Dr. Suzanne Trupin is a Clinical Professor of Obstetrics and Gynecology at the University Of Illinois College Of Medicine at Urbana-Champaign. She graduated from Stanford University and completed her medical training at New York Medical in Valhalla, New York. She received her residency training at the University of Southern California Women's Hospital in Los Angeles, California. She is Board-Certified by the American Board of Obstetrics and Gynecology.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
For a first-trimester termination, particularly at less than 10 weeks' gestation, rarely do you need to have your cervix dilated (enlarged so the contents of the uterus can pass through and out of your body). If you are in the latter part of the first
trimester (first three months), you may have a small sterilized stick called a
laminaria japonica (or more than one) placed in your cervix to open it. These laminaria take about four hours to be useful and may be placed overnight.
Before inserting the stick, your cervix may be swabbed with Betadine, a cleaning solution. You may be given an injection of numbing solution into the cervix. This is the beginning of the abortion procedure. Please understand your risks, and they should have been explained in the counseling process, before you start the dilatation process.
Sedation during abortion
Most women are coached through an abortion as the health care
professional explains each step. Some women prefer to have some numbing in their cervix. Most do not require IV sedation.
If heavy sedation is selected, then IV fluids will be used.
First-trimester surgical abortion
Early terminations are performed with little cervical dilatation and using a hand-held
syringe or a small-bore
cannula (a tube) attached to a suction machine. Abortions performed with a syringe are referred to as manual aspirations (or menstrual extractions). Those performed with the suction generated by a vacuum aspirator are referred to as a vacuum
aspiration. Both procedures take only a few minutes.
Tools are used to grasp the cervix after it has been prepared with Betadine and possibly numbed. The cannula is carefully inserted through the cervix into your uterus. The actual evacuation is performed by applying suction to the syringe or via the machine. The procedure takes a few minutes to complete. There is a small amount of blood loss.
The doctor will check the tissue to make sure it has all been taken out.
Dilatation and curettage (D&C)
This specifically is a term that is usually applied to a diagnostic procedure or the treatment of an incomplete abortion.
The procedure is usually accomplished with similar
dilatation procedures, but the uterus is emptied with a sharp metal curette. These curettes are more dangerous than the flexible or rigid plastic devices, which are used in the suction procedures, and are not recommended for abortion procedures.
Second-trimester dilatation and evacuation
Dilatation and evacuation is the safest and most common method of second-trimester termination used by experienced health care professionals. Dilation takes place over hours and possibly days with the sticks to enlarge the cervix.
Once the cervix is enlarged enough, the procedure is accomplished using a combination of suction curettage and manual evacuation of the fetus and
placenta. Ultrasound may be used to guide the tools.
The procedure is longer and more uncomfortable than a first-trimester procedure, but many women can comfortably go through the procedure with local anesthesia.
Dilatation and extraction
This procedure is accomplished by cervical preparation similar to cases of dilatation and evacuation, but the fetus is removed in a mostly intact condition. The fetal head s able to be collapsed after the contents are evacuated so that it may pass through the cervix.
Very few health care professionals perform the procedure. It is
usually reserved for cases of maternal medical complications or serious medical problems with the fetus.
The procedure, referred to as intact dilatation and extraction, called partial-birth abortion, has now been banned by a 2007 Supreme Court ruling.
To avoid performing a partial birth abortion while
performing a legal dilatation and extraction, digitalis or potassium
chloride may be injected onto the fetus to induce preoperative fetal death. Fetal cord cutting may accomplish this as well.
Research has not firmly established at what age a
healthy fetus can feel pain, but generally it is thought that this occurs around 24-28 weeks.
Induction of labor
Most doctors have experience with the standard drugs used to induce labor for birth. These can be used in the second trimester of pregnancy.
Premature rupture of membranes is one indication
for this method.
Cervical ripening agents are typically necessary with either laminaria or misoprostal.