Definition & Overview
A surgical abortion refers to the procedure that removes the contents of the uterus, effectively ending a pregnancy, using different surgical means; the specific method used depends on how far along the pregnancy is. Regardless of the specific method, surgical abortion is a sensitive procedure, and the patient requires both pre-surgical and post-operative care to make sure no complications arise.
Who should undergo & expected results
Surgical abortion is an option when:
- The fetus has been diagnosed with fetal birth defects or severe medical problems (these are often detected through routine tests performed during the second trimester)
- The fetus has stopped developing
- The pregnancy puts the mother’s life at risk
- The pregnancy resulted from a birth contraceptive failure
- The pregnancy is unwanted
If abortion is being considered, it is important for the patient and her partner to carefully take all available options into consideration. However, if abortion has been decided, it is important to end the pregnancy as early as possible (ideally before the second trimester ends) to minimize possible risks and complications that can affect the mother.
Although invasive, surgical abortion only takes one visit, during which the entire process is completed so there is no need for the patient to come back. This is unlike a medical abortion that requires at least two more visits to the doctor in the course of 3 weeks. Surgical abortion also completely terminates the pregnancy in a single process, while medical abortion occurs gradually and may even take several days and several steps.
However, surgical abortion requires either local or general anesthesia, whereas no anesthesia or sedation is needed in a medical abortion. Both are considered effective, with high success rates (95% for medical abortion and 99% for surgical abortion).
How the procedure works
The specific process that is used to surgically remove the contents of the uterus depends on whether the pregnancy is in the first, second, or third trimester. The three different methods include:
Manual vacuum aspiration or machine vacuum aspiration – This method involves inserting a small tube all the way into the uterus and using a suction to remove all the tissue found inside. This method is used for patients who are only in the first trimester, or the 5th to 12th weeks, of the pregnancy. Since many fetal birth defects can be diagnosed prior to the second trimester, first trimester abortions are more common.
Dilation and evacuation (D&E) – Although second-trimester abortions are more commonly known as dilation and curettage (D&C) , this method is usually combined with vacuum aspiration, in which case it is called dilation and evacuation. This method is used during the second trimester, or the second 12 weeks of the pregnancy. The procedure uses a combination of suction and surgical instruments to remove all fetal and placental tissue inside the uterus. This method has a low risk of complication compared to inducing labor.
Induction abortion - This is a non-surgical method of terminating a pregnancy in its second trimester. Induction abortion uses medications to cause labor contractions, which will then push the fetus from the uterus.
Following a surgical termination of pregnancy, the patient is taken to a recovery room and will be monitored and cared for round-the-clock. The doctor will give specific instructions for post-surgical care and medications, if any is needed. It is also advisable to refrain from sexual intercourse for at least three weeks after the procedure; this is the average length of time it takes for the body to fully recover.
Surgical abortion is a single-step process that completely terminates the pregnancy, so there is usually no need for the patient to come back for a follow-up visit, provided that there are no complications.
Regardless of the method used, however, surgical abortion can only be carried out by a health professional, such as a gynecologist, certified nurse-midwife, or family doctor, who has specialized training in this specific procedure.
Possible Complications and Risks
The patient can expect to feel some pain, ranging from mild to severe, during and after a surgical abortion. The severity may depend on the patient’s physical and emotional state following the procedure. Both medical and surgical methods also cause temporary bleeding, which will eventually subside just like what happens after a normal delivery. Other normal symptoms that the patient may experience include:
- Spotting, which may last for three weeks following the procedure
- Cramping, typically lasting between two and six weeks
- Emotional effects, lasting between two and three weeks
If symptoms becomes severe, seems to be getting worse, or does not seem to subside, it is best to seek medical attention to avoid complications. Abnormal symptoms include:
- Severe bleeding for 12 straight hours and soaking two large pads within an hour
- Passing clots larger in size than a golf ball
- Signs of infection
- Severe belly pain
- High fever of 38 degrees C or higher
- Vomiting for 4 to 6 hours
- Rapid heartbeat
- Sudden swelling of the belly
- Swelling, pain, and redness in the genitals
- Absence of menstrual period six weeks following the abortion
- Signs of depression
Signs of infection may include:
- Muscle aches
- General feeling of being unwell
Between medical abortion and surgical abortion, the latter is considered as less risky. While medical abortion exposes the patient to the risk of severe infection, this does not apply to the surgical process because the procedure will be done in a surgical setting.
If, however, medical abortion is performed and it was unsuccessful, a surgical abortion can be done to complete the process. This often becomes necessary because an unsuccessful medical abortion heightens the patient’s risk of:
- Losing a lot of blood
- Fetal birth defects
In very rare cases, abortion may lead to death, but the risk is less than 1 out of 100,000 for surgical abortion. This risk is slightly higher for medical abortion.
Annas GJ, Elias S. Legal and ethical issues in obstetric practice. In: Gabbe SG, Niebyl JR, Simpson JL, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 54.
Jensen JT, Mishell Jr. DR. Family planning: contraception, sterilization, and pregnancy termination. In: Lentz GM, Lobo RA, Gershenson DM, Katz VL, eds. Comprehensive Gynecology. 6th ed. Philadelphia, PA: Elsevier Mosby; 2012:chap 13.