What Is Surgical Abortion?

Definition

Abortion is the removal of a fetus from the uterus before it is mature enough to live on its own. When this happens spontaneously we call it a miscarriage. Induced abortion is brought about deliberately by a medical procedure that ends pregnancy.

Legal abortion, carried out by trained medical practitioners, is one of the most common and safest surgical procedures. About 1.5 million American women choose to have induced abortions each year. Fewer than 1% of all abortion patients experience a major complication associated with the procedure.

Determination of Length of Pregnancy

Before an abortion is performed, it is important to establish that the woman is indeed pregnant and to measure as accurately as possible how far along her pregnancy is. Health professionals usually measure a pregnancy in terms of the time that has passed since the woman's last menstrual period (abbreviated as LMP). The woman is given a pregnancy test, then examined physically. She may also be examined by ultrasound, a simple use of sound waves (not x-ray) to view the inside of the uterus. Under most circumstances, abortions are not performed before six weeks LMP, and very few (about 0.01%) take place after 24 weeks LMP.

Surgical Methods

Two methods can be used to induce surgical abortion. The most common method is to open the cervix (the entrance to the uterus) slightly and remove the contents of the uterus (including the fetus and placenta). The second method, used much less frequently, is to induce labor, so that the fetus and placenta are expelled as in childbirth. This method is used mainly when pregnancies are past 22 weeks.

First-trimester Abortion

If less than 13 to 15 weeks have passed since her last menstrual period, the woman is considered to be in the first trimester, and the standard method for abortion is vacuum aspiration or suction curettage. This method is safely performed on an outpatient basis in a doctor's office or clinic. Most often a local anesthetic is used to numb the cervix. Sometimes medication is used to relax the woman. Occasionally, a general anesthetic that puts her to sleep briefly will be used instead.

Dilation. The woman lies on an examining table with her feet in stirrups. The doctor inserts an instrument into the vagina that will hold the vaginal walls apart, and then begins to gradually dilate, or open, the cervix. The cervix is a ring of muscles that is normally tightly closed. It can be dilated in one of two ways. One way is to insert and remove narrow, tapered rods of increasing width, one at a time, until the cervical opening is about the diameter of a drinking straw (up to 1/2 inch). This type of dilation usually takes only a few minutes to complete. Another method is to insert a sterile absorbent fiber rod (e.g., laminaria), which is left to expand slowly, like a sponge, by taking up moisture from the cervix, and thereby enlarging the opening. This more gradual method can take several hours, and may involve two visits to the clinic: one for insertion of the laminaria, and a second for completing the abortion.

Aspiration and Curettage. After the cervix is dilated, the physician inserts a small tube, or cannula, which is attached to an aspirator machine. This is similar to the apparatus dentists use to clear the mouth of saliva. In this case, the mild suction action of the machine empties the contents of the uterus. Then the doctor may carefully check the walls of the uterus with a spoon-shaped instrument, called a curette, to be sure the abortion is complete.

The entire procedure takes about 5 to 10 minutes. Some women experience pain -- especially menstrual-type cramping -- during the procedure. Cramping might continue for up to an hour afterwards. Some women describe this cramping as "uncomfortable but not painful," and others say the cramps were "slight." The procedure is usually followed by vaginal bleeding, similar to a menstrual period.

Techniques for Later Abortion

Ending a pregnancy is more complicated after 14 to 15 weeks because the fetus is larger and there is a greater blood supply to the uterus. Only about one tenth of the abortions in the U.S. are performed between 13 and 20 weeks LMP. Although they are occasionally done in hospitals, most are performed on an outpatient basis, using the dilation and evacuation, or D&E, method. The rest are performed by the induction method, in which labor is artificially started.

D&E Method. The D&E procedure is basically an expansion of the vacuum aspiration method described earlier, but a larger cervical opening is required. Depending on the method used, opening the cervix may be completed in a few minutes, or it may take several hours, or as long as two days.

To perform the abortion, the physician uses suction as in first-trimester procedures, along with forceps to remove the fetal parts that are too large to pass through the suction tube. Finally, she may check the walls of the uterus with another instrument, a curette, to determine that there is no tissue from the pregnancy remaining. The procedure itself takes from 10 to 30 minutes. Pain medication may be given to minimize the woman's discomfort.

Induction or Instillation Method. Less than 2% of all abortions in the U.S. are performed by the induction method, and they are almost always done in a hospital. The physician may administer a local anesthetic before passing a needle through the abdomen into the uterus to inject medication (prostaglandin, urea, saline solution, or a combination) to induce contractions. Some hours later, the patient goes into labor to expel the fetus.

Follow-up Care

Following an abortion, regardless of the method used, the woman is observed in recovery for a period of time to see that her blood pressure and heart rate are normal and that bleeding and discomfort are within normal limits. Before she goes home, she may be given a prescription for antibiotic and/or other medications. She should also be given instructions for post-operative care, including a 24-hour number for her to call in an emergency, and an appointment or referral for a check-up within 2-4 weeks. This follow-up visit is very important to make sure the abortion is complete and to discover and treat any problems that may have developed.

Complications from Abortion

During the years that abortion was illegal in parts or all of the United States (from the late 1800's until 1973), more pregnant women died from complications from self-induced abortions or abortions attempted by untrained or unqualified practitioners than from any other cause. Today, however, abortion is considered to be among the safest of all surgical procedures. For more information on this subject, see Fact Sheet: Safety of Abortion.