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Abortion - surgical

Definition

A surgical abortion is a procedure that ends a pregnancy by removing the fetus and placenta from the mother's womb (uterus).

There are different types of surgical abortion.

Sometimes the woman needs the procedure for a health reason. This is called a therapeutic abortion.

Other times, she chooses (elects) to end the pregnancy. This is called an elective abortion.

See also:

Alternative Names

Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical

Description

A surgical abortion uses a vacuum to remove the fetus and related material from a woman's uterus (womb). The procedure is usually done after 6 weeks of the woman's last menstrual period

You may receive medicine (sedative) to help you relax and feel sleepy. The doctor may numb the cervix so you feel little pain during the procedure.

If the surgical abortion is done after 12 weeks of pregnancy, the doctor must first open (dilate) the cervical canal. Small sticks called laminaria are placed into the cervix to help it open. Sometimes, this is done a day or two before the actual abortion procedure. Next, the doctor inserts a hollow tube into the womb before using the vacuum to remove the pregnancy-related tissues from the womb.

Medicines may be given to help the uterine muscles contract. This reduces bleeding.

Why the Procedure Is Performed

There are several reasons a surgical abortion might be considered:

  • The developing baby has a birth defect or genetic problem
  • The pregnancy is harmful to the woman's health (therapeutic abortion)
  • The pregnancy resulted after a traumatic event such as rape or incest
  • The woman may not wish to be pregnant (elective abortion)

The decision to end a pregnancy is very personal. Most health care providers recommend careful counseling before making such a decision.

Abortion is a controversial issue. A woman who chooses to end a pregnancy may feel she cannot share her decision with others. Therefore, it is important for her to identify those who may help her through what may be a difficult time.

Women who are trying to make this difficult decision should find a safe place in which they can obtain counseling regarding all options for pregnancy resolution.

If a woman chooses to have an abortion, she should find a safe place to have the procedure performed and obtain the proper support and follow-up care afterwards.

Risks

Risks of surgical abortion include:

  • Damage to the womb or cervix
  • Emotional or psychological distress
  • Excessive bleeding
  • infection of the uterus or fallopian tubes

The risks of surgical abortion increase as a woman gets further along in her pregnancy. That's why it's important to make a decision about abortion as early as possible, when the procedure is safest.

The risks for any anesthesia are:

  • Reactions to medications
  • Problems breathing

The risks for any surgery are:

  • Bleeding
  • Infection

Call your health care provider if you have had a surgical abortion and you have:

  • Excessive vaginal bleeding (may lead to shock)
  • Continued pain or pregnancy symptoms (possible sign of ectopic pregnancy)
  • Signs of infection, including persistent fever, vaginal drainage with a foul odor, vaginal drainage that looks like pus, or abdominal pain or tenderness

After the Procedure

Complications rarely occur. Most women who have a surgical abortion in an appropriate medical center recover without any physical complications.

Some women may need psychological and emotional support at the time of their procedure. It's important to seek counseling before making this very difficult decision.

Outlook (Prognosis)

Physical recovery usually occurs within a few days, depending on the stage of the pregnancy. A small amount of vaginal bleeding and mild uterine cramping should be expected for a few days.

A hot bath or use of a heating pad or hot water bottle on the abdomen may help relieve discomfort. Strenuous activity should be avoided for a few days following an abortion. Tampons may be used after 3 days. Sexual intercourse should be avoided for 2 to 3 weeks. A normal menstrual period should occur 4 to 6 weeks after the operation.

It's important to begin using birth control immediately after the abortion procedure. It is possible to get pregnant again even before having a normal menstrual period. Improved methods of contraception can help prevent many unplanned pregnancies. However, unplanned pregnancies occur even when couples use birth control. See also: Emergency contraception

References

Mischell DR. Family planning: contraception, sterilization, and pregnancy termination. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 14.

Simpson JL, Jauniaux ERM. Pregnancy loss. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 24.

Annas GJ, Elias S. Legal and ethical issues in obstetric practice. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 5th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2007:chap 51.


Review Date: 2/19/2009
Reviewed By: Linda Vorvick, MD, Family Physician, Seattle Site Coordinator, Lecturer, Pathophysiology, MEDEX Northwest Division of Physician Assistant Studies, University of Washington School of Medicine; and Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.
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