Do you have questions about surgical abortion?
Please contact us or call by phone: (585) 473-8770.
Many women in the Rochester and surrounding areas choose to undergo a surgical abortion. The reasons for choosing surgical abortion vary. Often women are beyond 7-9 weeks pregnant and prefer the relative predictability and simplicity of a surgical procedure. In other instances women prefer to be “asleep for the procedure” and have it completed in a physician’s office in a short period of time.
Surgical abortion – 0 – 63 days
Between conception and 63 days gestation, a woman may choose between a medical abortion and a surgical abortion. Both medical and surgical abortions are safe methods and may be performed up to 63 days of gestation as calculated from the first day of your last menstrual period. Surgical abortions have been studied for many decades and have an excellent safety record with a very low risk of complications in experienced hands.
The effectiveness of surgical abortion is well over 99%–a little better than with medical abortion. However, both procedures may require a suction “completion” in about 4-5% of cases because of retained tissue or clots. With medical abortions, the abortion happens in the privacy of one’s own home at any hour of the day or night. Early surgical abortion allows the termination to be performed under controlled circumstances.
What are the advantages of early surgical abortion?
Surgical abortions have the ‘advantage’ of allowing the woman to be treated with intravenous sedation during the most difficult portion of the procedure. This is often beneficial for women who are very anxious. You should discuss both surgical and medical abortion options with your physician or healthcare provider and arrive at the best possible choice for you!
What are the disadvantages of early surgical abortion?
Frankly, not many. Operator skill and experience are very important to your safety and well-being. Additionally, the procedure is highly dependent on sonographic (the use of ultrasound) skills and adherence to a strict protocol. In the presence of a known genital tract anomaly (double uterus, double cervix, double vagina), or severe cervical stenosis (a cervix which is scarred), early medical abortions may be safer than early surgical abortions.
How safe is early surgical abortion?
Surgical abortion within the first 63 days are extremely safe. Uterine perforation is rare—especially with the use of ultrasound guidance. Infections occur in less than 1% of cases.
Can women receive intravenous sedation for early surgical abortion?
What happens on the day of the procedure?
Women are asked to bring the following information: the date of their last menstrual period (LMP), insurance information, results of a urine or serum pregnancy test, and Rh type (if known). If a woman is planning on receiving intravenous sedation, she should be accompanied by an adult who must remain in our waiting room during the entire procedure. You will be asked to not eat or drinking anything for 4 hours prior to your procedure.
Please understand that we ask that you do not bring young children with you. The actual procedure takes 2-4 minutes, excluding the time necessary for ultrasound examinations (about 1-2 minutes). MicRhoGAM will be administered to all Rh negative women. If you are receiving intravenous sedation you should expect to spend 30-60 minutes at our office for observation.
What is the procedure like?
Patients who receive intravenous sedation are essentially pain free.
Women who choose not to have sedation will experience the stimulus of surgical manipulation differently. Most women will experience some cramps during dilation—the intensity varies from one woman to the next.
Is sedation necessary?
Abortion, unlike other surgical procedures, is not emotionally neutral. Many complex issues confront a woman undergoing abortion in a very short period of time. Our objective is to provide for your comfort without being judgmental. We often encourage women to take advantage of intravenous sedation if they feel they can benefit from it.
What if a woman wishes to begin the procedure without sedation and then changes her mind?
No problem. This happens all the time. You will need to have someone here, however, to drive you home.
What happens after the procedure?
Patients are given routine postoperative instructions, prophylactic antibiotics, contraceptive advice and/or a prescription, and, whenever appropriate, MicRhoGAM. Follow up appointments for a post-operative ultrasound are scheduled for 2-3 weeks after a surgical abortion.
Does insurance cover the procedure?
The vast majority of Rochester-area carriers, as well as private insurance companies, do cover the majority of the procedure costs. We check each contract individually for your specific coverage.
What are my limitations afterwards?
Patients will be asked to refrain from driving the day of the procedure if they have received intravenous sedation. Otherwise, a woman should plan on spending several hours resting at home before resuming her normal activity.
Are there any long-term risks that I should know about?
The risk to future fertility and subsequent premature delivery is virtually immeasurable. Surgical abortion is an exceptionally safe procedure.
Surgical abortion through 12 weeks
During this period, the risks of surgical abortion are actually less than with medical abortion, and therefore surgical abortions are performed from this point on in gestation. Intravenous sedation and narcotics are made available to all women. Surgical procedures are extremely safe during this period.
