The Difference Between Surgical and Medical Abortion Procedures.

The Difference Between Surgical and Medical Abortion Procedures.

Medical Abortions and Surgical Abortions are the two procedures performed to end an unintended pregnancy or women who have maternal or fetal indications to end their wanted pregnancies. There are many reasons why one procedure may be preferable over the other depending on the pregnant woman’s situation, individual experience and preference of the Physician and medical personnel involved with carrying out the procedure. The Abortion Pill procedure and surgical abortion procedures are both highly safe, effective and efficient in terminating pregnancies. The medical abortion procedure under 8 weeks gestation, is rapidly becoming the most common means of ending. pregnancy in the U.S. It is associated with a 97 to 99% successful completion rate. There is a rare chance of serious complications which include hospitalization, surgery or blood transfusion.

Many women have had an unplanned pregnancy. Approximately 1 out of 3 women will have an abortion before age 35. There are over 2.4 million women in the US yearly that conceive and the pregnancy is unwanted. Over 1 million abortion procedures are carried out yearly in the United States. There are many women who either are not aware of or find it difficult to obtain a medical abortion procedure. Numerous women fear the idea of surgery or the risks associated with local, sedation or general anesthesia methods that reduce pain. The possibility of the risks associated with surgery, the psychological turmoil and stigma that some women go through with aborting their pregnancy, is less likely to occur with the abortion pill procedure. Generally the medical abortion procedure is can be carried out earlier in pregnancy than surgical abortion. Women tend to feel like they are having a spontaneous miscarriage when undergoing the abortion pill procedure in early pregnancy.

This abortion blog will help you understand the two abortion methods, and what they include. Also, you learn what some of the side effects are and help you decide between the medical vs surgical abortion what is best for you to end your pregnancy.

What is a Medical Abortion?

A medical abortion procedure, also known as a medication abortion is a non-surgical procedure that is used to terminate an unplanned pregnancy. The procedure is performed by taking two types of medications. Most people use the term “Abortion Pill”. The medical abortion became an alternative method of terminating a pregnancy after the availability of Mifepristone came on the market in France in the 1980’s. The abortion pill became legal in the US to carry out early abortions (7 weeks or less) in Sept. 2000. The abortion pill is slowly becoming legal in many parts of the world and commonly used to end pregnancies in the first 12 weeks of gestation.

A medical abortion works by terminating pregnancies in the first, second and third trimesters of pregnancy. Studies from Brazilian and African medical literature appeared in the early 90’s, where women were using part of the abortion pill method (Misoprostol) to carry out unsupervised medical abortions at 12 weeks, 14 weeks, 16 weeks, 21 weeks, 24 weeks or further to ending their pregnancies. There were hundreds of thousands of unsupervised medical abortions being performed. Abortions were and still are illegal in Brazil and many African countries. The abortion pill using Misoprostol (Cytotec) only, could be purchased in pharmacies over the counter in Brazil. This is no longer the case in Brazil. Cytotec is available for purchase over the counter in countries like Mexico. There is no abortion pill that can be purchased over the counter or even available by prescription through any pharmacies including Walgreens, CVS or Walmart in the United States.

Many women in countries where abortions are illegal show up at hospitals after performing or attempting to perform a unsupervised medical abortion on themselves with abortion pills. They most commonly present with vaginal bleeding and cramps. They are found to be in different phases and process of having an abortion. This could range from complete abortion, incomplete abortion, uterine infection (endometritis, endomyometritis, parametritis), Pelvic Inflammatory Disease (PID) or sepsis. What makes the unsupervised medical abortion pill procedure more dangerous, is that many women have no idea the number of weeks pregnant they are. Generally the further the number of weeks in pregnancy women are, the higher the incidence of heavy vaginal bleeding or retained pregnancy tissue. This may lead to a higher incidence of maternal morbidity and mortality. The illegal use of Misoprostol lead to being unable to be purchased over the counter in Brazil and other countries.

