Types & Risks of Abortion Procedures
There are three ways a pregnancy can end: a woman can give birth, have a miscarriage or she can choose to have an abortion. Different methods of abortion are used depending on how far along the pregnancy is. The physician will often use ultrasound to determine the fetus's gestational age. If you make an informed decision to have an abortion, you and your doctor will need to consider how long you have been pregnant before deciding which abortion method to use.
Based on data from the Centers from Disease Control and Prevention (CDC), the risk of dying as a direct result of a legally induced abortion is less than one per 100,000.
Suction curettage (also referred to as vacuum aspiration) is generally used during the first trimester. Unless there are complications, this procedure is done on an outpatient basis and may be done in a physician's office or a clinic.
- An anti-bacterial solution is used to cleanse the vaginal area.
- The doctor will spray or inject medicine on the opening of the uterus (cervix) to prevent pain.
- The opening of the cervix is then gradually stretched. This is done by the insertion of a series or rods, each one thicker than the previous one, into the opening of the cervix. The thickest rod used is about the width of a fountain pen.
- After the opening is stretched, a clear plastic tube (catheter) is inserted into the uterus.
- The suction (vacuum) is turned on and fetal tissues and other products of pregnancy are removed through the catheter.
- After the suction tube has been removed, a narrow metal loop (curette) may be used to gently scrape the walls of the uterus to be sure it has been completely emptied.
- The procedure will usually take about 10 to 15 minutes, but recovery may require staying at the clinic for a few hours following the procedure.
From 14-23 weeks after the first day of the last menstrual period, dilatation and evacuation (D&E) and labor induction are the two methods typically used.
Dilatation and Evacuation (D&E)
- The procedure will generally be done on an outpatient basis, but may require hospitalization.
- An abortion using the D&E method is done in two steps: dilation (opening the cervix) and evacuation (emptying) the uterus.
- An antibacterial solution is used to cleanse the vaginal area.
- The doctor may insert a sponge-like material into the cervix. As the sponge gets wet, it swells and opens the mouth of the cervix. You may feel pressure or cramping while the dilator is in place.
- The doctor will remove the sponge between two and 16 hours after placement.
- You may be given intravenous medications to ease pain and prevent infection.
- After a local or general anesthesia is given, the fetus and other products of pregnancy are removed from the uterus with medical instruments such as forceps and suction curettage.
- The procedure will generally require a hospital stay of one or more days.
- Labor induction method is used if the doctor determines that the age of the fetus is late in the second trimester. Labor induction usually requires a longer stay and is not performed in a clinic setting.
- The medicine to induce labor will be injected in one of two ways:
- directly into a vein; or
- through the belly into the amniotic sac.
- Labor will usually begin in two - four hours.
- If the afterbirth is not removed with the fetus during labor induction, the doctor must open the cervix and use suction curettage as described in the first trimester.
- Labor induction abortion carries the highest risk for problems, such as infection and heavy bleeding, stroke and high blood pressure.
- When medicines are used to start labor, there is a greater risk of rupture of the womb than during normal childbirth.
An abortion at this stage of your pregnancy may only be done if your doctor reasonably believes it is necessary to prevent your death or to preserve your health.
- Labor induction usually requires the woman to be admitted to the hospital.
- Labor will be started by injecting medicines into the woman's blood stream.
- Labor and delivery of the fetus during the third trimester are similar to childbirth.
- The duration of labor depends on the size of the baby and the readiness of the womb.
- As with childbirth, possible complications of third trimester labor induction include infection, heavy bleeding, stroke and high blood pressure.
- When medicines are used to start labor, there is an increased risk of rupture of the womb than during normal childbirth.
- Other immediate medical risks may include pelvic infection, incomplete abortion, blood clots in the uterus, heavy bleeding, cut or torn cervix, perforation of the wall of the uterus, anesthesia-related complications.
- This method requires that the woman be admitted into a hospital.
- A caesarean section may be performed if labor cannot be started by inducing labor, or if the woman or her fetus is too sick to undergo labor.
- A caesarean section is removal of the baby by surgically cutting open the belly and womb. The woman is made numb by medication, either injected into the vein or spine or inhaled into the lungs.
- Complications are similar to those seen with childbirth caesarean sections and with administration of anesthesia, such as severe infection (sepsis); blood clots to the heart and brain (emboli); stomach contents breathed into the lungs (aspiration pneumonia); severe bleeding (hemorrhage); and injury to the urinary tract.
- Other possible immediate risks include: pelvic infection, incomplete abortion, blood clots in the uterus, heavy bleeding, cut or torn cervix, perforation of the wall of the uterus, anesthesia-related complications.
The chance of the fetus' living outside the uterus (viability) increases as the gestational age increases. The doctor must tell you the probable gestational age of the fetus at the time the abortion would be performed.
- The physician who terminates the pregnancy must certify the medical reasons making performance of the abortion necessary and the probable health consequences if the abortion is not performed;
- The physician must select a procedure that is most likely to allow the unborn child to live; and
- A second physician must be in attendance to provide immediate medical care to the child born a result of the pregnancy termination.