Alternative Names induced abortion, interruption of pregnancy
Definition When a woman chooses to end a pregnancy, the procedure is called an elective abortion. The fetus may be removed from the uterus by means of an elective medical abortion or an elective surgical abortion. A surgical abortion is a medical procedure that removes an embryo or fetus from the uterus before it is able to live on its own.
Who is a candidate for the procedure? Any woman who chooses to end a pregnancy for health or personal reasons is a candidate for an elective abortion. Abortions are legal in the United States during the first 12 weeks of pregnancy. After that amount of time, abortion is regulated by each state.
How is the procedure performed? Before an abortion is performed, a healthcare provider will confirm the existence and length of a pregnancy. A pelvic examination might be done to confirm the size of the uterus. Laboratory studies will rule out anemia, determine the woman's Rh factor, and screen for sexually transmitted diseases. Education about the procedure used should be offered by the healthcare provider, and psychological support should be given as needed.
A surgical abortion involves one of several procedures for entering the uterus and removing the fetus.
dilation and evacuation (D&E), which involves opening the cervix and suctioning out the contents of the uterus. The cervix can be opened with a series of narrow rods called dilators or with an absorbent fiber rod such as a laminaria.
dilation and curettage (D&C), a procedure in which a narrow tube is inserted into the uterus through the dilated cervix. The uterine contents are suctioned out, and the lining of the uterus is scraped out with a tool called a curette.
Options for surgical abortions after 14 to 15 weeks of pregnancy include:
dilation and evacuation (D&E) or a dilatation and curettage (D&C), similar to the procedures described for first trimester pregnancies. Because the fetus is larger, the healthcare provider may use a curette and forceps in these procedures.
an instillation of prostaglandin, urea, or a highly concentrated saline or salt solution into the amniotic fluid surrounding the fetus. The woman goes into labor several hours later and the fetus is expelled.
What happens right after the procedure? A woman who has a surgical abortion will be watched carefully for a short period of time to make sure that her blood pressure, pulse, and bleeding are within normal limits. She will then be allowed to go home and will have a return visit in 2 to 4 weeks to check for complications.
After any abortion, a woman with Rh negative blood should be given an injection of Rh immune globulin, unless the father is also known to have Rh negative blood. She may also be given a prescription for pain medications. Antibiotics may also be prescribedto prevent infection.
What happens later at home? After returning home, a woman should:
call the healthcare provider if there are any new or worsening symptoms, including fever, severe or lasting abdominal distress, or heavy vaginal bleeding
avoid using tampons or having sexual intercourse for at least 2 weeks
slowly resume daily activity as tolerated
If a woman has no complications from the abortion, it is likely that she will be able to get pregnant at a later time. A follow-up visit with a healthcare provider should include a pelvic exam to make sure the uterus is shrinking in size. This office visit is also a good time for a woman and her provider to discuss birth control, so she can choose a method that will work well for her.
What are the potential complications after the procedure? Any type of abortion can cause heavy bleeding that might require a D&C or blood transfusion. In addition, there are possible complications associated with each type of abortion. Generally, early abortions are much safer than later abortions. In the first trimester of pregnancy, rare complications of a D&C are:
a hole in the uterus
infection in the lining of the uterus
severe bleeding
These complications are far more likely to happen when a D&E is done after 12 weeks of pregnancy. At that time, the uterus is larger and softer, and more tissue must be removed.
In late abortions, putting very concentrated salt solutions, urea, or prostaglandin into the amniotic fluid can cause:
infection
some tissue to remain in the uterus, which means a D&C would need to be done
severe bleeding
damage to the cervix
Occasionally, too much of the uterine lining is scraped away, causing scar tissue to form within the walls of the uterus. The scar tissue can cause infertility.
Author: Eva Martin, MD Reviewer: Barbara Mallari, RN, BSN, PHN Last Updated: 11/15/00 Contributors Potential conflict of interest information for reviewers available on request