Though medical abortions can be used to terminate pregnancies as an early option to late term abortions, it is imperative that women be under medical supervision so that potential complications may be immediately addressed. Even women who carry out unsupervised medical abortions, maternal death is a rare event.

It is imperative that the abortion pill procedure remain legal in the States of Florida, Texas and throughout the United States. Abortions became legal throughout the US in 1973 in the decision Roe vs Wade. It is a known from previous history in the U.S. and around the world today, that the number of abortions performed do not decrease when abortions are made illegal. A woman who is determined to end her unwanted pregnancy will do so; even if there is an increased risk of maternal death. There have been millions of women who have died in the US and around the world due to a botched abortion. Legalizing abortions reduces the incidence of maternal morbidity and mortality. It does not increase the overall number of abortions.

What Happens During a Medical Abortion?

The medical abortion procedure has several steps. They have been described in detail below:

  1. The First Pill

Firstly, you would need to take Mifepristone (Mifeprex, RU 486, French Pill). For maintenance of pregnancy, progesterone is required. A progesterone deficiency in early pregnancy is a common reason for causing spontaneous miscarriages. Without progesterone, there is an increase of pressure that occurs within the intrauterine cavity, the lining of the uterus (endometrium) thins (decidualization) and the cervix becomes soft and it opens. Mifepristone works by competing with progesterone. It attaches to the progesterone receptors on the uterus. Mifepristone works faster to attach to the uterine receptors than progesterone. The body reads this as a message that says there is a lack of progesterone. This leads to the decidualization process described above. The thinning of the lining of the uterus along with the increase in the intrauterine pressure causes the pregnancy to detach from the uterine wall and the tissue is able to pass through the cervix (opening in the womb). The most common side effects that occur after taking Mifepristone are nausea, headaches, dizziness, weakness, abdominal discomfort, vomiting, diarrhea and bleeding. French Medical literature, studies in the 1980’s showed that the use of Mifepristone alone was able to terminate approximately 40% of pregnancies 8 weeks or less gestation. The process took up to 30 to 40 days to complete in some patients. Not only was this a long procedural process, but it meant that in approximately 60% of cases, the abortion pill using Mifepristone alone does not work. Mifepristone does increase the sensitization of the uterus to prostaglandins. Prostaglandins cause uterine contractions. The combination of Mifepristone and the prostaglandin Misoprostol, significantly reduces the incidence of medical abortion failure. There was a study published in January issue of Obstetrics and Gynecology in 2015 looking at over 50,000 medical and surgical abortions showing the complication rate with the surgical or medical abortion procedures were far less than getting wisdom teeth pulled or having a normal term vaginal delivery or Cesarean Section. It cannot be explained why the abortion pill process does not work in some women. The abortion pill failure rate with the combined use of Mifepristone and Misoprostol found in the world literature is 1 to 3 %. To say this another way, the abortion pill has a 97 to 99% success rate in terminating pregnancies. The earlier in pregnancy the abortion pill process is performed, the greater the chance of success and minimal to no complications.

  1. The Second Pill

Misoprostol (Cytotec) is the second pill taken as part of the abortion pill procedure. It is generally taken 24 to 48 hours after taking the Mifepristone tablet. There are studies that suggest that taking Cytotec before or after this time may cause the abortion pill not to work. On the other hand, recent studies show that taking Misoprostol immediately or up to 5 days after taking Mifepristone does not make any difference in the medical abortion success rate.

The side effects associated with taking Misoprostol are nausea, chills, fever, skin lesions (redness, urticaria), itchy palms, vomiting, diarrhea, cramps, lower back pain, dizziness, feeling faint and bleeding.

The vaginal bleeding may start within 30 minutes after taking Misoprostol. The pregnancy tissue commonly passes within 2 to 6 hours for early pregnancies. The majority of pregnancies terminate within the first 24 hours after taking Misoprostol.

  1. After Medication Pain:

Why Does The Abortion Pill Hurt?

