Abortion

Suction and curettage

(Also referred to as mechanical vacuum aspiration)

Performed later in pregnancy—from 6 to 14 weeks since the start of your last menstrual period—a suction and curettage abortion is a surgical procedure using a mechanical suction machine to remove the pregnancy tissue from the uterus. Suction and curettage (also referred to as mechanical vacuum aspiration) can be performed under either local or general anesthetic. Local anesthetic numbs the cervix. General anesthetic, on the other hand, implies that you will be asleep throughout the procedure.

Hours before or the day before a machine vacuum aspiration, a cervical dilator is placed in the cervix to slowly dilate it. This device, when placed in a closed cervix, absorbs moisture from the tissues surrounding the cervix. This causes the device to swell and to open the cervix slowly, with little discomfort.

A synthetic dilator may be used instead. This device saves time and can be used several hours before the procedure. In this instance, the cervical opening is dilated by inserting and removing a series of narrow, tapered rods, each wider than the last.

What will happen?

Just before the procedure is set to begin, you will be given antibiotics to prevent infection. You may also be given misoprostol, a medication to induce labor. Misoprostol is sometimes given to soften the cervix.

Usually lasting between 10 and 15 minutes, suction and curettage can be performed in a doctor's office or clinic under local anesthetic. It can also be performed in a hospital or clinic under general anesthetic.

The doctor will place you on an exam table in the same position as for a pelvic exam: you will be lying on your back with your feet in stirrups. He or she will insert a speculum into your vagina. Once your vagina and cervix are cleaned with an antiseptic solution, a local anesthetic will be injected into your cervix. Pain medication and/or sedative, in addition to local anesthetic, may be administered intravenously. In addition, Vasopressin or a similar medication may be mixed with the local anesthetic to slow the uterine bleeding and prevent blood loss.

The doctor will then grasp the cervix with an instrument designed to hold the uterus in place and will dilate the cervical canal. Dilation reduces the risk of injury to the cervix. Once the cervix is dilated, the doctor will then pass a thin, hollow tube called a cannula into the cervical canal. A gentle vacuum is attached to the cannula and is used to draw the pregnancy tissue out of the uterus. As this tissue is removed, the uterus will contract, causing cramping. The cramps will lessen once the cannula is removed. You may experience nausea or sweating, and/or you may feel faint.

Once the uterus is empty, the suction is stopped and the walls of the uterus are then felt with a loop-shaped instrument called a curette. This is done to ensure no pregnancy tissue remains. The tissue removed from your uterus will then be examined to make sure all pregnancy tissue has been removed and that the abortion is complete.

What are the advantages of a suction and curettage abortion?

• Mechanical vacuum aspiration is safe and simple.
• This type of abortion can be performed later in the first trimester of pregnancy.
• There is a less than 1 percent chance the abortion will be incomplete.

What are the disadvantages?

• You may experience side effects such as pain, menstrual-like bleeding, and abdominal cramping for 2 weeks following the procedure.
• You may experience cramps for up to a week afterward.
• Although rare, serious complications such as infection or damage to the uterus and/or cervix are possible. The risk of complications increases with more advanced pregnancies.

What can I expect afterward?

Immediately following your surgery, you'll be taken to a recovery area where nurses will observe you and care for you. You will stay in the recovery room from 1 to 4 hours. Before you are discharged, your doctor or nurse will give you special instructions and information to help you in your recovery. You will likely be given a sheet with these instructions and the names and numbers of whom to contact if a problem arises.

Once you return home following your abortion, rest quietly. You may feel tired. You may also experience pain, cramping, and light vaginal bleeding. You may also experience other side effects such as nausea, diarrhea, headache, constipation or gas. In order to feel better and recover quickly, it's important to limit your activity and to increase it slowly. Rest when you need to, and be sure to get enough sleep.

Walking can help alleviate gas pain. If you have too much pain or feel too tired, slow down.

Depending how you feel the following day, you should be able to resume normal activities. You may experience pain: medications such as Ibuprofen (Advil) or Acetominophen (Tylenol) can help relieve cramping pain.

You'll want to avoid sexual intercourse until you are fully recovered and the bleeding has stopped-usually 2 to 3 weeks. You can begin birth control pills immediately following the procedure, but be sure to use a condom during the first weeks of intercourse to prevent infection.

Following surgery, you can expect to have irregular bleeding or spotting during the first 2 weeks. During the first week, avoid tampons and use only pads. You'll also want to avoid rinsing your vagina with douche or other fluids.

As the uterus shrinks back to its pre-pregnancy state, you'll experience cramps similar to menstrual cramps. They may be present for several hours or possibly a few days. Some women experience cramps for up to 6 weeks after their abortion.

You can also expect emotional reactions for 2 to 3 weeks.

Avoid intense exercise such as sit-ups or heavy lifting for at least 6 weeks.

It's important after surgery to take all your prescribed antibiotics in order to prevent infection.

What about my follow-up visit?

A follow-up examination is needed 2 to 3 weeks after a suction and curettage abortion. During this visit, your doctor will perform a pelvic exam, conduct a follow-up pregnancy test, check for low blood counts and discuss any problems or concerns you may have. He or she will also tell you when you can resume sexual relations and will help you choose an appropriate method of birth control to start using.

How will I feel?

Some women find it very emotionally difficulty to cope with having had an abortion. In fact, between 5 and 30 percent report feelings of anxiety, guilt or mild depression. It's normal to experience a broad range of emotions after an abortion—from relief and happiness to sadness, shame, regret, guilt, grief and loss. There are as many reactions as there are women and each woman is unique.

Most women feel they have made the right decision; it's rare for them to become clinically depressed following an abortion. However, if your feelings are overwhelming and persistent, or if you have a previous history of depression, you should consult a professional therapist. (Refer to Finding and Evaluating a Therapist for more information.) Depression is a very serious illness.

Consider counseling even if you feel "OK"—abortion is a weighty issue and there is no "right" or "normal" way to feel about it: every woman is different.

Understanding your emotions and taking care of yourself are important: doing so can help you let go of pain and start to heal. Talk to your partner, friends, or family to let them know what you're feeling. You may also want to consider professional counseling. If you're not sure where to go for counseling, talk to your abortion provider: most providers can refer you to counseling services to assist you in dealing with your feelings.