Surgical Abortion – Types, Procedure and Risks

It is the right of every woman to have children by choice. When abortion seems to be the right choice or is medically required, here is all you may want to know about surgical abortions – types, procedures and risks, in a simplified manner.

What is a Surgical Abortion?

The foetus or fertilized egg is lodged and attaches itself to the uterine lining. An abortion is said to be done when the foetus is vaginally evacuated through a surgical procedure. This procedure is based on the age of the foetus and other factors. For example, an ectopic pregnancy cannot be terminated this way.

It is always wise to educate yourself, speak to your doctor and then decide on a surgical abortion. The answers below are not meant to replace the doctor’s advice.

Preparation for Surgical Abortion

Surgical abortion process and procedures depend on the age of the foetus and whether any factors negate the abortion. Though the procedure is surgical, you should be well advised and mentally prepared to terminate the unwanted pregnancy. Given below are some pointers to help you through an abortion.

• Ensure that you confirm your appointment and have an attendant accompany you.
• Ensure that you do not eat anything for at least 3 hours prior to the procedure.
• Ensure that you carry an ID card, health insurance and payment for the abortion and antibiotics prescribed.
• Ensure that you have the contact details of your regular doctor and an emergency number to be called, written down.
• Ensure that you carry all medical reports.
• Ensure that you carry fresh underwear, sanitary pads, etc.

You can also keep in mind how long does a surgical abortion take in order to plan your day or ask for support from any trusted friend or family member.

Pain Management Available During the Process

Is surgical abortion painful? Yes, it will be. However, various pain management methods are available to make the process less painful. You can receive local anaesthesia which will numb your cervix but keep you awake. Doctors may also give you oral pain relief medication like ibuprofen or mild sedatives to keep you relaxed. You can also discuss with your doctor the possibility of opting for a stronger sedative that can be administered through an IV.

Anaesthetic Choices You May Use

Though you may have a choice of anaesthetics, the doctor’s decision is final! Based on a medical evaluation of your case, one of the following methods may be used.

• General anaesthesia
• A lighter mild anaesthetic gas
• A local cervical anaesthetic also called the spinal tap
• Intravenous sedation with local anaesthesia

Some of the factors that help the doctor decide on the right anaesthetic procedure are:

• Allergies and health conditions like asthma, epilepsy, anaemia, etc.
• Observing a fast and completion of bowel evacuation
• Age of the foetus
• Your weight and stress levels will determine how you cope with the surgery
• Any previous complications in surgery and gynaecological procedures

Types of Surgical Abortion Procedures

The surgery and procedures used depend on the age of the foetus. The procedures that happen in Indian hospitals are:

• First trimester – Medicational abortion, Vacuum Aspiration, or Dilation and extraction (D&E)
• Second trimester – Dilation and extraction (D&E), Dilation and Curettage (D&C)

1. Aspiration

Surgical abortion at 12 weeks is performed using the suction and aspiration method. The process is also called suction curettage, suction-aspiration or vacuum aspiration. This is the method used between 6 and 16 weeks. The procedure takes about 10 to 15 minutes.

How is it performed?

• You will be given pain relief medication or sedation.
• A speculum used to open your vagina as you lie back with your feet in the stirrups.
• Your cervix is numbed with a local anaesthesia.
• A surgical tool called tenaculum is used to dilate your cervix and facilitate the insertion of absorption rods.
• After the cervix dilates enough, a plastic tube with a suction device called a cannula is inserted into your uterus. The placenta and the foetus are suctioned out by this.
• A few hours of stay at the clinic may be required for recovery. During this period, you will also be given antibiotics to prevent any infection.

Risks and Side Effects of Suction Aspiration

• Dizziness
• Cramping
• Nausea
• Sweating
• Severe bleeding for long durations
• Perforation of the uterus
• Cervical damage
• Blood clots

The last four side effects are rare and the procedure is deemed safe 97% of the time.

2. Dilation and Evacuation (D&E)

After a gestational time of 16 weeks, the surgical abortion procedure of dilation and evacuation, or D&E, is used. The procedure takes about 15 to 30 minutes.

How is it performed?

• A synthetic dilator is inserted into your vagina, 24 hours prior to the procedure.
• On the day of the procedure, the cervix is numbed with medication.
• A tenaculum is used to hold the cervix and the uterus in place.
• Cone shaped rods are inserted to dilate the cervix further.
• A cannula or a plastic tube with a suction device is used to take the foetal tissue out.
• Using a surgical instrument called a curette, any residues on the lining are scraped off.
• Forceps may be used in case larger pieces are to be removed.
• Suctioning is performed in the end to ensure the complete removal of the tissue.

Risks and Side-Effects of Dilation and Evacuation

• Nausea
• Cramping
• Bleeding
• Blood clots
• Perforation of the uterus
• Damage to the uterine lining
• Cervical damage
• Infection

What Happens After the Abortion?

After any surgery, a period of recovery is always present. Antibiotics are prescribed and should be taken to prevent infections and manage any surgical abortion side effects. Normally, a follow-up after a week is recommended. No special care may be required. However, general precautions for two weeks after the procedure are

• Shower instead of taking a bath.
• Avoid sexual intercourse and insertion of any foreign objects into the vagina.
• Use clean sanitary pads and avoid tampons.
• Avoid going swimming and exposure to urinary tract infections.

How to Care for Yourself After Surgical Termination of Pregnancy

It is normal to have some bleeding and abdominal cramps following the abortion process and the surgical abortion recovery period may vary for women. Regular pain relief (except aspirin) can alleviate the pain and sanitary pads can be used to manage bleeding. Complications are rare if you follow the instructions and are on medications.
During this time avoid the following to prevent the risk of infection:

• Sexual intercourse
• Being submerged in water (swimming or taking baths)
• Heavy exercises
• Use of tampons

Contact your doctor or head to the hospital if:

• You develop an infection
• You notice heavy bleeding
• You develop a fever
• You have severe cramping or tummy pain
• A postoperative check-up for side effects, one or two weeks after your procedure is a must.

The abortion process is a dilemma and is always undertaken after due deliberation and counselling. It is painful both mentally and physically, and hence, managed with painkillers and anaesthetics. In case of any complications or side effects like a fever, cramps, heavy bleeding, etc., immediately get in touch with your doctor or head to the nearest hospital.

Also Read:

After Abortion Care
Period after Abortion