Hailey Tran
Abortion is a medical procedure that can be carried out in different ways, depending on how far along the pregnancy is, the relevant laws in the state, and the patient's health. The two main types of abortions are medical and surgical. A medical abortion is a nonsurgical way to terminate a pregnancy in the first trimester, using a combination of medicines to stop the growth of the pregnancy and then cause the uterine lining to shed. A surgical abortion, on the other hand, is carried out by a doctor or trained nurse in a medical office, clinic, or hospital, and may involve procedures such as dilation and curettage (D&C) or dilation and evacuation (D&E).
| Characteristics | Values |
|---|---|
| Types of Abortion | Medical, Surgical |
| Medical Abortion | Uses prescription drugs to end a pregnancy |
| Surgical Abortion | Requires a procedure done by a doctor in a hospital or clinic |
| Abortion Procedures | D&E, D&X, labor induction, hysterotomy, hysterectomy, dilation and curettage (D&C) |
| D&E Procedure | Takes 10-20 minutes, requires ultrasound, prep work to soften and dilate the cervix, and medication to manage pain |
| D&X Procedure | Done by a specialized doctor for pregnancies with medical complications or serious problems with the fetus |
| Pain Management | IV anesthesia, nonsteroidal anti-inflammatory drugs (ibuprofen, naproxen) |
| Recovery | Bleeding and cramping are common, birth control can be started immediately |
| Risks | Infection, heavy bleeding, injury to uterus, bowel, or cervix |
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What You'll Learn
Surgical abortion: a procedure done by a doctor in a hospital
Surgical abortion is a medical procedure that ends a pregnancy. It is a good option for people who want their abortion completed in a hospital setting. Surgical abortions are very safe and effective more than 99% of the time. They are usually performed in the first trimester, but can sometimes be carried out in the second trimester.
Before the procedure, a doctor or nurse may give you medication to help with cramping and to open your cervix, the passage between your vagina and uterus. Doctors may insert small dilators into the cervix a few hours before the procedure, or even the day before. These dilators absorb fluid from your body and slowly expand, widening your cervix. You will also be offered light sedation, which may make you sleepy and calm, or put you to sleep completely.
During a surgical abortion, doctors use gentle suction to remove the contents of the uterus. This is known as vacuum aspiration and is the most common type of in-clinic abortion. It is usually used until about 14-16 weeks after your last period. Dilation and Evacuation (D&E) is another kind of surgical abortion procedure. It uses suction and medical tools to empty your uterus and is performed later in a pregnancy than aspiration abortion, usually after 16 weeks.
After the procedure, your doctor will examine your uterus to make sure the abortion is complete. You will then be taken to a recovery room until you feel better and are ready to leave. You will typically be given instructions on how to care for yourself after the procedure, and you may be prescribed antibiotics to prevent infection.
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Medical abortion: a combination of drugs to end an early pregnancy
A medical abortion is a non-surgical method of terminating a pregnancy in its early stages. It involves taking prescription medication to end the pregnancy. This method is also known as a medication abortion or abortion with pills. It is considered a safe and effective procedure with rare complications.
The most common regimen for a medical abortion involves taking two pills—mifepristone and misoprostol. Mifepristone blocks progesterone, the hormone required for a pregnancy to grow and develop. Misoprostol, the second medicine, is administered up to 48 hours later. It induces cramping and bleeding to empty the uterus. This combination of drugs can be used for at-home abortions up to 12 weeks into a pregnancy. The U.S. Food and Drug Administration (FDA) has approved this method as safe and effective for up to 10 weeks of gestation. However, evidence suggests that it is safe and effective beyond this timeframe as well.
The effectiveness of the abortion pill depends on the stage of pregnancy and the dosage of medicine. The earlier the pregnancy, the higher the success rate. For instance, at 8 weeks or less, the abortion pill works about 94-98% of the time. At 9-10 weeks, the success rate is approximately 91-93%. Taking an extra dose of misoprostol increases the effectiveness to about 98-99%.
While medical abortion is generally safe, there are some potential risks and side effects. These include heavy bleeding, diarrhea, digestive pain, allergic reactions, and infection. It is important to carefully follow the prescribed medication instructions to minimise health risks. After a medical abortion, most providers will schedule a follow-up appointment to ensure recovery and confirm the absence of pregnancy.
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Dilation and curettage: a surgical abortion procedure
Dilation and curettage (D&C) is a surgical abortion procedure. It is a commonly used method for first-trimester abortions. The procedure involves dilating (widening or opening) the cervix and then surgically removing tissue from the lining of the uterus by scraping or scooping (curettage). The amount of dilation depends on the amount of tissue to be removed and the size of the instruments used.
Before the procedure, a speculum is placed in the vagina to visualise the cervix, which may be stabilised with a tenaculum. Cervical dilation can be achieved with Hegar dilators or similar instruments.
After sufficient dilation, a curette, a metal rod with a handle on one end and a loop on the other, is inserted into the uterus through the dilated cervix. The curette is used to gently scrape and remove the uterine lining and tissue. If a suction curette is used, a plastic tubular curette is introduced and connected to a suction device to remove all tissue from the uterus. The tissue is then examined for completeness or by pathology for abnormalities.
