Therapeutic Abortion: Surgical

(Abortion; Vacuum Aspiration; Dilation and Curettage; Dilation and Evacuation)

Definition

Therapeutic abortion is a procedure to end a pregnancy. It is done before the fetus is able to survive on its own. A surgical therapeutic abortion is done using 1 of 3 methods:

  • Manual vacuum aspiration (MVA)
  • Dilation and suction curettage ( D&C)
  • Dilation and evacuation (D&E)

Undilated Cervix

female organs cervix
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Reasons for Procedure

A therapeutic abortion may be done to:

  • Preserve the mother’s physical or mental health
  • End a pregnancy that tests have shown would result in a child with severe abnormalities

Possible Complications

These procedures are safe. But, no procedure is free of risk. Problems resulting from abortion can include:

  • An incomplete procedure
  • Bleeding
  • Infection
  • Injury to the cervix or other organs
  • Reaction to anesthesia

The earlier in a pregnancy the abortion is done, the better the chances of a procedure with no complications.

If you think you might be pregnant, see your doctor. The earlier you find out, the more time you have to make an informed choice about the pregnancy. Early symptoms of pregnancy include:

  • A missed period
  • Tender, swollen breasts
  • Fatigue
  • Nausea or vomiting

What to Expect

Prior to Procedure

Your doctor may:

  • Examine you—to determine the stage of your pregnancy by checking the size of the uterus (womb)
  • Do blood and urine tests—to confirm the pregnancy
  • Use ultrasound—to give an accurate assessment of the stage of pregnancy
  • Give you medicine—to help dilate the cervix

Talk to your doctor about your medicines. You may be asked to stop taking some medicines up to 1 week before the procedure

Anesthesia

Local anesthesia with sedation may be used. The local anesthesia will numb the cervix. Sedation will help you relax. In some cases, regional or general anesthesia may be used.

Description of Procedure

You may be given an antibiotic before the procedure.

MVA

The doctor may inject a numbing agent in or near the cervix. Special tools will be used to stretch the cervix opening. A tube will be inserted into the uterus. The tube will then remove the fetus and other products of conception.

D&C

The steps for an MVA will be followed. The doctor will then use a narrow metal loop to remove the tissue lining the uterine walls.

D&E

This procedure is similar to a D&C, except that it is done during the second trimester. It will also require wider dilation of the cervix. The fetus and other products of conception are removed from the uterus with medical instruments and suction. This usually requires regional or general anesthesia.

How Long Will It Take?

About 5-20 minutes

How Much Will It Hurt?

Women report cramps similar to menstrual cramps. Talk to your doctor about medicine to help manage discomfort.

Acetaminophen or ibuprofen can reduce most of these symptoms. Do not take aspirin unless directed to by your doctor.

Post-procedure Care

After a therapeutic abortion:

  • You may have cramps and bleeding.
  • You may also have nausea and diarrhea.
  • You should not use vaginal medicines until your doctor allows it.
  • Do not have sex for at least 1 week.
  • Baths and showers are okay.
  • You should recover within a couple of days.
  • Make sure you return to see your doctor for follow-up.

Sudden hormone changes may intensify natural feelings of guilt, anger, sadness, and regret. Most doctors can offer or refer you to follow-up counseling, if you choose.

Call Your Doctor

After arriving home, contact your doctor if any of the following occur:

  • Signs of infection, including fever and chills
  • Increasing abdominal pain
  • Heavy vaginal bleeding (soaking more than 1 pad per hour)
  • Foul-smelling vaginal discharge
  • Pain that is not helped by medicine, heat, and rest
  • Persistent vomiting

In case of an emergency, call for medical help right away.

RESOURCES:

American Congress of Obstetricians and Gynecologists
http://www.acog.org
Planned Parenthood Federation of America, Inc.
http://www.plannedparenthood.org

CANADIAN RESOURCES:

The Society of Obstetricians and Gynaecologists of Canada
http://www.sogc.org
Women's Health Matters
http://www.womenshealthmatters.ca

References:

American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 135: Second trimester abortion. Obstet Gynecol. 2013 Jun;121(6):1394-406, reaffirmed 2017
Lohr P, Fjerstad M, DeSilva U, Lyus R. Abortion. BMJ. 2014;348:f7553
Induced abortion. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T115505/Induced-abortion. Updated October 4, 2018. Accessed December 28, 2018.
1/11/2010 DynaMed Plus Systematic Literature Surveillance http://www.dynamed.com/topics/dmp~AN~T115505/Induced-abortion: Robson SC, Kelly T, Deverill M, et al. Randomised preference trial of medical versus surgical termination of pregnancy less than 14 weeks' gestation (TOPS). Health Technol Assess. 2009;13(53):1-124.
Last reviewed December 2018 by Michael Woods, MD
Last Updated: 12/31/2018

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