Surgical Abortion

First Trimester Abortion

A first trimester surgical procedure, up through 13 weeks LMP, is referred to generally as aspiration, but also as manual vacuum aspiration, suction aspiration, or suction curettage.

A speculum is inserted into the vagina to bring the cervix into view.  Your provider will use a tool called a tenaculum to hold the cervix in place.  Your cervix will be numbed using a local anesthetic.  Metal rods, called dilators, are typically used to stretch the opening of the cervix. Then a thin, hollow, plastic tube called a cannula is inserted into your uterus.  It is attached to a handheld or electric suction pump, which removes the baby from your uterus.  This may be followed by a procedure called curettage which involves insertion of a long instrument with a loop-shape at its end used to scrape the uterus to assure that the uterus is completely empty.

Second Trimester

During the second trimester (from about 14-24 weeks of pregnancy), a dilation and evacuation (D&E) procedure is used.  Additional dilation is required beyond that used in first trimester aspiration.  Laminaria, a dried seaweed product, which absorbs moisture and slowly opens the cervix, may be placed 24 to 48 hours before the abortion.  Or misoprostol, one of the drugs used in a medication abortion may be used to soften the cervix.  Once laminaria is removed, and if additional dilation is necessary, metal dilators may be used to further expand the cervical opening.  Because the baby is larger, forceps are used to remove its extremities (arms, legs, head) from the body so that these body parts are small enough to be removed through the cervix and vaginal canal.  Then a cannula is inserted into the uterus, and any remaining contents are suctioned out.  This procedure may be followed with curettage and/or additional suctioning.

After having laminaria placed, it may be possible to change your mind about going forward with the abortion. There is a possibility that you may miscarry, but some women have changed their minds and successfully carried to term.  If you change your mind about going through with an abortion after insertion of laminaria, we recommend you go to a local hospital emergency room or seek other medical attention as soon as possible.

Late Term

Late term abortion, from approximately 24 weeks of pregnancy may be accomplished by dilation and evacuation or by induction, that is by inducing labor.  This is a multiple day procedure.  On day 1, a large needle is used to inject potassium chloride or digoxin into the baby’s heart, causing its death.  The cervix is softened and opened for 2-3 days using laminaria and/or vaginal medication.

On day 2, laminaria is replaced and an ultrasound performed to determine whether the baby has died.  If not, a second injection of digoxin or potassium chloride is administered.

Labor-inducing drugs, such as Pitocin, are administered.  Contractions like those experienced during labor will begin, and the baby will eventually be delivered.  The time from beginning to the end of the procedure varies.

If the induction method fails or cannot be used, a D&E procedure like that used in the second trimester may be used.  However, because of its advanced gestational age, the baby’s head may need to be crushed before removal.