Friday, January 13, 2012
Surgical Abortion : Types, Procedure, Advantages & Risks
Types of Surgical Abortion
There are quite a few ways in which a pregnancy can be terminated via surgery. In other words, there are several surgical abortion methods. The type of surgical abortion that will or should be used mainly depends on the age of gestation i.e. how far along the pregnancy has progressed plus any prior or existing health problems in the woman who is about to undergo the surgical abortion. Based on the age of gestation, the surgical abortion methods that are regularly employed are as follows:
Manual Vacuum Aspiration (MVA)
Also knowns as suction aspiration, is the most common surgical abortion procedure, used up to the first twelve weeks of pregnancy and sometimes all the way up to the 14th week at the doctor’s discretion. There is no general anesthesia involved although there will be some medication administered to ease any pain or discomfort experienced during the procedure. A local anesthetic is administered to the cervix, which is then slightly dilated and held open by an instrument known as tenaculum. Then a cannula – a long tube with a suction device at the end of it – is inserted through the cervix and into the uterus, whereupon the contents of the pregnancy are literally vacuumed out. This whole surgical abortion procedure may take about 10 to 15 minutes.
Dilation & Curettage or D&C
Is another very simple and safe procedure for surgical abortion. The cervix is prepared in the same way as for an MVA. Then a curette – a thin, long surgical knife – is inserted and used to scrape away the uterine wall where the embryo is implanted, thus terminating the pregnancy. Sometimes, a cannula is also used after the curette to suction away the remains of the pregnancy. In this case, the surgical abortion method will be known as a suction curettage. The procedure takes about ten minutes.
After the 16th week of pregnancy and up to the 19th week – considered late-term surgical abortions – the following surgical abortion methods have a better chance of success.
Dilation & Evacuation or D&E
Is a little more complicated than a D&C or an MVA. The procedure usually begins about 24 hours before the actual surgery. A synthetic dilator known as laminaria will be inserted in the cervix. This will cause the cervix to dilate over the next 24 hours., which is necessary since the foetus is bigger at this point and a larger cervical opening will be required to carry out the surgical abortion. When you come in for the surgical abortion the next day, a cannula will first be used to suction tissue from the lining of the uterine wall. Then a curette is used to scrape away residues and cut the larger pieces of the foetus into smaller, more manageable ones. The larger pices may need forceps to be removed properly. A final suctioning is done to ensure that no bits are left inside. The procedure takes about half an hour.
After the 19th or 20th week of pregnancy, most doctors will refuse to conduct a surgical abortion unless the mother’s life is at stake. This is because a surgical abortion is just too risky after this point and can have serious repercussions. However, this does not mean that you have no say in the matter if you decide to terminate your pregnancy even at this late time. If you understand the risks and are willing to go through with the surgical abortion anyway, the following surgical abortion methods may be employed:
An Abdominal Hysterotomy is just like a C-section or a cesarean delivery. A cut will be made on the lower abdomen and into the uterus. The only difference is that the umblical cord will be severed completely so that the baby cannot survive. The dead foetus will then be removed along with the placenta and the abdominal and uterine cut is stitched up.
Dilation and Extraction or D&X
Is also known as partial birth abortion. Just like D&E, laminaria is used to dilate the cervix, but here it is about 2 days before the D&X. Usually, the water breaks on the third day when you return to the hospital or clinic. Since the baby is not head down yet, forceps will be used to turn the baby the right way, and then to pull the baby’s head, shoulders and arms out. A cut is made at the back of the baby’s skull, and a suction catheter is inserted to vacuum out the contents. The skull collapses in on itself after this. The baby is removed fully from the uterus along with the placenta.
Involves inducing labour by introducing medications that cause the uterus to contract. The baby is soon delivered and left to die. This method is not very unpopular with both patients or doctors and is rarely used anymore.
Side Effects of Surgical Abortion
After the surgical abortion, you can expect to experience some of the following side effects to some degree. However, every woman is different. So for all you know, you may not experience any side effects at all.
Bleeding will most likely occur after the surgical abortion. The level of bleeding will differ.
Clotting may occur too.
Spotting will also likely take place for a few weeks after the surgical abortion.
Period-like cramping which may last anywhere from a few hours to a few days. This usually goes away on its own or with the use of over-the-counter pain medication. It has been seen that the more negative emotions associated with the surgical abortion, the greater the pain that is felt.
