Elective Surgical Abortion

When a woman chooses to end a pregnancybefore the child is ready to be born,it is called an abortion. The fetus may be removed from the woman’suterus using one of two methods:

elective medical abortion

elective surgical abortion, which is the subject of this article

A surgical abortion is a medical procedurethat takes an embryo or fetus from the uterus before it is able to live on itsown. An abortion may be termed elective, because it is a chosen course of action,rather than a naturally occurring bodily process. (A naturally occurring abortion isalso known as spontaneous.) Sometimes, an abortion is called therapeutic. This meansit is a treatment used to protect the health of the woman. That is, to continuethe pregnancy would endanger the woman’s health.

Who is a candidate for the procedure?

Any woman who chooses to end a pregnancy for healthor personal reasons is a candidate for an elective abortion. Abortionsare legal in the United States during the first 12 weeks of pregnancy.After that, the legality of abortion is regulated by each state.

How is the procedure performed?

Before doing an abortion, a doctor will confirm that the womanis pregnant as well as the approximate age of the fetus. Apelvic exammight be done to check the size of the uterus. Lab studies will rule outanemia,determine the woman’s Rh factor,and screen for sexually transmitted diseases.The doctor should offer information about the procedure used.Psychological support should be given as needed.

Some of the options for surgical abortion in thefirst trimester of pregnancyare:

Dilation and evacuation, also called D&E. This procedureinvolves opening the cervix andsuctioning out the contents of the uterus. The cervix can be opened with aseries of narrow rods called dilators. Or it can be opened with an absorbent fiberrod such as a laminaria.

Dilation and curettage, also calledD&C.In this procedure, a narrow tube is inserted into the uterus through the dilated cervix.The uterine contents are suctioned out. Then the lining of the uterus isscraped out with a tool called a curette.

Some of the options for surgical abortions after14 to 15 weeks of pregnancy include the following:

A D&E or a D&Ccan be done. These are much the same as the procedures describedfor first trimester pregnancies. However, because the fetus is larger, thedoctor may use a curette and forceps.

Prostaglandin, urea, or a highly concentrated saline or salt solutioncan be injected into the amniotic fluid around the fetus. The woman goesinto labor a few hours later, and the fetus is expelled.

What happens right after the procedure?

A woman who has a surgical abortion will be watched closely fora short time to make sure that her blood pressure, pulse, and bleedingremain stable. She will then be allowed to go home. In 2 to 4 weeks,she will have a return visit to the health care provider to check for problems.

After any abortion, a woman withRh-negativeblood should be given a shot of Rh immune globulin, unless the father alsohas Rh-negative blood. The woman may be prescribed a pain medicine.Sometimes, antibiotics are used as well to prevent infection.

What happens later at home?

At home, a woman should take these steps.

Avoid using tampons or having sex for at least 2 weeks.

Be aware of the possible emotional aspects of abortion.Some women have depressionsimilar to postpartum depressionafter an abortion.

Call the doctor if there are any new or worsening symptoms, such as fever,severe or lasting abdominal distress,or heavy vaginal bleeding.

Slowly resume daily activity.

If a woman has no problems after the abortion, it is likelythat she will be able to get pregnant at a later time. A follow-up visitwith a doctor should include a pelvic examto make sure the uterus is shrinking in size. This office visit is also a goodtime for a woman and her doctor to talk about birth control.This will help the woman choose a method that will work well for her.

What are the potential complications after the procedure?

Any type of abortion can cause heavy bleeding that mightrequire a D&Cor blood transfusion.There are other possible complications linked to each type of abortion.Early abortions tend to be much safer than later ones. In the firsttrimester of pregnancy, rare complications of a D&Care:

a hole in the uterus

infection in the lining of the uterus

severe bleeding

These problems are far more likely to happen when a D&Eis done after 12 weeks of pregnancy. At that time, the uterus is largerand softer. This means more tissue must be removed.

In late abortions, putting very concentrated salt solutions,urea, or prostaglandin into the amniotic fluid can cause the problemslisted below:

damage to the cervix

infection

leftover tissue that remains in the uterus, which means aD&Cwould need to be done

severe bleeding

Sometimes, too much of the uterine lining is scraped away,causing scar tissue to form within the walls of the uterus. The scartissue can cause infertility.