The most common complications associated with D&C include infection, bleeding, or damage to nearby organs, including through uterine perforation. Aside from the surgery itself, there are also risks related to anaesthesia administration. Infection is uncommon after D&C for a non-pregnant patient, and prophylactic antibiotics are not routinely recommended.
The use of dilation and curettage for abortion has been declining due to the availability of medication-based non-invasive methods. Suction curettage is now the most common method to ensure complete removal of remains. The World Health Organization recommends D&C with a sharp curette only when manual vacuum aspiration with a suction curette is unavailable.
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Dilation and evacuation: a procedure used later in pregnancy
Dilation and evacuation (D&E) is a type of in-clinic abortion procedure that can be performed in the second trimester of pregnancy. It is often carried out in a clinic but can also be done in a hospital. The procedure typically lasts less than 30 minutes, but patients may need to stay in the hospital or clinic for a few hours for observation.
Before the procedure, patients are given medicine to reduce pain and help them relax. An ultrasound is also performed to determine the gestational age of the fetus and confirm the number of weeks of pregnancy.
To prepare the cervix for the procedure, a healthcare provider may insert thin rods called dilators into the cervix a day or a few hours beforehand. These dilators slowly stretch the cervix, making it wider. Additionally, the patient may be given medicine the night before the procedure to soften the cervix and make it easier to widen. Antibiotics may also be administered to prevent infection.
During the D&E procedure, a speculum is inserted into the vagina to widen it and allow access to the cervix. The dilators are then removed, and the cervix is cleaned with an antiseptic cleanser. The healthcare provider uses a tool to hold the uterus steady and then opens the cervix further with a series of dilators of increasing sizes. Once the cervix is open wide enough, a tube called a cannula is inserted into the uterus. This tube is attached to a bottle and a pump, which creates suction to remove tissue from inside the uterus. Large pieces of tissue may also be removed using large, rounded tweezers called forceps.
After the procedure, patients are taken to a recovery area where they are monitored until they are ready for discharge. This typically involves staying in the recovery area for about an hour, although patients may experience irregular bleeding or spotting and cramps similar to menstrual cramps for the first two weeks after the procedure.
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Pain management: medication to help with cramping
Abortion is a safe and low-risk procedure, but it may cause some pain, cramping, and other side effects. The level of discomfort varies from person to person and depends on the type of abortion, medications, and pregnancy stage. Medical abortions, which use a combination of drugs, may cause pain and cramping as the uterus contracts to expel the pregnancy tissue. Surgical abortions, on the other hand, involve a procedure performed by a healthcare provider and typically involve the use of local or general anesthesia, resulting in minimal pain during the procedure. However, some cramping may occur afterward.
For pain management during medical abortions, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen are recommended. Ibuprofen has been found to be more effective than acetaminophen or a placebo in relieving pain during medical abortions, especially in pregnancies of less than seven weeks of gestation. It is suggested to take pain relief medication before taking the second medication (misoprostol) or when cramps start to build up. Other over-the-counter (OTC) medications can also be used, and doctors can prescribe stronger medications if needed.
In addition to medication, non-pharmacologic pain management strategies can be employed. These include:
- Using a hot water bottle, heat pack, or warm compresses on the lower abdomen
- Taking warm baths, if recommended by a healthcare professional
- Applying transcutaneous electrical nerve stimulation (TENS) to the abdomen and back when cramping begins
It is important to note that some pain during a medical abortion is typical, and severe pain is usually short-lived and relieved when the pregnancy passes. However, if you experience intense pain, a fever over 100°F, or soak through more than two pads per hour, it is crucial to contact your healthcare provider or their emergency contact right away.
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Frequently asked questions
There are two main types of abortions: medical and surgical. A medical abortion uses a combination of prescription drugs to end a pregnancy in the first trimester. A surgical abortion, on the other hand, is a procedure performed by a healthcare provider in a medical office, clinic, or hospital.
A medical abortion uses a combination of two medicines, mifepristone and misoprostol, to end a pregnancy. Mifepristone blocks progesterone, the hormone needed to support a pregnancy, while misoprostol causes cramping and bleeding to empty the uterus.
There are several types of surgical abortion procedures, including suction abortion (also called vacuum aspiration), dilation and curettage (D&C), and dilation and evacuation (D&E). Suction abortion uses gentle suction to empty the uterus and is usually performed until about 14-16 weeks after the last period. D&E is typically used after 16 weeks and involves using suction and medical tools to safely empty the uterus.
Before a surgical abortion, you will meet with a nurse, doctor, or counsellor to discuss your options and ensure abortion is the right decision for you. You will undergo an exam, lab tests, and possibly an ultrasound to determine how far along you are in your pregnancy. Your cervix may also need to be prepared by using medicine or dilators to gradually open it.
After a surgical abortion, you will be monitored to ensure your pain and bleeding are under control, and you may be given juice, water, or a snack. You will stay in a recovery area until you feel better and are ready to leave. You will also receive instructions on how to care for yourself after the procedure and may be offered birth control options.
