Abortion procedures - surgical

Surgical abortion is a common procedure, and most are performed in the first trimester. It is a very safe procedure when carried out by a trained medical professional. Where abortion is legal and how it can be accessed varies from place to place, so check the laws and services that apply where you live.

As with any surgery, however, there is some risk. The possible complications of surgical abortion include infection, injury to parts of the reproductive system and excessive bleeding.

The female reproductive system#

The female reproductive system is made up of the:

• vagina – a muscular, hollow tube that leads from the outside of the body to the uterus
• cervix – the entrance (neck) of the uterus, where the vagina meets the uterus
• uterus (womb) – where a pregnancy develops
• fallopian tubes – tubes that extend from the uterus, one on each side; each opens near an ovary and carries the eggs (ova) from the ovaries to the uterus
• ovaries – two small glands that contain and release the eggs (ova)

Pregnancy occurs when an egg is fertilized by a sperm and the fertilized egg then implants in the lining of the uterus (the endometrium). A surgical abortion involves removing the pregnancy (sometimes called the “contents of the uterus”) through the vagina by surgical means. To do this, the cervix must be opened wide enough to allow the surgical instruments into the uterus.

Preparing for a surgical abortion#

Always follow your clinic’s instructions, but general advice before a surgical abortion includes:

• do not smoke, eat or drink anything (not even water) for about 6 hours before the operation
• expect to be at the clinic for at least 2 hours
• bring sanitary pads and any documents your clinic asks for, such as a referral letter and details of your blood group
• arrange for someone to drive you home

Anesthetic for a surgical abortion#

Your clinic will explain what type of anesthetic it can offer and how to prepare for it. Options may include:

• general anesthetic – this makes you completely unconscious. Any operation involving a general anesthetic carries some risk, and there is a danger of choking if fasting is not done properly beforehand.
• nitrous oxide gas or a similar gas – this puts you in a state of “twilight sleep”, in which you are awake but sedated and calm
• local anesthetic – anesthetic is injected into your cervix to numb the area so that you do not feel anything during the operation (this is known as a paracervical block)
• local anesthetic with intravenous sedation – a combination of sedative medication given through a line into your vein and local anesthetic injected into your cervix

Method of surgical abortion#

Most abortions are performed using “suction (vacuum) aspiration”, also called “suction curettage”. For this procedure you need to be in your first trimester (the first 3 months, or 12 weeks, of pregnancy).

Your cervix is gradually widened with rods of increasing size, and a slim tube is then inserted into your uterus. The pregnancy (the fetus and the placenta) is removed with gentle suction. Another instrument, called a curette, is used to check that the uterus is empty. The operation takes less than 15 minutes.

During the abortion it is also safe to have contraception, such as an intrauterine device (IUD) or a contraceptive implant, inserted if you wish.

Surgical abortion after 12 weeks#

For an abortion in the second trimester, from 13 weeks to 24 weeks of pregnancy, the surgery is called a “dilatation and evacuation” (D&E). It is similar to a first trimester abortion but uses additional instruments and may involve extra steps to prepare the cervix:

• Hormone-blocking tablets may be used to help soften the cervix before surgery. These tablets (“misoprostol”) may be taken by mouth or placed in the vagina, and take about 2 hours to work.
• Another tablet, “mifepristone”, may also be used 1–2 days before the abortion to prepare the cervix in some cases.
• A special device may be placed in the cervix to help it widen. It swells over several hours until the cervix is open wide enough for the abortion to take place. The abortion is usually performed one or two days later.

Complications of surgical abortion#

Complications occur in around 3 per cent of surgical abortion cases. The risk depends on how many weeks pregnant you are; abortions performed in the first trimester are the safest. Possible complications include:

• Hemorrhage – bleeding after an abortion should be similar to a menstrual period. Heavy bleeding can be a sign that the abortion is not complete and some pregnancy tissue remains in the uterus (“retained products of conception”). This may need treatment with tablets or with surgery such as a suction curettage. A blood transfusion is rarely required.
• Infection – a fever (high temperature) may indicate an infection, which can be caused by an incomplete abortion or a sexually transmitted infection. Treatment is with antibiotics. Sometimes a longer-lasting infection called pelvic inflammatory disease (PID) can develop.
• Injury to the uterus – the walls of the uterus are muscular but soft, and the surgical instruments can sometimes injure (or “perforate”) it. In rare cases this can cause an abdominal infection (peritonitis) and severe blood loss. This is very rare and, if it happens, is usually recognized and treated straight away.
• Injury to the cervix – the cervix is stretched during an abortion, and having multiple procedures can weaken it. A weakened cervix (sometimes called an “incompetent” cervix) can cause problems in later pregnancies if it is too weak to stay fully closed under the weight of a growing pregnancy.

The last two complications are rare when surgical abortions are carried out by experienced surgeons.

After a surgical abortion#

Follow your clinic’s advice on how to care for yourself and reduce the risk of infection. In general, for 2 weeks after the procedure, or for a few days after bleeding has stopped:

• shower instead of taking a bath
• avoid vaginal intercourse
• use sanitary pads instead of tampons or menstrual cups
• avoid swimming

When to seek medical advice#

See your clinic, doctor or a hospital emergency department immediately if:

• your bleeding becomes heavy, such as passing clots larger than golf balls, or soaking through a maxi pad every 30 minutes for 2 hours
• you develop severe cramping or abdominal (tummy) pain
• you develop a fever

These symptoms could indicate an infection or another complication.

Key points#

• surgical abortion is a safe procedure when performed by a trained medical professional
• all surgery carries some risk
• any operation involving a general anesthetic carries risk
• the risk of complications depends on how many weeks pregnant you are
• retained pregnancy tissue may need treatment with tablets or surgery such as a suction curettage

Where to get help#