Surgical Abortion

Types of Surgical Abortion

Manual Vacuum Aspiration (Within 7 weeks after LMP)
This surgical abortion is done early in the pregnancy up until 7 weeks after the woman’s last menstrual period. The cervical muscle is stretched with dilators (metal rods) until the opening is wide enough to allow the abortion instruments to pass into the uterus. A hand held syringe is attached to tubing that is inserted into the uterus and the fetus is suctioned out.

Dilation and Curettage (D & C) with Vacuum Aspiration
(Within first 12 weeks after LMP) *Most Common
In this procedure, the doctor opens the cervix with a dilator (metal rod) or laminaria (thin sticks derived from plants and inserted hours before the procedure). The doctor inserts tubing into the uterus and connects the tubing to a suction machine. The suction pulls the fetus’ body apart and out of the uterus. After suctioning, the doctor may scrape the walls of the uterus to make sure the unborn child, placenta, and contents of the uterus have been completely removed.

Dilation and Evacuation (D & E)
(Generally used after12 weeks of pregnancy)
This surgical abortion is done during the second trimester of pregnancy. Because the developing fetus doubles in size between the eleventh and twelfth weeks of pregnancy, the body of the fetus is too large to be broken up by suction and will not pass through the suction tubing. In this procedure, the cervix must be opened wider than in a first trimester abortion. Most women experience some pain, so the doctor may give you a painkiller – either locally by shots in the area of the cervix or by a general anesthetic. After opening the cervix, the uterus will be scraped and the unborn child and placenta are removed. After 16 weeks, the unborn child and placenta are removed piece-by-piece, using forceps or other instruments.

Possible Side Effects and Risks:
• Cramping of the uterus or pelvic pain.
• A hole in the uterus (uterine perforation) or other damage to the uterus.
• Injury to the bowel or bladder.
• Incomplete removal of the unborn child, placenta, or the contents of the uterus requiring an additional operation.
• Infection.
• Complications from anesthesia, such as respiratory problems, nausea and vominting, headaches, or drug reactions.
• Inability to get pregnant due to infection or complication from an operation.
• A possible hysterectomy as a result of complication or injury during the procedure.
• Hemorrhage (heavy bleeding).
• Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.
• Loss of the protective effect of a full term pregnancy against breast cancer.
• Rarely, death.

Abortion by Labor Induction (Medical Induction)
(Generally used after 16 weeks of a pregnancy. Usually requires a hospital stay of one or more days.)
Medicines will be used to start labor. These medications can be put in the vagina, injected in the uterus (womb) or given intravenously or by IV. The medication will cause the uterus to contract and labor to begin. In some cases more than one medication will be used. This procedure may take from several hours to several days. Your doctor may use instruments to scrape the uterus to ensure the unborn child, placenta, and other contents of the uterus have been completely removed.

Possible Side Effects and Risks:
• Nausea or vomiting.
• Diarrhea.
• Fever.
• Infection.
• Complications from anesthesia such as respiratory problems, nausea and vomiting, headaches, or drug reactions.
• Inability to get pregnant due to infection or complication from an operation.
• A possible hysterectomy as a result of complication or injury during the procedure.
• Damage or rupture of the uterus (womb).
• The possibility of a live-born baby. (If the unborn child is born alive, the attending physician has the legal obligation to take all reasonable steps necessary to maintain the life and health of the child.)
• Incomplete removal of the unborn child, placenta, or contents of the uterus requiring an operation.
• Homorrhage (heavy bleeding).
• Water intoxication.
• Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.
• Rarely, death.

Who should NOT have an abortion by medical induction?
Some women should not have a medical induction, such as a woman who has had previous surgery to the uterus or a woman with placenta previa. You should discuss with your doctor if you are one of these women.

Dilation and Extraction (D & X)
(May be used after 16 weeks gestation. May be performed in a clinic or in the hospital for more advanced pregnancies.)

The doctor will dilate (open) the cervix. The doctor will grasp the unborn child’s foot with an instrument and deliver the child except for the head. While the head is kept in the birth canal, scissors are used to make a hole in the back of the head, a tube is inserted, and suction is applied. The contents of the unborn child’s skull are suctioned out, the bones of the head collapse, and the child is delivered dead.

NOTE: Former Surgeon General C. Everett Koop and the Physician’s Ad Hoc Coalition for Truth stated in 1996 that this type of procedure “…is never medically necessary to protect a mother’s health or her future fertility. On the contrary, this procedure can pose a significant threat to both.”

Possible Side Effects and Risks:
• Cramping of the uterus or pelvic pain.
• A hole in the uterus (uterine perforation) or other damage to the uterus.
• Injury to the bowel or bladder.
• Incomplete removal of the unborn child, placenta, or the contents of the uterus requiring an additional operation.
• Infection.
• Complications from anesthesia, such as respiratory problems, nausea and vominting, headaches, or drug reactions.
• Inability to get pregnant due to infection or complication from an operation.
• A possible hysterectomy as a result of complication or injury during the procedure.
• Hemorrhage (heavy bleeding).
• Emergency treatment for any of the above problems, including the possible need to treat with an operation, medicines, or a blood transfusion.
• Loss of the protective effect of a full term pregnancy against breast cancer.
• Rarely, death.

After a Surgical Abortion

It is normal for you to have some cramping and a small amount of bleeding after having any type of abortion. Your uterus contracting back to its normal size causes the cramping.

GO TO THE EMERGENCY ROOM, OR CALL THE CLINIC OR DOCTOR WHO PERFORMED THE ABORTION IF:
• Heavy bleeding occurs (2 or more pads per hour).
• Pain is severe or not controlled by pain medication.
• You have fever.
• You have difficulty breathing or shortness of breath.
• You have chest pain.
• You are disoriented.
It is important that you return to your doctor for all scheduled follow-up visits.

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