What to Know About Surgical Abortion

There are various means through which abortions are done in the United States. The most common way, especially in the early stages of pregnancy, is by means of prescription medication, however many abortions are still done surgically. If you missed our blog on the abortion pill/medication abortion, feel free to check it out here. If you’re interested in learning more about surgical abortions, read on.

The type of surgical abortion done often depends on how far along in your pregnancy you are. Below are the three main types of surgical abortions. All of them involve artificially dilating a woman’s cervix and then removing a baby, placenta, and membranes from the uterus. All of these procedures are usually done with either local anesthetic (numbing medication injected at the cervix or surrounding area), twilight sedation (pain and relaxation medication administered through an IV), or sometimes under general anesthesia.  All three types should be done by licensed medical personnel, and all carry inherent risks to a woman’s health ₍₁₎.

Before 14 Weeks Gestation:

Vacuum Aspiration
The cervix is gradually opened/stretched using a series of dilators. The biggest dilator is about the width of a fountain pen.
Once the cervix is opened and the physician now has access to the uterus/womb, a tube is inserted into the uterus and connected to a suction device. The baby, placenta, and membranes are removed via the suction device.

Dilation and Curettage (D&C)
In a similar fashion to the vacuum aspiration abortion, the cervix is dilated using a series of dilators.
Once the cervix is opened and the physician now has access to the uterus/womb, a tool called a “curette” is used by the physician to scrape the lining of the uterus and remove the baby, placenta, and membranes.

Both procedures carry the risk of an incomplete abortion, pelvic infection, heavy bleeding, torn cervix, and perforated uterus ₍₁₎.

*Note about Incomplete Abortion: There is an inherent risk with any type of abortion of incomplete abortion, which is when fetal or placental parts are left behind in the uterus, causing potential infection and bleeding ₍₁₎. One important thing to note is that in the event a chemical abortion (abortion done via prescription medication) or surgical abortion does not result in the elimination of all fetal remains, an additional surgical intervention/abortion will be necessary in order to extract the remaining parts and prevent infection or further complications ₍₃₎. Surgical abortions carry inherent risks just as chemical abortions do, and the more procedures and interventions are done, the higher the risk for both short-term and long-term complications.

*Note about GA Law: In Georgia, the LIFE Act states that no abortion can be performed once a baby’s heartbeat is detected, which can be as early as 6 weeks gestation. Possible exceptions to this include a medical emergency or medically futile pregnancy, or cases involving rape or incest in which an official police report has been filed and where the probable gestational age of the unborn child is 20 weeks or less. For more on GA law surrounding abortion, see the Department of Public Health’s A Woman’s Right to Know pamphlet here.


After 14 Weeks Gestation:

Dilation and Evacuation
Because the size of the baby is larger at this stage of development, the dilation of the cervix may be done over a longer period of time (overnight or potentially 2 days). The dilation of the cervix is done with a series of dilating sticks, called laminaria or Dilapan ₍₂₎. These are often made of a seaweed or synthetic material that expands as they absorb moisture from the cervix or surrounding tissues. Larger ones may need to be placed depending on how quickly or readily your cervix dilates.
Once the cervix is opened and the physician now has access to the uterus/womb, medical instruments such as forceps and suction devices are used to remove the baby, placenta, and membranes. The baby may be dismembered in order to remove it from the uterus depending on the size and gestational age.

A D&E abortion carries with it risk of heavy bleeding, cut or torn cervix, perforation of the wall of the uterus, pelvic infection, weakened cervix, incomplete abortion, and anesthesia-related complications ₍₁₎.

The risk of complications for the woman increases with each week of pregnancy ₍₁₎.

*Note: In GA, this type of surgical abortion is limited to circumstances involving medical emergency, medically futile pregnancy, or rape or incest where a police report has been filed. For more on GA law surrounding abortion, see the Department of Public Health’s A Woman’s Right to Know pamphlet here.

Takeaway: Surgical abortions involve invasive procedures and inherent risks that should be heavily considered prior to choosing this form of abortion. A woman has the right to know all the inherent risks of any procedures she has done to her body. It is also important prior to any abortion, to confirm your pregnancy via a medical-grade pregnancy test, verify how far along you are in your pregnancy, and to rule out an ectopic pregnancy.

Pregnant and not sure what to do next? Have further questions about abortion types, procedures, and risks? Schedule a free and confidential nurse consultation here.

*The information contained in this blog is for educational and informative purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice and care of your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or treatment.*

Sources:
(1) Georgia Department of Public Health - A Woman’s Right to Know Brochure
(2) Second Trimester Abortion Procedure - Family Planning | UCLA Health
(3) Retained Products of Conception (RPOC): Causes, Risks & Treatment (clevelandclinic.org)