The honest answer is that undergoing any abortion process will be associated with vaginal bleeding and pain. With the Abortion Pill process,over 99% of women will bleed and it is common for the abdominal and uterine cramps to hurt. There is just no getting around this fact.

In the majority of cases, cramping and bleeding will start within 1-4 hours of taking Misoprostol. It is normal for large sized blood clots or tissue to pass through the vagina. Most women say they feel and know when the pregnancy passes. There is generally a sudden gush of blood with almost a significant reduction in cramping and pain. It is suggested by medical personnel that women do not look at the tissue that passes. Fetal tissue is normally not visualized until after 7.5 weeks of pregnancy. The cramping and bleeding normally lasts for many hours to days. Once, the tissue is out of the body, both cramping and bleeding will slow down. Bleeding normally lasts 5 to 16 days. Eight percent of patients may bleed up to 30 days. There is a very small number of patients that bleed up to 60 days after the abortion pill procedure is started.

  1. The Solution for Cramps and Nausea

The majority of women do not need any medications for pain or discomfort that occurs during the medical abortion procedure. Ibuprofen, Advil, or Motrin is used by 30% to 40% of patients for pain or discomfort. Eight percent or less women need a narcotic for pain.

Generally within one or two hours after taking Misoprostol, the nausea and vomiting subside. If it does not, anti-nausea medications such as meclizine, phenergan or zofran are commonly used and work very well.

  1. Alternate Solution

It is completely normal for bleeding and spotting to occur for several weeks after the medical abortion procedure is completed. Maxi Pads are commonly used for the vaginal bleeding and to monitor the amount of blood loss. For bleeding that is greater than two pads an hour for more than two hours is an indication to call the abortion pill clinic immediately. Some facilities allow tampons to be used after the first week or so as the incidence of infection related to the abortion pill process is lower. The use of super tampons was associated with causing toxic shock syndrome. Several women died from sepsis (bacteria in blood) on their regular menses. This is theoretically due to prolonged retention of the tampon inside the vagina and bacteria migrating to the uterus causing infection and subsequently spreading into the blood and throughout the body. This caused multiple organ failure and death. It is this reasons that many Physicians are reluctant to suggest the use of tampons after having a abortion procedure.

WHAT METHODS ARE USED TO PERFORM MEDICAL ABORTION?

A medical abortion procedure includes two methods; these have been described below in details;

Method 1: Methotrexate and Misoprostol (MTX)

The MTX method in a medical abortion procedure that is effective up to the first seven weeks of pregnancy. Methotrexate is a anti-cancer drug that was FDA approved in the 1950’s. It was commonly used to treat Head and Neck tumors and breast cancer. It is also used to treat Rheumatoid Arthritis and Choriocarcinoma. Since the late 1980’s it has been used to treat patients who have ectopic pregnancies. (pregnancy that implants anywhere outside of the uterus). It was known through early reports that Methotrexate caused spontaneous abortions in women who have a early pregnancy. Medical studies show that for women who are 6 weeks or less pregnant, there is nearly a 100% success rate in termination using Methotrexate alone. It may take 30 to 45 days for the pregnancy tissue to pass. When a prostaglandin was added, the time to complete the abortion process was significantly reduced. There was a higher success of termination of pregnancies beyond 7 weeks.

Methotrexate works by stopping the growth of the trophoblastic tissue. That tissue is responsible for producing the beta-HCG. That allows for fetal growth up to approximately 7 weeks. That is when the trophoblastic tissue is no longer primarily responsible for the production of Beta-HCG. Methotrexate can cause significant fetal organ damage up to 12 weeks gestation. Women who are given Methotrexate to end their pregnancy and there is continued fetal growth, it is highly recommended that pregnancy termination be carried out surgically or repeat the second part ot the Mtx procedure where Misoprostol is given.

The MTX procedure includes the following steps:

  1. Methotrexate is given orally or by injection during the first visit at the medical facility. Antibiotics may be given to lower the possibility of uterine infection.