Surgical abortions involve a two-step process: dilation of the cervix and vacuum aspiration. Beyond 10 weeks of gestation we often insert a laminaria the day prior to your surgical procedure. A laminaria is actually about the size of a small matchstick and is made of seaweed. The laminaria swells over the next 24 hours allowing us to introduce a suction tubing on the day of your procedure. Cervical dilation can also be accomplished by inserting a medication called misoprostol which softens the cervix. This is typically inserted a few hours prior to your office visit. In other instances dilation is performed with plastic or mechanical dilators. The choice of dilators will depend on many factors which you will discuss with your health care provider.
The suction portion of the procedure involves the insertion of a vacuum tube into the uterine cavity. Both dilation and suction are carried out under ultrasound guidance to minimize the risk of injury to your uterus.
Frequently Asked Questions
Can complications occur following a surgical abortion (4-12 weeks)?
Yes. Although uncommon complications do occur. The most common complication of an abortion is retained tissue or retained blood clots. The treatment for this complication is most often a re-suction procedure. The next most common complication is infection — occurring in less than 1% of all women who have abortions. Hemorrhage is a very uncommon complication of surgical abortions and occurs in less than 1 in 1000 abortion procedures and hysterectomy occurs in fewer than 1 in 10,000 procedures. But keep in mind that the complication rate increases with gestational age. This is why—if at all possible– you should undergo any abortion procedure sooner rather than later in pregnancy.
Can complications be prevented?
Although complications can never be completely prevented, their incidence can be minimized. We do our best to minimize complications by providing you with a vast amount of experience, ultrasound guidance during and after your procedure and the best technology available. You can help by following all of the postop instructions that we supply. It’s important to take any antibiotics that are prescribed or supplied. You should call us immediately if you have any concerns about infection, excessive bleeding, fever, or excessive pain. We would rather you call us only to out find that your concern is not a medical problem, than have you wonder if you should. As a rule, if you have a question or a doubt, call us.
Will there be any pain during or after the abortion?
Surgical abortion without sedation
Yes. In most cases there is real—albeit brief– pain for women who choose to have their procedure under local anesthesia. This pain varies from mild to severe and depends on the individual – some women having a higher pain threshold than others. The pain may last no more than 30-60 seconds and is often described as similar to a labor pain or a severe menstrual cramp. You may prevent some of the pain by taking aspirin (two tablets), ibuprofen (400-800mg), or Aleve (two tablets), approximately 30-60 minutes prior to the procedure.
Surgical abortion with intravenous sedation
Many women choose to have intravenous sedation during the actual procedure. In the mid-trimester the use of these medications is required. These medications are very effective and nearly always provide a pain-free experience.
Will an abortion affect my ability to have children in the future?
Numerous studies have concluded that there is no impaired fertility after a medical or a surgical abortion in the first trimester. Furthermore, women who have undergone abortions are no more prone to have miscarriages in subsequent pregnancies than are women who have never had one.
How will I feel afterwards?
Some women are very relieved after the procedure while others are tired and emotionally drained. Many women are very sad and tearful while other struggle with guilt. There are a wide range of responses, and they vary considerably from one woman to the next.
Grief is a very common experience. Terminating a pregnancy involves a great loss to many women — often the grief is similar to what one experiences when losing a close friend or relative. For many women, the grief over a pregnancy termination is worse because of the relative secrecy and stigma surrounding the decision.
Guilt is also a common emotion following an abortion. Often, women experience a very real fear that they are “going to pay for this” in some way. They may feel that they won’t be able to have children when they are ready to. This guilt is a normal reaction to a very difficult choice.
Each woman experiences the grief process differently, so it’s difficult to set a time limit as to when these feelings should begin to subside. In general, if feelings of grief or guilt begin to interfere with normal daily functions, such as sleeping, ability to perform at work, or eating, you should call us to discuss whether or not you might wish to come into our office for counseling.
The use of ultrasound during and after a surgical abortion—improving safety
Ultrasound guidance is a technique whereby we place an ultrasound probe on your abdomen during any surgical procedure involving the placement of instruments inside the uterus. Without ultrasound the procedure is “blind” and the doctor operates exclusively by “feel”. Ultrasound allows us to actually “see” inside the uterus and prevents the vast majority of injuries to the uterus through the use of instruments. We believe that the use of ultrasound guidance greatly reduces the risk of injury and perforation to the uterus and makes your procedure safer.
Following a surgical abortion we perform a postoperative ultrasound to insure–to the extent possible–that no significant amount of tissue is left behind. This reduces the risk of prolonged vaginal bleeding following your procedure.