Surgical abortion, procedures and risks

Methods of termination of pregnancy change according to how far along your pregnancy has progressed, and whether you and your doctor choose a surgical or medical alternative.  This provides a brief outline of the 2 most commonly used surgical methods and their risks as well as information about medical abortion.

Suction Curettage

This procedure is the preferred method from 7 weeks to about 12 weeks of pregnancy.  You will usually be given either a local, or light general anaesthetic for the procedure.

The cervix is dilated with a series of rods of progressive larger sizes being inserted.   A tube with suction applied is then inserted into the uterus and the foetus and placenta are suctioned out.  The lining of the uterus is then scraped to ensure that all the contents have been removed.

Dilatation and Evacuation (D&E)

This method is used for pregnancies greater than 12 weeks.   As the foetus is larger, it requires greater dilation of the cervix.  A local or general anaesthetic will be used.

The cervix is first dilated and the foetus and placenta are removed.   The foetus is larger at this point in the pregnancy and will not usually be able to be removed intact, so is removed in pieces.

Risks and Complications

The complications of termination rise as the pregnancy progresses.

 

Retained contents: in around 1-2% of cases, not all the contents may be removed and a further surgical procedure may be required.

Trauma to the Cervix: Occurs in less than 10% of cases

Perforation of the Uterus:  1-4 women per 1000 can be affected.  This may require a surgical repair, and rarely a hysterectomy (complete removal of the uterus)

Severe bleeding requiring a transfusion: up to 2 in every 1000 women

Cervical Stenosis: Approximately 1 in 500 women will develop a small amount of scar tissue at the opening of the uterus.  This stops the blood from leaving the uterus.  In the majority of cases, this can be treated, but in rare cases can lead to extensive scarring (Aschermann's Syndrome) and lead to untreatable infertility.

Psychological Disturbances: Significant psychological problems following termination are more likely if the woman has suffered psychological problems in the past, if she feels pressured or coerced into having a termination, or if having a termination is in conflict with her own morals or beliefs.   Some women do experience severe psychological and emotional difficulties following abortion

Infection:  Up to 10% of women experience an infection.   Your doctor will usually prescribe antibiotics to prevent an infection.  It is important to take these exactly as prescribed, and to complete the full course. It is still possible to develop an infection of the fallopian tubes or uterus.  Symptoms include a temperature over 37.5c, pain or increasing discharge.  Infection can result in infertility if left untreated.

Retained products of conception: It is possible for the abortion procedure to fail to remove all the contents of the uterus.  This may cause prolonged or heavy bleeding and can require a repeat curette to be undertaken.  Symptoms include pain, heavy or prolonged bleeding or the passing of clots.


Medical Abortion (RU486)

The process of medical abortion allows a woman to carry this procedure out herself after consultation with a doctor and provision of the necessary drugs.    The first drug you will be asked to take is called Mifepristone.   This drug blocks the hormone progesterone from reaching the cells of the uterus, causing the lining to deteriorate.   This causes the death of the embryo.

About 24-48 hours later you will need to take a second drug, Misoprostol.  This drug causes the uterus to contract and remove the embryo and placenta.   Women can experience mild to extremely painful contractions accompanied by bleeding within a very short time after taking this second drug.

It is also possible that you may see the expelled embryo and this can be very distressing for many women.

Risks and Complications

A recent Australian study has found that the risks associated with medical abortion are significantly higher than those associated with surgical abortion.  The study shows that 5.7% of women undergoing medical abortion require admission to hospital due to complications compared to 0.4% of women following surgical abortion.   Infection rates following medical abortion are 1 in 480 for medical abortion compared to 1 in 1500 for surgical abortion.  Risk of haemorrhage (severe bleeding) is 1 in 200 for medical abortion compared to 1 in 3000 for surgical abortion.

Other studies also demonstrate a much higher incidence of adverse events after medical abortion than after surgical abortion.

Severe bleeding:   Up to 15.6% of women compared to 2.1% of women suffered severe bleeding in a Finnish study published in 2009.

Incomplete abortion:  The Finnish study found 5.9% of women required follow up surgical abortion

Psychological adverse effects:  Women undergoing medical abortion have at least the same risk of up to 30% experiencing serious prolonged mental health problems, although because of the added burden of the woman more actively participating in the abortion by taking pills, the trauma of seeing the fetus, and the higher incidence of complications, the psychological risks of abortion may prove to be higher as more data is gathered.

References:
Termination of Pregnancy, (2005) Royal Australian and New Zealand College of Obstetricians and Gynaecologists
Planned Parenthood of Australia, Risks of Abortion Procedures (accessed April 2010)

Maarit Niinimaki, M.D (2009) Immediate Complications after Medical Compared iwth Surgical Termination of Pregnancy,  Obstetrics and Gynecology

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