  1. Misoprostol tablets are taken orally (swallowed, placed buccally or sublingually) or inserted vaginally 3 to 7 days after receiving Methotrexate.

  1. The MTX procedure usually leads to contractions and bleeding and passage of the pregnancy tissue within a few hours or days after the Misoprostol is given. The abortion process using Methotrexate and Misoprostol takes longer to complete than the combination of Mifepristone and Misoprostol.

  1. The doctor will conduct a physical exam after a week to 21 days to assure the abortion is complete.

Are there any side effects of using the MTX method to abort the pregnancy?

The side effects of using the MTX method include cramping, nausea, fever, and heavy bleeding, lightheadedness, dizziness, or abdominal discomfort. A diffuse rash and stomatitis (inflammation and swelling around the mouth) is common in women who expose themselves to direct sunlight. A significant drop in the white blood cell count may occur along with the possibility of becoming severely anemic is rare but seen. The Methotrexate abortion procedure is not recommended for women who have anemia, liver or kidney disease, seizure disorder or use an intrauterine device (IUD).

Method 2: Mifepristone (Mifeprex) and Misoprostol

In the First Trimester Of Pregnancy, Mifepristone and Misoprostol are commonly used to perform the medical abortion procedure from 3 to 10 weeks. This method includes the following:

  1. The doctor will go over the history and perform a physical examination to determine whether you are eligible for this method. You will not be eligible in case you have an ectopic pregnancy, IUD, adrenal failure, anemia, liver or kidney problems, asthma, heart disease, high blood pressure, undiagnosed vaginal bleeding, an adnexal mass, porphyria, Cushing’s Disease or severely immunocompromised (HIV, Autoimmune Disease, Cancer etc.). Antibiotics may also be given to reduce the chance of infection.

  1. Mifepristone is given orally during the first visit to the doctor. It blocks Progesterone from attaching to the Progesterone receptors on the uterus as described previously. This leads to the process known as decidualization occuring where the the uterine lining breaks down along with dilation and softening of the cervix.

  1. The Misoprostol medication may be

taken orally or inserted vaginally. These tablets cause uterine contractions and expel the fetus through the vagina.

  1. Usually within two to four weeks, your doctor schedules you for a follow-up physical exam to confirm that the procedure was successful.

Side Effects Associated with the Method of Medical Abortion:

Some of the side effects of using Mifepristone and Misoprostol method of abortion include headaches, dizziness, lightheadedness, fever, chills, constipation diarrhea, infection and heavy vaginal bleeding. Women who have seizure disorders, Acute Inflammatory Disease or using an Intrauterine device should not use this method.

Does the Abortion Pill Carry Long-Term Side Effects?

The medical abortion method is safe as well as effective. Unless a serious medical develops, there is little to no risk that a woman will have medical problems regarding future pregnancies. There is no increased incidence of congenital abnormalities, preterm births or infants born with low birth weight. A medical abortion procedure does not increase the chance of breast cancer or have any effect on a woman’s fertility.

What are The Side Effects of Medical Abortion?

The medical abortion procedure is an effective and less intrusive way of taking care of an unplanned pregnancy. However, this method comes with its share of side effects, which include;

  1. Stomach Cramps

Stomach cramps may be the most painful side effect of the medical abortion process. These occur due to uterine contractions and the increase in the bowel motility peristalsis. However, the stomach cramps are normally not so bad that pain medication is required. Narcotic pain medications in a small percentage of patients may be prescribed by your doctor for pain control. This helps to lead to effective mental recovery in some women undergoing the medical abortion procedure. The pain associated with the medical abortion is the most common complaint that women have when undergoing the abortion pill procedure. If severe pain or discomfort is prolonged for longer than 24 hours, it is a indication to immediately contact medical personnel. It can indicate a incomplete abortion or onset of infection.