The intensity of the side effects of surgical abortion will not be the same for every woman. If the pain or bleeding gets too intense or lasts longer than two weeks, it is an indication of a problem and you should tell your doctor.
Risks and Complications of Surgical Abortion
All surgeries have risks, and there is always a small possibility of future complications even with a procedure as routine as an abortion. The longer you wait to get your surgical abortion the more complicated the procedure of performing the abortion and thus the higher the risk and thus the complications arising from the surgical abortion.
There may be damage to the cervix as a result of the surgical abortion. This can cause infection or problems in the functioning of the cervix. It may lead to complications in future pregnancies. Damage to the cervix may be one of the causes of miscarriage, especially if surgical abortions are repeated.
Similarly, the uterus or womb may be damaged as well in a surgical abortion, which could result in problems getting pregnant or pregnancy complications in the future. However, uterine and cervical damage occur in less than 1% of all surgical abortions conducted worldwide.
The main complication of a surgical abortion that worries patients and doctors alike is hemorrhage. A hemorrhage is basically excessive bleeding. This can occur as a result of insufficient clotting of the blood or an improperly conducted surgical abortion. However, rest assured that hemorrhage or excessive bleeding occurs in less than .01% of all surgical abortions. But since it is a rather fatal complication of surgical abortions, your doctor will ensure that there is no chance of it happening by making sure you are not on any anti-coagulant medication, do not and never have suffered from blood disorders and renal failure, and have not recently taken aspirin which is a natural blood thinner. You will also be asked to avoid certain foods that act as natural blood thinners a few days before the surgical abortion is conducted.
There is a small chance that pieces of the pregnancy may be left behind in the womb even after the surgical abortion is complete. This is what causes infection. If left untreated, infections can cause damage to other parts of your reproductive system as well. In extreme cases, infection can even be fatal.
Some studies have linked multiple surgical abortions to infertility. This may be true if the uterus or cervix or other parts of the reproductive system are nicked or ruptured during the surgical abortion.
Surgical abortion may leave a scar on the uterus which increases the risk for pregnancy complications like placenta previa. Surgical abortion is also linked to an increased possibility of miscarriage in future pregnancies.
There are also several studies that link surgical abortion to increased incidence of ectopic pregnancies.
Another pregnancy complication that multiple surgical abortions have been linked to is premature delivery which leads to its own set of further risks for the baby. But this is highly disputed since most first-time mothers give birth prematurely regardless of whether or not they have had a surgical abortion before. Since a majority of the women undergoing surgical abortion are younger than 25 and have never had children before, it is reasonable to assume that the data that points towards the link between premature delivery and surgical abortion has nothing to do with the abortion itself but rather that these women were having children for the first time themselves.
Surgical abortion can make you more prone to pelvic infections in the future, not necessarily just after the procedure.
If you are undergoing a surgical abortion method which requires the use of anesthesia, this automatically increases your risk, albeit slightly, for heart attack, convulsions, and even death.
Advantages of Surgical Abortion
The biggest advantage of a surgical abortion is that it takes less time to complete than a medical abortion. The surgical abortion procedure itself can take as little as 5 to 10 minutes and only as long as 30 minutes. The remaining time you spend at the clinic will be preparation before the surgical abortion and about half an hour or so of recovery time after the surgical abortion is complete. Since it takes such little time, it is less of an emotional trauma for the women involved. It all happens in the doctor’s clinic and it’s over and done with in the span of two to three hours. But this only applies to surgical abortion in the first 20 weeks of pregnancy.
There’s also fewer trips to the clinic with a surgical abortion – 3 or 4 maximum including your initial consultation and follow-up appointment. This means less time away from work and less stress.
Compared to a medical abortion, a surgical abortion is more thorough in that the doctor is sure immediately that the surgical abortion is complete.
There is a lower risk of an incomplete abortion, which means a lower risk of infection and related complications.
Disadvantages of a Surgical Abortion
There are actually very few disadvantages of a surgical abortion.
There is no such thing as a 100% safe surgical procedure. So no matter how safe the procedure or how qualified the doctor there is always that small margin that something could go wrong with a surgical abortion as well. Perhaps you will experience one or more of the complications of surgical abortion discussed earlier.
A surgical abortion is a little more expensive than a medical abortion, but this will differ from clinic to clinic. Many family planning clinics now charge approximately the same amount for both medical and surgical abortions done in the first few weeks of pregnancy.