Abortion Surgical Procedures Explained

Abortion is a very controversial issue, but, through education and better understanding of the facts, we can make more informed decisions concerning abortion and pregnancy.

First Trimester (6–14 weeks)

  1. Suction Curettage. The physician dilates (opens) the cervix (the opening to the uterus or womb) with a series of gradually larger dilators or the physician may choose to use the laminaria (a porous material which expands with moisture in order to open and soften the cervix) procedure. During the abortion, the doctor attaches tubing to a suction machine and inserts the tubing into the uterus. The suction created by the vacuum pulls the fetus apart and detaches the placenta from the wall of the uterus, sucking the fetal parts and placenta into a collection bottle.
  2. Manual Vacuum Aspiration (Menstrual Extraction). This method is only done up to 7 weeks. The cervix is dialated and the uterus is emptied with a handheld syringe by applying manual suction.
  3. Dilation and Curettage (D&C or sharp curettage). This method is not common since it is considered less safe than suction curettage. The cervix (the opening to the uterus or womb) is dilated and a curette, or loop-shaped tube, is inserted into the uterus to pull the pre-born’s body apart and detach the placenta from the wall of the uterus. All body parts and membranes are then scraped out of the mother’s body.

What are the physical risks of first trimester surgical abortions?

  • Infection, local and systemic (sepsis).
  • Hemorrhage and shock, especially if the uterine artery is torn.
  • Retained tissue, indicated by cramping, heavy bleeding, and infection.
  • Post-abortal syndrome, referring to an enlarged, tender, and soft uterus retaining blood clots.
  • Cervical tearing and laceration from the instruments.
  • Perforation of the uterus by instruments. May require major surgery, including hysterectomy.
  • Scarring of the uterine lining by suction tubing, curettes, and other instruments.
  • Failure to recognize an ectopic pregnancy. This could lead to the rupture of a fallopian tube and hemorrhage. The result could be infertility or death, if treatment is not provided in time.
  • Anesthesia risk, the same as the risks of undergoing anesthesia for any other procedure.

Getting accurate statistics on abortion complications and death rates is difficult. Reporting on abortions is strictly voluntary in most states.

Second Trimester (13–24 weeks)

  1. Dilation and Evacuation (D&E). At this point in pregnancy, the pre-born’s body is too large to be broken up by suction and it will not pass through the suction tubing. The cervix (the opening to the uterus or womb) must be more dilated (opened) than in a first-trimester abortion. This is usually accomplished by inserting laminaria (a porous material which expands with moisture in order to open and soften the cervix) a day or two before the abortion. The physician then dilates the cervix and dismembers the body and crushes the skull to facilitate removal.
  2. Saline, Prostaglandin, and Urea instillation. These methods, more common during the 1970s and 1980s, are rarely used now.

What are the physical risks of a second trimester surgical abortion?

Dilation and Evacuation (D&E)

  • Retained tissue, including the placenta.
  • Uterine perforation, possibly resulting in severe pain and blood loss, this may require major surgery, including hysterectomy.
  • Cervical laceration, perforation, and heavy bleeding (hemorrhage).
  • Infection.

Second and Third Trimester

Abortion by Induction. Fetal demise is accomplished by injection of medication into the fetal heart. This medication can be digoxin or potassium chloride. The cervix is softened with medication and laminaria. Labor is induced and the fetus is expelled on average 20 hours later. In some cases the induction method fails or cannot be used, an extraction procedure is used to remove the fetal pieced using forceps. A hysterotomy (c-section) may be used as well.1

Possible side effects of labor induction include infection and excessive bleeding. When medications are used to initiate labor, there is risk of rupture to the uterus. Other immediate medical risks may include the following:

  • Blood clots in the uterus.
  • Heavy bleeding.
  • Lacerated or torn cervix.
  • A perforation of the wall of the uterus.
  • Pelvic infection.
  • Incomplete abortion.
  • Anesthesia related complication2

Psychological Risks

What are the psychological risks of abortion?

A 2011 article published in the British Journal of Psychiatry reviewed 22 major studies between 1995 and 2009 that examined the psychological effects of abortion on women. The results of the survey were alarming. Compared to women who carried their babies to term, women who obtained abortions were:

  • At an 81 percent increases risk for mental health problems, 10 percent of which is directly attributable to the abortion.
  • 27 percent more likely to use marijuana.
  • 21 percent more likely to display suicidal behaviors.
  • 35 percent more likely to commit suicide3

Such symptoms may include the following:

  • Alcoholism – Abortion doubles the risk of alcoholism in women. Studies have shown an increased risk of alcohol abuse during subsequent pregnancies following an abortion.
  • Child Abuse – Abortion is linked to depression, violent behavior, and difficulty in bonding to children born subsequent to an aborted pregnancy. One study indicated that women who had an abortion history reported more frequent slapping, hitting, kicking or biting, beating, and use of physical punishment compared to women without an abortion history.
  • Divorce and Relationship Problem – Many post-abortive women have trouble forming lasting bonds and report substantial conflict within their relationships.
  • Drug Abuse – Abortion is linked to subsequent drug abuse. One study found that the use of illicit drugs among post-abortive women is 6.1 times higher than for those without a history of abortion. Another study showed that post-abortive women were 4.5 times more likely to abuse drugs during subsequent pregnancies.
  • Post Abortion Syndrome (PAS) – At least 19 percent of women who have had abortions suffer from PAS. About half of women who have had abortions suffer form many, but not all, of the symptoms of PAS. The symptoms include anxiety attacks, irritability, outbursts of rage, sleep difficulties, flashbacks of the abortion experience, reactions of intense grief on the date of abortion or the baby’s due date, nightmares about the abortion, and drug or alcohol abuse. The best evidence regarding negative effects of abortion indicated that 10-30 percent will experience serious psychological problems.
  • Psychological Impairment – Women with a history of abortion are 81 percent more likely to encounter psychological health problems. This includes a 34 percent greater risk of anxiety issues and a 37 percent higher rate of depression.
  • Repeat Abortions – Studies indicate that nearly half of all abortions are repeat abortions that carry risks such as substance abuse and premature birth in subsequent pregnancies. Women who have undergone repeat abortions are also 80 percent more likely to experience vaginal bleeding in subsequent pregnancies, greatly increasing the risk of perinatal mortality.
  • Sleep Disorders – Women who underwent abortions were twice as likely to seek treatment for sleep disorders in the first six months after pregnancy than women who had given birth. The higher risk for sleep disorders persisted for four years following an abortion, although not as high a level.
  • Suicide – One study of post-abortive women in California found that those who elected to have an abortion were 2.6 times more likely to die of suicide compared to those that carried their babies to term.
  • Thoughts of Suicide – A study published in 2009 indicated that post-abortive women are 60 percent more likely to experience thought of suicide following the procedure.4

1-2 – Abortion methods: Chemical, medical and instrument free. (2015) Retrieved May 12, 2013, from Orlando Womens Center: womenscenter.com/abortion_methods.html

3 – Priscilla K. Coleman, Abortion and mental health: quantitative synthesis and analysis of research published 1995-2009, 199 Brit. J. of Psychiatry 180,183 (2011).

4 – azpolicypages.com/life/the-abortion-pill-also-known-as-ru-486-or-mifeprex/