Abortion Procedures and Risks

It may seem like abortion will wipe away this situation and you can just move on.  It’s not that simple.  Abortion is not just a simple medical procedure. For many women, it is a life changing event with significant physical, emotional, and spiritual consequences. Most women who struggle with past abortions say that they wish they had been told all of the facts about abortion and its risks.

Abortion Procedures

First Trimester Aspiration Abortion between 4-13 weeks after last menstrual period (LMP)

This surgical abortion is done throughout the first trimester. Depending upon the provider and the cost, varying degrees of pain control are offered ranging from local anesthetic to full general anesthesia. For very early pregnancies (4-7 weeks LMP), local anesthesia is usually given. Then a long, thin tube is inserted into the uterus. A large syringe is attached to the tube and the embryo is suctioned out.

Towards the end of the first trimester, the cervix needs to be opened wider to complete the procedure because the fetus is larger. This may  require a two-day process where medications are placed in the vagina, or a thin rod made of seaweed is inserted into the cervix to gradually soften and open the cervix over night. The day of the procedure, the doctor may need to further stretch open the cervix using metal rods. This is usually painful so local or general anesthesia is typically needed. Next, the doctor inserts a plastic tube into the uterus and then applies suction. Either electric or manual suction machines are commonly used. Manual Vacuum Aspirators (MVA) are becoming more popular in the U.S. The suction pulls the fetus’ body apart and out of the uterus. The doctor may also use a loop-shaped tool called a curette to scrape the fetus and fetal parts out of the uterus.  (The doctor may refer to the fetus and fetal parts as “products of conception.”) 1, 2, 3, 4

Dilation and Evacuation (D&E): between 13 to 24 weeks after LMP

This surgical abortion is done during the second trimester of pregnancy. In this procedure, the cervix must be opened wider than in a first trimester abortion because the fetus is larger. This is done by inserting numerous thin rods made of seaweed into the cervix a day or two before the abortion. Sometimes, other oral or vaginal medications are used to further soften the cervix. The day of the procedure, after anesthesia is given (local or general), the cervix is further stretched open using metal rods. Until about 16 weeks gestation, the procedure starts with a plastic tube inserted through the cervical opening and suction is applied. The suction pulls the fetus’ body apart and out of the uterus any remaining fetal parts are removed with a grasping tool (forceps). A sharp tool (called a curette) may also be used to remove any remaining tissue.

After 16 weeks, much of the procedure is done with forceps to pull fetal parts out through the cervical opening. The doctor keeps track of what fetal parts have been removed so that none are left inside to potentially cause infection. Lastly, a curette, and/or the suction machine is used to remove any remaining tissue or blood clot ensuring the uterus is empty. 5, 6, 7

Dilation and Evacuation (D & E) After Potential Viability: about 24 weeks and up

When the abortion is done at a point when a live birth is possible, injections are given to cause fetal death. This is done in order to comply with the federal law which requires that the fetus be dead before complete removal from the mother’s body. The medications (digoxin and potassium chloride) are either injected into the amniotic fluid, the umbilical cord or directly into the fetus’ heart. The remainder of the procedure is the same as described above.

An alternate technique called “Intact D and E” may also be used.  The goal of this procedure is to remove the fetus in one piece thus reducing the risk of leaving parts behind to cause infection, among other things. This procedure requires the cervix to be open even further by inserting the seaweed rods in the cervix two or more days prior to the abortion. Often it is necessary to crush the fetus’ skull for removal as it is difficult to dilate the cervix enough to bring the head out intact. 8, 9, 10

Medication Abortion RU486 (Abortion Pill)

This drug is only approved by the Food & Drug Administration  for use in women up to the 49th day after their last menstrual period; however, it is commonly used “off label” up to 63 days. This procedure usually requires three office visits. On the first visit, the woman is given pills to cause the death of the fetus. Two days later, if the fetus has not been expelled from her body, the woman is given a second drug (misoprostol) to accomplish this. One to two weeks later, an evaluation is done to determine if the procedure has been completed. 11, 12

RU486 will not work in the case of an ectopic pregnancy.  This is a potentially life-threatening condition in which the embryo lodges outside the uterus, usually in the fallopian tube. 13, 14

If an ectopic pregnancy is not diagnosed early, the tube may burst, causing internal bleeding and in some cases, the death of the woman.

Medical Methods for Second Trimester Induced Abortion

This technique involves the termination of pregnancy by the stimulation of labor-like contractions that cause eventual expulsion of the fetus and placenta from the uterus. Like labor at full term, this procedure typically involves 10-24 hours in the hospital labor and delivery unit. Digoxin or potassium chloride is injected into the amniotic fluid, or umbilical cord or fetal heart prior to the procedure in order to avoid the delivery of a live baby. The cervix may be softened either with the use of seaweed sticks, or medications at the start of the procedure. Various combinations of oral mifepristone and oral or vaginal misoprostol are the medications of choice for midtrimester pregnancy terminations.  These medications cause the pregnancy to detach from the uterus and the uterus to contract and expel the fetus and placenta, in most cases. Throughout the procedure, the patient may receive oral or intravenous pain medications. Occasionally, a scraping of the uterus is needed to remove the placenta. Potential complications include hemorrhage and the need for a blood transfusion, retained placenta and uterine rupture. The absolute risk of uterine rupture is not known. 15