  1. Vaginal Discharge

Some women might experience smelly vaginal discharge. A smelly vaginal discharge, lower abdominal pain, listlessness, difficulty in responding or arousal is possibly a indication of severe sepsis and must be immediately evaluated by medical personnel.

  1. Nausea

Nausea is a common side effect that occurs after taking Mifepristone or Misoprostol. If you vomit within an hour or two after taking Mifepristone, a second tablet should be taken or another method of completing the abortion must be considered.

  1. A Headache

Medical abortion might save you from a surgical abortion but in some rare cases intense headache may occur. This is unusual as research is showing that Mifepristone can be used to treat recurrent migraine headaches. Non-Steroidal Anti-Inflammatory medications (Advil, Ibuprofen, Motrin) and bed rest may be helpful in alleviating the headache.

  1. Bleeding

Bleeding is expected during the abortion pill procedure. It is not excessive if the bleeding soaks less than two pads an hour for two hours in a row. Passing of large clots are also common during this time. The heaviest bleeding commonly occurs just before the pregnancy tissue passes through the cervix. After passage, the bleeding normally lasts from 5 to 16 days. A blood transfusion is necessary in less than 1 per thousand medical abortion procedures

  1. Lightheadedness

Dizziness will subside within an hour or two of the abortion, but if dizziness and fainting like symptoms continue after 24 hours of completion of the abortion then a medical professional should be contacted immediately.

  1. Diarrhea

The medical abortion procedure leads to the disturbance of bowel movements. It is very important to remain hydrated throughout the abortion process by increasing the intake of liquids such as water.

8. Incomplete Abortion

  • The incidence reported in the medical literature of a medical abortion leading to retained pregnancy tissue in the uterus occurs in less than 3 out of 100 procedures. This may lead to pain, bleeding and may cause an infection. The treatment is individualized but the options to consider will be to repeat the Misoprostol tablets or have a surgical procedure performed.

9. Continued Pregnancy (Abortion Pill Failure)

  • This occurs approximately 1 in 100 cases where the medical abortion does not work. Misoprostol may be repeated or the surgical procedure may be performed.

Thus, these are the two methods used in a early medical abortion procedure to remove the unwanted pregnancy.

The medical abortion procedure as discussed earlier can also be used to terminate second trimester and late term abortions using Mifepristone and Misoprostol.

Now, we will look at what a surgical abortion is, and how safe it is to follow through.

WHAT IS A SURGICAL ABORTION?

As compared to a medical abortion procedure, a surgical abortion is known as in-clinic abortion. The procedure is performed at the Abortion Clinic. Surgical Abortions are performed electively from 3 to 21 weeks gestation and further for maternal or fetal indications.

Why should I choose surgical abortion and not medical abortion?

With a surgical abortion, there is a higher rate of success and the abortion process is completed faster than compared to a medical abortion. The advantages offered by surgical method outweigh the ones offered by a medical abortion procedure in some women’s minds. The advantages include:

  • It is less time consuming with a single visit to the clinic to get the pregnancy terminated. Many women want the abortion procedure “over and done with”. They do not want the possibility of having to return to the medical facility two or more times for follow-up visits as required with the abortion pill procedure.

  • The medical staff will be present until the time the procedure is complete. This allows assurance in the patients mind there will be minimal to no complications after discharge.

  • There is less bleeding and cramping as compared to a medical abortion.

  • There is generally a lower chance of complications and slightly higher success rate when undergoing the surgical abortion procedure.

Are There Any Guidelines I Need to Follow for a Surgical Abortion?

As opposed to medical abortion, a medical professional does the surgical procedure inside a clinic. Since it includes surgery, certain guidelines are generally followed:

  1. Do not smoke, eat, or drink at least six hours or longer before the operation. Taking a shower the morning of the procedure is recommended.

  1. Do bring along sanitary pads, dress warm and usually no bags or purses are allowed in the Abortion Clinic facility due to security purposes.

