With few exceptions, surgically (as opposed to medically) induced abortions are performed by a procedure generally known as Dilation and Aspiration (“D&A”). Typically, this procedure is performed in a physicians office or abortion clinic. It may also be performed in an out patient surgical center or hospital.
The procedure may safely be performed using local anesthesia with reasonable comfort, but in recent years it has become common practice to provide various levels of sedation or “twilight sleep” using intravenous drugs in the category of narcotics and tranquilizers. Once a satisfactory level of sedation and local anesthesia is achieved, the cervix or neck of the uterus (womb) must be opened to remove the contents of the uterus.
In the first 12 weeks of pregnancy this is generally accomplished by sequentially inserting tapered rods of increasing width called “dilators”. Usually, the cervix needs to be opened no more than 1/4″ – 1/2″ in the first trimester. This can be done with anywhere between 1 and 8 dilator insertions, depending on the stage of pregnancy and the resistance of the individual cervix.
Once the cervix has been adequately dilated, the products of conception are removed by inserting a hollow plastic tube called a “vacurette” and applying negative pressure (suction/ vacuum). Generally, the vacurette is moved in a series of in and out strokes or is rotated to enhance the traction forces at the tip of the vacurette. This is sometimes followed by curetting (scraping) the walls of the uterus to ensure that no tissues are remaining that might cause subsequent problems.
It is appropriate immediately following surgery to examine the tissues to assure compatibility between what was removed and what was expected based on pre-operative evaluation.
D&A in reasonably experienced hands is one of the safest surgical procedures performed today, the mortality being 80 times less than child birth which is quite low. The most common complications involve excessive bleeding and infection that sometimes require recuretting (repeat suctioning) of the uterus.
Infrequently, D&A may result in injury to the uterus or surrounding internal organs, e.g. intestines, bladder or major blood vessels which requires opening the abdomen to surgically repair. The aftermath of D&A typically consists of bleeding which is similar in degree to a normal menstrual period and menstrual-like cramps which are similar in severity to a “bad menstrual period”. These symptoms tend to subside rapidly but persist to some degree for as long as 2 weeks.
Emotional reactions to surgery are common. Mild depression associated with low hormone levels and a feeling of loss is usually brief. The emotionally healthy individual will generally rationalize the situation as they do with other life stresses and quickly put their experience in perspective. On rare occasion, counseling or drug therapy may be required. Long range concerns usually center about future fertility. If there have been serious complications from surgery such as severe infection or excessive bleeding that required vigorous scraping, fertility may be affected.
Obviously, complications, which result in hysterectomy, will result in sterility. These problems are rare. The issue of an increased risk of breast cancer has received wide publicity. This concern has been essentially put to rest by studies which rather than relying on an individual recollection, reviewed patient records.