Surgical Abortion

 

What is it?

A surgical abortion empties the contents of your uterus and is usually performed within 12 to 14 weeks from your last normal menstrual period (first-trimester). However, the procedure can be done up to 20 weeks (mid-trimester). The procedure involves "vacuum aspiration" of the contents of the uterus.

What happens before the abortion?

  • Your doctor may do a pelvic exam and ultrasound before the procedure to help determine the stage of your pregnancy.

Will it be done in the clinic?

The decision of whether the abortion will be performed in a clinic depends on your medical history, a physical exam, lab tests, and the stage of the pregnancy. Most clinics will perform abortions up to 14 weeks. An alternative is to have it done in a hospital. Hospital abortions need a referral from a doctor.

How is it done?

The standard method is vacuum aspiration (also called suction curettage). Usually, a local anaesthetic (freezing) is used, but sometimes hospitals use a general anaesthetic instead. Here's an example of the usual procedure:

  1. A nurse will take a short medical history, and possibly ask you to take some antibiotics. An IV (tube placed in your vein) may be started. Sometimes, a medication is injected into the IV or a muscle to reduce discomfort and help you to relax. A medication called misoprostol is sometimes given which dissolves in your mouth and causes the uterus to cramp (like menstrual cramps), its purpose is to soften the cervix and prepare it for the procedure.
  2. A local anaesthetic (freezing) is usually injected into or around your cervix (the lower part of your uterus). Like a Pap exam, a speculum is used to see your cervix. Your cervix is gradually stretched by a series of narrow rods (dilators), each a little wider than the one before. The largest dilator is about as thick as your index finger.
  3. A second method of dilating the cervix is to insert a sterile type of seaweed (laminaria) that gradually absorbs moisture and expands and gradually opens the cervix. Dilation happens over several hours for first trimester termination, or one to two days for mid-term termination.
  4. A tube (called a cannula) goes into your uterus through your widened cervix. This tube is attached to a suction machine, which is then turned on. After the uterus has been emptied by gentle suction, a spoon-shaped instrument (called a curette) may be used to check that the uterus has been emptied completely. This procedure takes 5 to 10 minutes.

    What about after the abortion?

    • Spend as much time as you need resting at the clinic, under observation.
    • When you feel stable and ready to leave, you will get follow-up instructions, including what you should do in the event of any complication.
    • You may experience some bleeding (no heavier than a regular period), cramping, and breast tenderness.
    • Have someone available who can drive you home.
    • Avoid tampons, douching, baths, swimming, sexual penetration, and strenuous exercise for two weeks.
    • You may want to rest the next day but you can resume most of your normal activities within a couple of days
    • Most forms of contraception, including the pill, patch, ring, and IUDs can be started the day of or the day after your procedure.

    What are the risks?

    Early abortion by vacuum aspiration is one of the safest operations in all of medicine. However, as with any medical procedure, complications can happen.

    Less than 1 woman in 100 will have any serious complications (blood clots in the uterus, infection, haemorrhaging [bleeding in the uterus], cervical tear, perforation of the uterus, anaesthetic reaction or an incomplete abortion).

    Possible treatments for complications may include further antibiotics, repeat vacuum aspiration, medication, transfusion or rarely surgery. Early abortion is one of the safest operations in all of medicine. The risk of a woman having complications or dying from full term pregnancy and childbirth is many times greater than that from an early abortion.

    What about possible emotional reactions?

    Women may have a variety of feelings after an abortion ranging from relief, to sadness, guilt and grieving. Emotional concerns after an abortion are rare in women who are comfortable with their decision to abort before they have a procedure. There are counselling services available at all the clinics to help you with decision-making, and for discussing your feelings after the abortion.

    When should I have a check up?

    Schedule an appointment for a check up 2 weeks after your abortion. This check up can be done at the abortion clinic, by your doctor, a walk in clinic, an OPT clinic, or a youth clinic. A follow-up is important to check for a healthy recovery and to ensure the abortion was successful.

    What is the effect of abortion on subsequent pregnancies?

    Studies have shown that one uncomplicated first-trimester abortion by vacuum aspiration does not pose a risk to a woman's future ability to have children. Whether more than one abortion affects a woman's future childbearing ability is less clear, since there has been conflicting research.

 

FS450
Revised March 2009