Surgical Abortion Procedures

Abortion is the termination of a pregnancy by the eviction of an embryo. Abortion either is due to the embryo’s death in the uterus or will result in its death. Surgical abortions are done manually through surgical methods, while Medical abortions are done usually in the first trimester (1-12weeks) of a pregnancy by taking an abortion pill. Surgical abortion takes lesser time when compared to medical abortion.

Factors that determine which procedure will be suitable:

There are a number of factors that play a crucial role in deciding which abortion procedure will be more suitable for a woman.

Pregnancy stage:

  • The factor that decides which procedure needs to be followed depend upon how advanced the pregnancy is. At every different trimester different procedure is followed which are discussed below.
  • Surgical abortions are done only at advanced stages (not less than 6 weeks from last period) else the success rate decreases.
  • Surgical abortions done at first trimester has the least risks (less than 1%).

Health issues:

  • It also depends upon the various health factors of the patient. A woman with any disorder such as anemia, heart problem, HIV, persistent miscarriages, or any major illness should immediately seek medical advice before going for a surgical abortion.

Surgical Abortion Procedures:

There are different procedures followed in surgical abortions depending upon the state of the pregnancy. A sonogram is advised to determine the accurate gestation period and to confirm a non- ectopic pregnancy (egg being fertilized inside the uterus).

Suction Aspiration:

Suction Aspiration is done during the first trimester (up to 12weeks) of the gestation period. In this process a local anesthesia is followed by inserting a suction instrument, which is a tube connected to a vacuum cone on one end and a collecting bottle in the other end, into the uterus and a vacuum is created. This disconnects the embryo from the womb crushing it to pieces, draining it into bottle and then discarded. The whole process takes about 20 minutes.

Side effects of this process include abdominal cramps, drowsiness, nausea and slight bleeding. There is a possibility of the cervix or even the uterus getting damaged. This is the most common process followed and is 97% reliable.

Dilation and Curettage (D&C):

Dilation and Curettage procedure is done during the 12-24 weeks from the last period. This process is similar to the suction aspiration but a curette (scoop shaped instrument with a sharp edge) is inserted instead of a vacuum cone to cut the fetus into pieces and is then scrapped out from the tube­­.  The vagina is enlarged (dilation) using a speculum. D&C is a most common procedure followed after a miscarriage in the 2nd trimester of pregnancy. The process takes about 10-15min. It requires some post process treatment to avoid infections, hemorrhage and also if any damage to the uterus or cervix has occurred.

It has similar side effects as that of vacuum aspiration. The risk of tear or perforation of the uterus in this case is higher. There could be a possible damage to the vagina followed by bleeding and cramps.

Dilation and Evacuation (D&E):

The D& E procedure is followed in the 3rd trimester (15-21) weeks of the pregnancy period. In this process a laminaria piece (dried seaweed stick used for slow dilation) is kept in the cervix 24 hours (or until required amount of dilation occurs) prior to the abortion procedure. This is because the cervix needs to be enlarged more to remove the much developed fetus. Then, the laminaria is removed and the fetus is disconnected from the uterus and scrapped out by crushing the skull and removing the entire fetus parts. A vacuum aspiration is then followed to remove any residues, placenta and the uterus lining.

Risks of this abortion include hemorrhage, perforation of uterus, breast cancer (risk increases with repeated abortions).

Induction Abortion:

Induction abortion is done at the 3rd or the last trimester of a pregnancy and is usually done in case of any serious illness to the fetus or the pregnant woman. In this type the woman has to undergo all the stages of labor and delivery.

Dilation of the cervix is done prior to the induction process. The pregnancy has to be initially stopped by injecting the solution containing sodium chloride (salt), potassium chloride or urea into the sac containing amniotic fluid(amniotic sac). The contractions are triggered using medication. This in turn leads to the eviction of the fetus from the uterus while the process is being monitored to avoid complications. The time taken varies just as in the case of labor and delivery in normal conditions from few minutes to few hours.

There are various risks of induction abortion depending upon where the medicines are injected, the amniotic sac or the vagina. Injecting the medicine to the vagina has lesser risks while the amniotic sac injection might affect the mother’s bloodstream causing other complexities.

Dilation and Extraction:

The D&X (Partial Birth Abortion) procedure is performed at 21-32 weeks of pregnancy period. Dilation and Extraction is sometimes referred to as ‘Intact D&X’ or even ‘Intrauterine Cranial Decompression’. Similar to D&C, this process involves dilation of the cervix atleast 24hrs prior to the actual procedure by inserting the dried sea weed stick (laminaria) in the vagina. The fetus is then dismembered from the uterus and is removed using forceps, suction or curette.

The risks are uterine infection, prolonged bleeding, damaged uterus, blood clot.

Effect of surgical abortion on menstrual cycle:

During and after a surgical abortion there could be painful cramps.

Bleeding clots could be more than normal for a few days and spotting for few weeks after which the menstrual cycle should get back to normal.

In any case of prolonged bleeding, severe pain or anything unusual consult a doctor immediately.

Follow Up:

The follow up has to be done within a month or until the menstrual cycle is back to normal.

It is also required to confirm the reproductive system being normally functioning.

Also is required to avoid any kind of vaginal or uterine infections.

As the saying goes ‘Prevention is better than cure’, the best one could do is to avoid such complications by taking preventive measures. Since this is quite common among the young couples, who should also know that an abortion could also lead to infertility. Abortion should be an option only at inevitable situations such as serious illness of the mother or the fetus. If one doesn’t need to be conceived there are a lot of birth control alternatives available.  It is inhumane to deprive the unborn of all the worldly pleasures. Every individual has the right to live and be a part of the society.