Interruption of Pregnancy - Elective Surgical Abortion

Overview & Description

When a woman chooses to end a pregnancy before the child is ready to be born, it is called an abortion. The fetus may be removed from the woman's uterus using one of two methods:

  • elective medical abortion
  • elective surgical abortion, which is the subject of this article

    • A surgical abortion is a medical procedure that takes an embryo or fetus from the uterus before it is able to live on its own. 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 is also known as spontaneous.) Sometimes, an abortion is called therapeutic. This means it is a treatment used to protect the health of the woman. That is, to continue the pregnancy would endanger the woman's health.

    Who is a candidate for the procedure?

    Any woman who chooses to end a pregnancy for health or personal reasons is a candidate for an elective abortion. Abortions are 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 woman is pregnant as well as the approximate age of the fetus. A pelvic exam might be done to check the size of the uterus. Lab studies will rule out anemia, 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 the first trimester of pregnancy are:

  • Dilation and evacuation, also called D&E. This procedure involves opening the cervix and suctioning out the contents of the uterus. The cervix can be opened with a series of narrow rods called dilators. Or it can be opened with an absorbent fiber rod such as a laminaria.
  • Dilation and curettage, also called D&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 is scraped out with a tool called a curette.

    • Some of the options for surgical abortions after 14 to 15 weeks of pregnancy include the following:

  • A D&E or a D&C can be done. These are much the same as the procedures described for first trimester pregnancies. However, because the fetus is larger, the doctor may use a curette and forceps.
  • Prostaglandin, urea, or a highly concentrated saline or salt solution can be injected into the amniotic fluid around the fetus. The woman goes into labor a few hours later, and the fetus is expelled.

    • Preparation & Expectations

    What happens right after the procedure?

    A woman who has a surgical abortion will be watched closely for a short time to make sure that her blood pressure, pulse, and bleeding remain 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 with Rh-negative blood should be given a shot of Rh immune globulin, unless the father also has Rh-negative blood. The woman may be prescribed a pain medicine. Sometimes, antibiotics are used as well to prevent infection.

    Home Care and Complications

    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 depression similar to postpartum depression after 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 likely that she will be able to get pregnant at a later time. A follow-up visit with a doctor should include a pelvic exam to make sure the uterus is shrinking in size. This office visit is also a good time 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 might require a D&C or 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 first trimester of pregnancy, rare complications of a D&C are:

  • 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&E is done after 12 weeks of pregnancy. At that time, the uterus is larger and 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 problems listed below:

  • damage to the cervix
  • infection
  • leftover tissue that remains in the uterus, which means a D&C would 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 scar tissue can cause infertility.

    Attribution

    Author:Eva Martin, MD
    Date Written:
    Editor:Crist, Gayle P., MS, BA
    Edit Date:08/17/02
    Reviewer:Barbara Mallari, RN, BSN, PHN
    Date Reviewed:08/22/01