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Therapeutic Abortion: Surgical

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

Definition

Therapeutic abortion is 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 one of three 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 very 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
  • Increased sensitivity to odors

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 one week before the procedure, like:
  • Aspirin or other anti-inflammatory drugs
  • Blood thinners

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 contents.
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 (eg, Tylenol) or ibuprofen (eg, Advil) 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 one 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 occurs:
  • Signs of infection, including fever and chills
  • Increasing abdominal pain
  • Heavy vaginal bleeding (soaking more than one 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

Abortion. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed . Updated November 9, 2012. Accessed December 17, 2012.

Abortion. Planned Parenthood website. Available at: http://www.plannedparenthood.org/health-topics/abortion-4260.asp . Accessed on December 17, 2012.

Surgical abortion. The Abortion Clinic Directory website. Available at: http://www.abortionclinic.org/topics/articles/article%5F99.asp . Accessed December 17, 2012.

The Women’s Health Centre: therapeutic abortion. Regina Qu’Appelle Health Region website. Available at: http://www.rqhealth.ca/programs/in%5Fhospital%5Fcare/womens%5Fhealth/therapeutic.shtml . Access December 17, 2012.

1/11/2010 DynaMed's Systematic Literature Surveillance DynaMed's Systematic Literature Surveillance : 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.

Revision Information

  • Reviewer: Andrea Chisholm
  • Review Date: 11/2012 -
  • Update Date: 11/26/2012 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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