Surgical Termination of Pregnancy: Helpful Guidelines
Dr. Saloni Manwani

Dr. Saloni Manwani

May 22Pregnancy and fertility

Surgical Termination of Pregnancy: Helpful Guidelines

This article has been compiled by Vaibhavi Kodnani, a content writer at Proactive For Her.

 

What is surgical abortion?

Surgical termination of pregnancy or surgical abortion involves using surgical methods to terminate an unwanted pregnancy. An experienced doctor can perform this procedure in the clinic or the hospital. There are two methods of surgical abortion.

  • Aspiration abortions
  • Dilatation and curettage or D&C abortions

When is surgical abortion done?

Surgical abortion is allowed if the pregnancy is less than 12 weeks. The decision to opt for this method of termination of pregnancy depends on the doctor’s advice and the woman’s approval.

Who can opt for a surgical abortion?

Generally, surgical abortion is recommended in the following situations:

  • If the medical abortion has failed
  • If concurrent sterilization is required
  • If there are contraindications for medical abortion, such as heart disease

 

Who cannot opt for a surgical abortion?

The doctor cannot perform a surgical abortion for a woman whose pregnancy has exceeded 12 weeks. In case it crosses the first trimester, they will do induction of labour and delivery. Apart from that, there are no other restrictions.

 

What is the effectiveness of surgical abortion?

Surgical abortion is considered safer than medical abortion. With more than 95% efficacy, this method is also more effective.

 

What is the procedure of surgical abortion?

Preparing for surgical abortion is not too elaborate. You will have to go through a few tests and take some precautions before the operation. It is a quick procedure and you may be discharged on the same day itself.

 

Before the procedure

During your initial visits to the clinic or hospital, the doctor will perform a few tests and official procedures before proceeding with the surgical abortion.

  1. Pregnancy test: The doctor will do this to confirm the pregnancy.
  2. Ultrasound test: This test will help in recognizing the age of the pregnancy, i.e. the number of weeks pregnant you are. If you are less than 12 weeks pregnant, you can go for surgical abortion. 
  3. Other tests: Blood tests are done to check your CBC, blood group, blood sugar and serology.
  4. Signing consent papers: Once you are proven eligible for the surgical abortion, you will have to sign the abortion consent papers.  
  5. Date for abortion: Lastly, the doctor with schedule a date for the abortion.

 

Preparing for the procedure

Your doctor will guide you about the dos and don'ts before the abortion. Here a set of general instructions given before undergoing an abortion:

  • Don’t smoke, eat or drink anything (not even water) for about six hours before the operation.
  • Carry sanitary pads with you on the day of the abortion.

 

On the day of the surgical abortion

Surgical abortion is divided into two types:

  • Aspiration abortion
  • Dilatation and curettage or D&C (also called dilation and evacuation or D&E)

All the steps except the last one for both kinds of surgical abortion are the same. The entire operation takes less than 15 minutes.

1. You will lie down on your back on the bed or exam table with your feet on elevated footrests.

2. Before the operation, anaesthesia is administered to manage the pain. Depending on various factors, your gynaecologist and anaesthetist will decide the kind of anaesthetic. The anaesthetic options include:

General anaesthetic: General anaesthetic puts you in a state of ‘twilight sleep’, where you are awake but sedated and calm. However, any operation done under general anaesthetic carries some risk.

Local anaesthetic: The anaesthetic is injected into the cervix to make that area numb. You will not feel anything during the operation. Local anaesthetic with intravenous sedation: This involves a combination of local anaesthetic and intravenous sedation. The local anaesthetic is injected directly into the cervix, and the sedative medication is put into the vein using an intravenous line.

3. Using a device called dilators (rods), the doctor will gradually widen your cervical opening.

4. Then, they will insert a slim tube into the uterus.

5. With a gentle suction, the pregnancy tissues, including the fetus and the placenta, are withdrawn through the tube.

6. Lastly, an instrument called a curette is used to check if the uterus is empty.

7. In dilatation and curettage, all the previous steps are the same. But if any more pregnancy contents are remaining in the uterus, they are removed using a curette.  

 

After the procedure 

  1. Discharge: The doctor will decide whether you will be immediately discharged or a day later based on your recovery. 
  2. Side-effects: You may experience slight pain and discomfort with minimal bleeding. Some women might also feel nauseous and vomit.
  3. Painkillers: For easing the pain, your doctor will prescribe you painkillers. 
  4. Next menstruation: You will get your next menstruation 4-6 weeks after the surgical abortion, provided there are no complications.
  5. Sexual intercourse after abortion: You must wait for at least 1-2 weeks after the abortion for having sex.

 

What are the complications associated with a surgical abortion?

Complications of surgical abortion can include:

Haemorrhage: Usually, you can expect some bleeding after the abortion. It would resemble a menstrual period. However, the occurrence of heavy bleeding may suggest that the abortion is incomplete. The treatment for it includes doing a suction curettage of the uterus to remove the remaining pregnancy tissues. In rare cases, a blood transfusion may be required.

Infection: If you develop a fever after the abortion, it may be due to an infection. An incomplete abortion or a sexually transmitted infection can lead to the development of an infection. Sometimes, women can develop a chronic infection called pelvic inflammatory disease (PID). Treatment includes taking antibiotics.

The other two below-mentioned complications are rare occurrences as surgical abortions are performed by experienced surgeons.

Injury to the uterus: The walls of your uterus are muscular but soft. If the surgical instruments injure the uterus, it could lead to an abdominal infection (peritonitis) and severe blood loss. It is a rare complication, but if it happens, it is treated without any delay.

Injury to the cervix: For the surgical abortion, your cervix stretches. In the case of multiple procedures, the cervix can weaken. This condition is known as incompetent cervix. Having an incompetent cervix can cause problems in the future when you conceive again because it will be too weak to remain fully closed under the weight of a growing pregnancy.

 

What are the advantages of a surgical abortion?

Surgical abortion is a quick procedure with very few complications. You are more likely to have a complete abortion in the first attempt itself through this method. Very few cases are reported with an incomplete abortion wherein the pregnancy is not completely evacuated.

How soon can you recover and return to your normal activities?

After the surgical abortion is complete, rest for a few days. Mostly, you can get back to your usual routine within a week.

 

When should you see your doctor?

If you notice any of these symptoms, go to the hospital immediately.

  • Fever
  • Pain in abdomen
  • Vaginal bleeding
  • Foul-smelling vaginal discharge
  • Missed periods

 

Bottom line

Surgical abortion can be performed in the first trimester, i.e. before 12 weeks of pregnancy. After the doctor conducts a proper diagnosis by conducting some tests, they can decide if you are eligible for surgical abortion. Consult your doctor for further information and advice on this subject.

 

Disclaimer: This information is provided for educational purposes and should not be construed as medical advice. Please consult with your healthcare practitioners before undertaking any changes in your diet or adding supplements.

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