Medical & Surgical Abortion

Medical abortion

Early medical abortion (up to nine weeks of pregnancy)
Early medical abortion can be carried out up to nine weeks of pregnancy and it involves taking special drugs to cause an early miscarriage. It does not involve any surgery and does not need an anaesthetic. You will need three appointments. The first is an assessment – the abortion will not be carried out at this visit. You will then need two appointments on two separate days. You should be able to carry out your usual activities between appointments. You will be given a 24-hour contact telephone number if you are worried or want to talk to someone at any time.

At the second appointment, you will be given a tablet (called mifepristone) to swallow. This blocks the pregnancy hormone that is necessary for the pregnancy to continue.

It is very unlikely that the abortion will happen after taking only the mifepristone, but very occasionally it can happen. Some women change their mind about the abortion after they have taken the mifepristone. Although studies so far do not show that mifepristone is associated with any risk of fetal abnormality, women are advised to continue with the abortion once they have taken mifepristone.

At the third visit (usually one to three days later) you will be given prostaglandin tablets, called misoprostol or gemeprost. Misoprostol can be used in the vagina or taken by mouth, gemeprost can be used only in the vagina. This causes the womb (uterus) lining to break down and bleed. You may feel cramping pains similar to period pains; you can ask for pain relief. The pregnancy is lost with the bleeding just like a miscarriage. This normally happens four to six hours after using the prostaglandin tablets. Sometimes you stay in the hospital or clinic, and sometimes you may be able to go home.

Medical abortion from 9–20 weeks
The drugs used for early medical abortion are also used for abortion later in pregnancy. Because the abortion is being carried out later in the pregnancy higher doses of prostaglandin have to be used. The abortion is like having a late miscarriage. You will stay in the hospital or clinic for this. The abortion at this stage is usually quick enough for you to return home the same day, but sometimes it is necessary to stay overnight, particularly when the abortion is carried out later in pregnancy.

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Surgical abortion

Manual vacuum aspiration (suction abortion) up to ten weeks
Manual vacuum aspiration is also known as MVA and can be used at up to ten weeks of pregnancy. It is a simple method and involves a small tube being inserted into the vagina, through the cervix (entrance to the womb) and into the womb to remove the pregnancy by suction. To reduce any discomfort or pain during the abortion the doctor will inject a local anaesthetic into the cervix.
Sometimes this injection can be painful. The procedure takes about 5–10 minutes. You will usually go home on the same day a few hours after the abortion has been carried out. Sometimes this may be earlier.

Vacuum aspiration up to 15 weeks
This method is similar to manual vacuum aspiration, but instead of removing the pregnancy using a manual suction technique it uses an electric pump. To reduce any discomfort or pain during the abortion there is a choice of pain relief. The abortion can be carried out using a local anaesthetic in the cervix or by giving you a light general anaesthetic so you are asleep during the procedure. Some women have conscious sedation – drugs that make you sleepy so you won’t remember everything that happens during the abortion. The procedure takes about ten minutes. You will usually go home on the same day a few hours after the abortion has been carried out.

Surgical dilatation and evacuation (D&E) abortion after 15 weeks
This method is carried out under general anaesthetic. The cervix is gently stretched and dilated to allow special forceps to remove the pregnancy in fragments. Any remaining tissue will be removed by suction as in vacuum aspiration. This takes 10–20 minutes. You may be able to return home on the same day if you are healthy and there are no complications.

Abortion after 21 weeks
Abortion at this stage is not common. It involves either the surgical dilatation and evacuation method, or medical abortion. Whichever method is used, a doctor will ensure the heart of the fetus is stopped so it is not born alive. The procedure takes time and you will have to stay in the hospital or clinic, sometimes overnight. The pregnancy is removed either surgically or by use of drugs. Having a late medical abortion will involve you going through what is similar to labour to deliver the fetus.

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