SURGICAL ABORTIONS CURETTAGE HYSTEROTOMY

Surgical abortions
MANUAL VACUUM ASPIRATION. Up to 10 weeks gestation, a pregnancy can be ended by a procedure called manual vacuum aspiration (MVA). This procedure is also called menstrual extraction, mini-suction, or early abortion. The contents of the uterus are suctioned out through a thin plastic tube that is inserted through the cervix; suction is applied by a syringe. The procedure generally lasts about 15 minutes.

A 1998 study of women undergoing MVA indicated that the procedure was 99.5% effective in terminating pregnancy and was associated with a very low risk of complications (less than 1%). Menstrual extractions are safe, but because the amount of fetal material is so small at this stage of development, it is easy to miss. This results in an incomplete abortion that means the pregnancy continues.

DILATATION AND SUCTION CURETTAGE. Dilation and suction curettage may also be called D & C, suction dilation, vacuum curettage, or suction curettage. The procedure involves gentle stretching of the cervix with a series of dilators or specific medications. The contents of the uterus are then removed with a tube attached to a suction machine, and walls of the uterus are cleaned using a narrow loop called a curette.

Advantages of an abortion of this type are:
• It is usually done as a one-day outpatient procedure.
• The procedure takes only 10 - 15 minutes.
• Bleeding after the abortion lasts five days or less.
• The woman does not see the products of her womb being removed.

Disadvantages include:
• The procedure is invasive; surgical instruments are used.
• Infection may occur.

The procedure is 97 - 99% effective. The amount of discomfort a woman feels varies considerably. Local anesthesia is often given to numb the cervix, but it does not mask uterine cramping. After a few hours of rest, the woman may return home.

DILATATION AND EVACUATION. Some second trimester abortions are performed as a dilatation and evacuation (D & E). The procedures are similar to those used in a D & C, but a larger suction tube must be used because more material must be removed. This increases the amount of cervical dilation necessary and increases the risk and discomfort of the procedure. A combination of suction and manual extraction using medical instruments is used to remove the contents of the uterus.

OTHER SURGICAL OPTIONS. Other surgical procedures are available for performing second trimester abortions, although are rarely used. These include:
• Dilatation and extraction (D & X). The cervix is prepared by means similar to those used in a dilatation and evacuation. The fetus, however, is removed mostly intact although the head must be collapsed to fit through the cervix. This procedure is sometimes called a partial- birth abortion. The D & X accounted for only 0.17% of all abortions in 2000.

• Induction. In this procedure, an abortion occurs by means of inducing labor. Prior to induction, the patient may have rods inserted into her cervix to help dilate it or receive medications to soften the cervix and speed up labor. On the day of the abortion, drugs (usually prostaglandin or a salt solution) are injected into the uterus to induce contractions. The fetus is delivered within eight to 72 hours. Side effects of this procedure include nausea, vomiting, and diarrhea from the prostaglandin, and pain from uterine contractions. Anesthesia of the sort used in childbirth can be given to reduce pain. Many women are able to go home a few hours after the procedure.

• Hysterotomy. A surgical incision is made into the uterus and the contents of the uterus removed through the incision. This procedure is generally used if induction methods fail to deliver the fetus.

Diagnosis/Preparation
The doctor must know accurately the stage of a womans pregnancy before an abortion is performed. The doctor will ask the woman questions about her menstrual cycle and also do a physical examination to confirm the stage of pregnancy. This may be done at an office visit before the abortion or on the day of the abortion.

Pre-abortion counseling is important in helping a woman resolve any questions she may have about having the procedure. Some states require a waiting period (most often of 24 hours) following counseling before the abortion may be obtained. Most states require parental consent or notification if the patient is under the age of 18.