  1. Expect to be at the clinic for at least 2 to 6 hours. For a nominal fee, VIP appointments may be scheduled where the patient is escorted into a private room and the entire abortion process (counseling, lab, sonogram) and surgery is completed in 90 minutes or less.

  1. Do not drive yourself to the office if you expect to have IV sedation or general anesthesia. In case you live at some distance, have a friend or family member drop you off at the abortion clinic. At times lower abdominal cramps may make it uncomfortable for women to drive a long period of time.

These guidelines will help to ensure that women have a safe surgical abortion without many complications.

What Methods Does Surgical Abortion Use?

The surgical abortion procedure has two methods that allow the termination of an unplanned pregnancy. These are associated with the number of weeks pregnant the patient is.

Method 1: Aspiration (Suction Curettage); 3 to 16 weeks

It is a surgical abortion procedure that is performed during the first 3 to 16 weeks of gestation. The aspiration method is also known as suction aspiration, suction curettage, and vacuum aspiration.

On arrival at the Abortion Clinic, the proper paperwork is filled out by the patient. Lab work is performed that includes collection of a urine sample and a small finger prick to collect a sample of blood. This is done to document a positive pregnancy test, Rh, and blood Hemoglobin. A law passed by most States in the US require mandatory sonogram (ultrasound) to document the weeks of pregnancy. Counseling is done with all patients. The risks of the medical and surgical abortion procedures is done and the final decision on how the abortion process is going to be carried out is between the Patient and Physician. It is determined if abortion is the right decision for her and she is not being coerced to end her pregnancy.

The medical professional attending that sees you will provide medication for pain and if one chooses, sedation as well. After entering the surgical room, the patient will lie down with her feet placed in stirrups. A speculum is inserted inside the vagina. Next, the Doctor gently injects a local anesthetic (Lidocaine) to numb the cervix. A tenaculum will be used for holding the cervix in place and it is slowly dilated (opened) using serial enlarging metal or plastic dilators. Once the cervix is adequately opened, a sterile single use curette is inserted into the uterus and the pregnancy tissue is removed via vacuum aspiration. Cramping may be felt with cervical dilation and the removal of the pregnancy tissue as the uterus contracts.

Although the procedure takes only 5 to 15 minutes to perform, the recovery process may take 15 minutes to several hours. Heavy IV sedation or General anesthesia are associated with longer recovery times. The patients blood pressure and vital signs are monitored along with checking the amount of vaginal bleeding. Monitoring the amount of blood and the number of times a patient changes her sanitary pads is important in determining the amount of blood loss. Patients with scant bleeding on each pad check, may be able to be discharged in 30 mins. A patient who has bled more than two pads an hour needs to remain in recovery and re-evaluated by the Physician to determine if the abortion is incomplete or the uterus has filled with a moderate amount of blood that may require re-aspiration.

Are there any side effects with the suction curettage method?

Some of the side effects related to Aspiration include sweating, cramps, and feeling like fainting. Less frequent side effects include passing of large blood clots, damage to the cervix, and perforation of the uterus. Side effects with detailed explanation follow:

  1. Infection:

This occurs less than 1 in 100 procedures. Lower abdominal pain, uterine tenderness, vaginal bleeding and low grade temperature are common symptoms and signs. On pelvic exam the uterus is generally tender to touch and there may be adnexal (fallopian tubes and ovary) tenderness which may be early sign of Pelvic Inflammatory Disease. Patients must be treated aggressively with antibiotics.

  1. Retained Products Of Conception:

Retained pregnancy tissue that is significant enough to cause clinical symptoms occurring after a surgical abortion occurs in less than 1 in 100 cases. Small amounts of pregnancy tissue and clots inside the uterus can cause continuous or intermittent bleeding with cramps and passage of gestational tissue. The choice of taking Misoprostol or repeating the surgical procedure are options that will resolve this issue.

