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Surgical Abortion

Introduction

Key points

  1. There are two types of surgical abortion: aspiration abortion and dilation and evacuation (D&E) abortion.
  2. Women up to 14 to 16 weeks pregnant can have an aspiration abortion, while D&E abortions are typically performed at 14 to 16 weeks or after.
  3. You should wait to have sex for at least one to two weeks after a surgical abortion. This can help reduce the risk of infection.

There are two types of surgical abortion: aspiration abortion and dilation and evacuation (D&E) abortion.

Women up to 14 to 16 weeks pregnant can have an aspiration abortion, while D&E abortions are typically performed at 14 to 16 weeks or after.

You should wait to have sex for at least one to two weeks after a surgical abortion. This can help reduce the risk of infection.

What are surgical abortions?

There are several options a woman can choose from when she needs to terminate a pregnancy. Options include medical abortions, which involve taking medications, and surgical abortions.

Surgical abortions are also called in-clinic abortions. They are typically more effective than a medical abortion, with a lower risk of an incomplete procedure. The two types of surgical abortions are:

  • aspiration abortions (the most common type of surgical abortion)
  • dilation and evacuation (D&E) abortions

The type of abortion a woman has often depends on how long it’s been since her last period. Both medical and surgical terminations are safe and effective when done in appropriate patients. The choice of what type of abortion depends on availability, or access, how far along the pregnancy is, and patient preference. Medical terminations are not as effective after 70 days, or 10 weeks, of pregnancy.

Abortion types

If a woman is 10 or more weeks into her pregnancy, she is no longer eligible for a medical abortion. Women up to 15 weeks pregnant can have an aspiration abortion, while D&E abortions are typically performed at 15 weeks or after.

Aspiration abortions

The average clinic visit will last up to three to four hours for an aspiration abortion. The procedure itself should take five to 10 minutes.

Aspiration abortions, also called vacuum aspirations, are the most common type of surgical abortion. During this procedure, you’ll be given pain medication, which can include a numbing medication that is injected into the cervix. You may also be given a sedative, which will allow you to stay awake but be extremely relaxed.

Your doctor will first insert a speculum and examine your uterus. Your cervix will be stretched open with dilators either before or during the procedure. Your doctor will insert a tube through the cervix into the uterus, which is attached to a suction device. This will empty the uterus. Many women will feel mild to moderate cramping during this portion of the procedure. The cramping typically decreases after the tube is removed from the uterus.

Immediately after the procedure, your doctor may check your uterus to ensure that it is completely empty. You’ll be given antibiotics to prevent infection.

The actual aspiration procedure takes approximately five to 10 minutes, though more time may be needed for dilation.

D&E

A D&E abortion is typically used after the 15th week of pregnancy. The procedure takes between 10 and 20 minutes, with more time potentially being needed for dilation.

This procedure starts the same way as an aspiration abortion, with the doctor applying pain medication, checking your uterus, and dilating your cervix. Like the aspiration abortion, the doctor inserts a tube attached to a suction machine to the uterus through the cervix and, combined with other medical tools, it will gently empty the uterus.

After the tube has been removed, your doctor will use a small, metal loop-shaped tool called a curette to remove any remaining tissue that is lining the uterus. This will ensure that the uterus is completely empty.

Preparation

Before your surgical abortion, you’ll meet with a healthcare provider who will go over all of your options with you to help you find the right one. Before the appointment for your abortion, there will be some preparation required, including:

  • Arrange for someone to drive you home after the procedure.
  • You can’t eat for a certain amount of time before the procedure, which will be specified by your doctor.
  • If your doctor gives you pain or dilation medication at an appointment before the procedure, follow the instructions carefully.
  • Don’t take any medications or drugs for 48 hours before the procedure without discussing it with your doctor first. This includes aspirin and alcohol, which can thin the blood.

Cost and effectiveness

In-clinic abortions are highly effective. They are more effective than medical abortions, which have an effectiveness rate of over 90 percent. You will have a follow-up appointment with your doctor or the clinic to ensure that the procedure was completely successful.

The cost of surgical abortions varies depending on several factors. Aspiration abortions are typically less expensive than D&E abortions. According to Planned Parenthood, it can cost up to $1,500 for a surgical abortion within the first trimester, with second trimester abortions costing more on average.

What to expect after a surgical abortion

It’s recommended that women rest for the rest of the day after the abortion. Some women will be able to return to most normal activities (except for heavy lifting) the next day, though some may take an extra day or so. The recovery period for a D&E abortion may last longer than that for an aspiration abortion.

Common side effects

Immediately after the procedure and during the recovery period, you may experience some side effects. Common side effects of surgical abortions include:

  • bleeding, including blood clots
  • cramping
  • nausea and vomiting
  • sweating
  • feeling faint

Once your healthcare provider ensures that your health is stable, you will be discharged home. Most women experience vaginal bleeding and cramping similar to a menstrual cycle for two to four days.

When to see your doctor

Some side effects are symptoms of potentially emergent conditions. You should call your clinic or seek immediate medical attention if you experience the following symptoms:

  • passing blood clots that are larger than a lemon for more than two hours
  • bleeding that is heavy enough that you have to change your pad twice in one hour for two hours straight
  • foul-smelling vaginal discharge
  • fever
  • pain or cramping that gets worse instead of better, especially after 48 hours
  • pregnancy symptoms that persist after one week

Menstruation and sex

Your period should return four to eight weeks following your abortion. Ovulation can occur without noticeable signs or symptoms, and often before you resume normal menstrual cycles, so you should always use contraception. You should wait to have sex for at least one to two weeks after the abortion, which can help reduce the risk of infection. You also should wait for this period of time to use tampons, or insert anything into the vagina.

Potential risks and complications

While abortions are typically extremely safe and most women have no complications outside of common side effects, the likelihood of complications increases slightly as the gestational period increases.

Potential complications from surgical abortions include:

  • Infection: can be serious and may require hospitalization. Symptoms include fever, abdominal pain, and unpleasant-smelling vaginal discharge. The chance of infection increases if you have a sexually transmitted infection.
  • Cervical tears or lacerations: can often be resolved with stitches after the procedure if necessary.
  • Uterine perforation: which can occur when an instrument punctures the uterine wall.
  • Hemorrhaging: which can result in bleeding sufficient enough that a blood transfusion or hospitalization is needed.
  • Retained products of conception: when part of the pregnancy is not removed.
  • Allergic or adverse reactions to medications: including pain medication, sedatives, anesthesia, antibiotics, and/or dilation medication. 

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