give birth.

Check prenatal diagnosis results by 21 weeks pregnant

After the 22nd week of pregnancy, it is called the third trimester.

During this period, abortions requested by pregnant women are no longer legally recognized, and abortions will only be performed if it is determined that the fetus cannot be saved no matter what method is used.

Therefore, if there is a possibility that you may choose to have an abortion based on the results of your prenatal diagnosis, you should check the results of your prenatal diagnosis by 21 weeks and 6 days at the latest.

New prenatal diagnosis and abortion

If you use NIPT (New Prenatal Testing), you can check the results within 12 weeks of pregnancy, so it is possible to perform an abortion in the early stages of pregnancy, which is less stressful for the mother.

However, the accuracy of NIPT (New Prenatal Testing) is lower than that of amniocentesis, so there is a risk of losing a fetus that might otherwise have tested negative through abortion.

Consider abortion when undergoing prenatal diagnosis

An increasing number of people are undergoing prenatal diagnosis for reasons such as giving birth at an older age or having siblings with chromosomal disorders.

Most people who undergo prenatal diagnosis also consider aborting the baby if it has a chromosomal abnormality.

To avoid panicking after the results come out, your husband and wife should discuss in advance what they will do in the event of a positive test and have a plan in mind.

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