  1. Continued Pregnancy

The chance of a continued pregnancy after a surgical abortion is approximately 1 in 2000 procedures. This is why follow-up in 3 to 4 weeks is important even for surgical patients. There is certainly the chance of surgical failure. A pregnancy test 3 to 4 weeks after the procedure can confirm the success of the abortion procedure if negative. If the pregnancy test is positive, it does not mean that the patient is still pregnant or even have a new pregnancy. A ultrasound will help determine if there is retained gestational tissue and whether or not retained tissue remains inside the uterus. Most commonly, there will be no evidence of pregnancy by sonogram. The patient may be instructed to return to the office in two weeks for another pregnancy test to assure it is negative. Another ultrasound should be done to rule out a new pregnancy.

  1. Cervical Tear:

A cervical tear general occurs with difficulty dilating the cervix and the tenaculum can come off the cervix and may damage it. This happens in less than 1 in 1000 surgical procedures. Most of the time nothing needs to be done as the cervix is able to heal itself. For deeper cervical tears, the need for repair with sutures may be required to control the bleeding.

  1. Uterine Perforation:

Dilators or an instrumental curette can puncture the uterus and injure the bladder, fallopian tube, ovaries, bowel or other pelvic organs. The further the number of weeks pregnant, the higher the chance of uterine perforation. The incidence of this occurring is less than 5 in 1000 cases. If the currette that perforates the uterus is less than a #10 curette, then observation for several hours should be done to ensure that the patient’s vital signs remain stable. For curettes that are size 11 or greater, the patient should be transferred to the hospital for observation and possibly a laparoscopy.

  1. Serious complications:

This includes patients that must be hospitalised, require a blood transfusion or have surgery. The chances of this occurring is less than 0.5% for patients who undergo surgery in the first or second trimester of pregnancy.

Method 2: Dilation and Evacuation

Dilation and Evacuation procedure is performed after 16 weeks of gestation. After 16 weeks many Physicians perform a 2 day procedure but some perform 1 day procedures up to 19 weeks with some cervical preparation. In many cases, the medical professional will insert laminaria or Dilapan (synthetic dilator) inside your cervix 24 hours prior to the procedure. They generally start out the size of a match stick are capable of soaking up fluids and water from the cervix like a sponge. This allows the cervix to dilate (open) and become soft. It allows larger instruments to dilate the cervix and remove the pregnancy tissue with less risk and complications.

Misoprostol may be given 4 to 6 hours prior to starting the surgical procedure which also causes softening and dilation of the cervix.

After 19 weeks, most Physicians will elect to perform a two day procedure where the Laminaria or Dilapan will remain overnight to give adequate dilation of the cervix. O the second day, the doctor will remove the Laminaria or Dilapan and check for adequate dilation. Misoprostol may also be started to induce uterine contractions if the cervix requires further dilation and softening in order for the procedure to be performed safely. IV sedation is given to help to alleviate pain and discomfort. A tenaculum is placed on the cervix in order to stabilize the uterus Next, cone-shaped rods of increasing size are used in the dilation process. Afterward, a numbing medication would be used on the cervix. A large cannula curette may be gently inserted to remove the tissue from the uterus. Special forceps may be used to assist in removing fetal tissue. The final step would be to perform Suction Currettage to ensure complete removal of all pregnancy tissue.

What are the Side Effects that Associates with Using Dilation and Evacuation Abortion Method?

The side effects of Dilation and Evacuation abortion method are the same as the suction Curettage method except there is a slightly higher chance of complications. The complication rate is less than 1%. It is far safer for the mother when compared to a term vaginal delivery or Cesarean Section.

What Precautions Should I Take After Surgical Abortion?

After the surgical abortion, a period of rest for complete recovery is important. Usually, antibiotics are prescribed and should be taken to prevent an infection or side effects. However, some general guidelines prescribed by your doctor can include:

  1. Shower instead of taking a bath

  2. Avoid sexual intercourse and inserting a foreign object into the vagina

  3. Always use clean, sanitary pads and tampons

  4. Avoid going swimming

How Would I Know Which Abortion Clinic Is the Best for My Condition?

An abortion procedure whether it is a medical abortion procedure or surgical abortion requires a medical professional with considerable experience. Thus, if you want to get the best services when choosing an abortion clinic, make sure to follow the guidelines below;

a) The Experience Counts

Experience is the primary factor to consider when looking for a clinic to terminate the unwanted pregnancy. Make sure to find a clinic with medical professionals who have a good record of successful surgical or medical abortion procedures. The staff should have complete knowledge about the procedure and aftercare. Do not ignore this factor as the slightest miscalculation could end up becoming a matter of life and death.

b) Do Not Trust the Hype

Before signing up with a particular abortion clinic, do not visit it just because a television commercial or a newspaper said so. When you call, are the people friendly and able to answer your questions? Are they knowledgeable? Have you inquired about what the abortion fee includes (antibiotics, free emergency contraception).

c) The Charges

When you decide to visit a particular abortion clinic, remember to ask about the charges for the entire procedure, right from admission to discharge. You should ask about the staff as to whether the fee covers all services including pain management. Also, inquire about the price and make sure there are no hidden charges. It will help you decide as to whether that clinic is in your budget or not.

d) Go Local

Over 89% of counties in the US do not have a abortion facility. There are several States in the US that have only one abortion facility. This means there are women that must drive hours in order to have an abortion procedure performed. There are many States where it is mandatory to be counseled and then wait 24 to 48 hours before the abortion can be performed. This makes it difficult for women to obtain an abortion in the local vicinity. It is best if possible not to be further than 2 hours away from the abortion facility when undergoing a medical abortion. This gives one the comfort of connecting with your medical professional whenever there is an emergency. A nearby clinic will help you deal with any emergencies that might arrive post-abortion, thereby ensure your safety. If unable to get to the abortion facility, one can go to the local community hospital to seek medical treatment for emergencies.

Future Fertility and Birth Control

Ovulation can return within 5 to 6 days of ending a pregnancy. It is important for patients to be counseled regarding methods of birth control during their initial counseling session. There are few abortion clinics that give the Morning After Pill (Emergency Contraception) Levonorgestrel 1.5mg) for free to all women who undergo the surgical or medical abortion procedure. The sooner after the unprotected event the Emergency Contraceptive Pill is taken, the higher the chance of preventing pregnancy. Emergency Contraception is effective up to 5 days after unprotected intercourse. The mechanism of how Emergency Contraception works is to prevent or delay ovulation. Emergency Contraception does not terminate pregnancies. It is imperative that all women of reproductive age who are active sexually, carry Emergency Contraception in their purse or medicine cabinet. Women should always inquire if Emergency Contraception is included in the abortion price. There are no contraindication in taking Emergency Contraception. There is significantly less maternal morbidity and mortality when pregnancy is prevented. There is up to 96% chance of not becoming pregnant when one takes 1.5 mg Levonorgestrel immediately after the unprotected event. Birth control pills, progesterone implants, injections and the IUD are all more effective in preventing pregnancy than taking the Morning After Pill.

Summing Up

Whether one chooses the surgical abortion or a medical abortion procedure there are pros and cons. It is important to know there are complications that may occur with each procedure. The complication rate is extremely low and serious complications are rare with either procedure.

The chance of an abortion affecting future fertility is rare when post procedure discharge instructions are followed. One must return to the Abortion Clinic as instructed at 3 or 4 weeks for follow up to assure there are no complications related to the pregnancy termination. It is highly important to have Emergency Contraception immediately available in case of a failed contraceptive method or a unprotected event. The morning after pill should be carried in the woman’s purse or stored in the medicine cabinet. Inquire when calling Abortion Clinics what is included in their fees. Preventing from becoming pregnant after an abortion should be an immediate priority.

Dr James S Pendergraft Orlando Abortion Clinicwww.womencenter.com.

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