Abortions performed after 14 weeks of pregnancy can be performed using two main methods - "dilation and evacuation" and "dilation and extraction." The type of procedure used depends on the length of the pregnancy and what your health care provider and you feel is best for you. The later into pregnancy, the more complicated an abortion might be. In some states, it also may be difficult to get an abortion after the first trimester.
DILATION & EVACUATION
Dilation & evacuation (D&E) is a technique of electively terminating a pregnancy. This method of abortion is recommended only if your pregnancy test was positive and your last menstrual period was 12 to 20 weeks ago. Dilation and evacuation is a surgical abortion procedure performed between 15 to 21 weeks gestation. In most cases, 24 hours prior to the actual procedure, your abortion provider will insert laminaria or a synthetic dilator inside your cervix. When the procedure begins the next day, your abortion provider will clamp a tenaculum to the cervix to keep the uterus in place and cone-shaped rods of increasing size are used to continue the dilation process. The cannula is inserted to begin removing tissue away from the lining. Then using a curette, the lining is scraped to remove any residuals. If needed, forceps may be used to remove larger parts. The last step is usually a final suctioning to make sure the contents are completely removed. The procedure normally takes about 30 minutes. Although some clinics may perform the procedure, it is usually performed in a hospital setting because of the greater risk for complications. The fetal remains are usually examined to ensure everything was removed and that the abortion was complete.
Side effects and risks of dilation & evacuation: The common side effects for most women include nausea, bleeding and cramping which may occur for two weeks following the procedure. Although rare, the following are additional risks related to dilation and evacuation: damage to uterine lining or cervix, perforation of the uterus, infection, and blood clots. Contact your health care provider immediately if your symptoms persist or worsen.
DILATION & EXTRACTION
Dilation & extraction (D&E) is a technique of electively terminating a pregnancy after 21 weeks of pregnancy. The procedure is also known as D & X, Intact D & X, Intrauterine Cranial Decompression and Partial Birth Abortion. Two days before the procedure, laminaria is inserted vaginally to dilate the cervix. Your water should break on the third day and you should return to the clinic. The fetus is rotated and forceps are used to grasp and pull the legs, shoulders and arms through the birth canal. A small incision is made at the base of the skull to allow a suction catheter inside. The catheter removes the cerebral material until the skull collapses. Then the fetus is completely removed.
Side effects and risks related to dilation and extraction: The side effects are the same as dilation and evacuation. However, there is an increase chance for additional emotional problems because of further fetal development. Contact your healthcare provider immediately if your symptoms persist or worsen.
In the late 1990s, anti-choice groups developed the emotionally charged term, "partial birth abortion" to describe this procedure. This is considered an inaccurate term and is not used by the medical community. Only 0.04 percent of all abortions use the D&X procedure, and only in rare and very serious circumstances. Nationwide, only a handful of physicians offer D & X abortions - usually at a high cost of $2000 or above.
This information and instruction discussion is based on the assumption that you have had counseling and competent guidance in making your decision to seek this procedure for termination of the pregnancy.
Wikipedia.org: Intact Dilation & Extraction Information
Wikipedia.org: Dilation & Evacuation Information
Induction abortion is a procedure that uses salt water, urea, or potassium chloride to terminate the viability of the pregnancy. Your abortion provider will insert prostaglandins into the vagina and pitocin will be given intravenously. Laminaria is then usually inserted into your cervix to begin dilation. This procedure is rarely used, and normally only occurs when there is a medical problem or illness in the fetus or women.
The side effects are similar to dilation and evacuation, although in rare cases it is possible for the motherís blood stream to be accidentally injected with saline or other medications. Excessive bleeding and cramping may also be experienced.
Contact your healthcare provider immediately if your symptoms persist or worsen.
REASONS FOR PROCEDURE
Personal concerns about the social or economic aspects that involve an unplanned pregnancy.
Continuing with the pregnancy may pose a threat to the life of the mother.
Mother has a genetic condition which the fetus is at significant risk of acquiring, or the fetus has been tested and is known to have the condition (such as cystic fibrosis).
Pregnancy resulted from a rape.
Fetus is affected with a major disorder such as chromosomal abnormality or birth defect.
Fear that the fetus has been harmed by medications or other conditions.
Dilation & Extraction: This procedure is only performed because the fetus has died or is badly malformed, or a continued pregnancy would place the woman's life or health in danger.
RISK INCREASES WITH
Recent or chronic illness.
Use of drugs such as antihypertensives; muscle relaxants; tranquilizers; sleep inducers; insulin; sedatives; narcotics; beta-adrenergic blockers; or cortisone.
Use of mind-altering drugs, including: narcotics; psychedelics; hallucinogens; marijuana; sedative; hypnotics; or cocaine.
DESCRIPTION OF PROCEDURE
For a surgical abortion, your health care provider will want to first give you a pelvic exam to determine the size of your uterus. This is a routine exam in which your health care provider will gather some more information about your body and your pregnancy.
A speculum (a plastic or metal instrument that gently stretches your vagina so that your health care provider may reach your uterus) in inserted, and the cervix (opening of the uterus) is cleansed before all surgical abortions.
In most instances, the D&E is an outpatient, operative procedure carried out under a sedative to relax you and local anesthetic injected into the cervix. Most women report that this injection does not hurt, although some say that it feels like a little pinch. Sometimes a general anesthetic is used.
Most abortions require the dilation (opening) of your cervix, so that the embryo or fetus may be removed from your uterus. The cervix is dilated to make it ready for the procedure. To dilate your cervix, your health care provider will typically apply some anesthesia to the cervix. After anesthesia, the cervical canal (the area between your vagina and your uterus) is opened by inserting several smooth slender rods, called dilators. These are used to gradually stretch open the cervical canal. The widest rod is about the size of your finger. The dilation may cause cramping similar to menstrual cramps. Some women have strong cramps, some not so much. Dilators may stay in for a few hours or overnight. Several methods are available that are used to soften (or ripen) the cervix and your health care provider will explain them to you.
Surgical instruments are then used to remove the fetal tissue, the fluid around the fetus and placenta. A curettage (scraping of the uterus) may follow.
The procedure takes increasingly more time with advanced gestational age. This procedure will usually take 10 to 20 minutes.
MoonDragon ObGyn Womens Health Information: Suction Curettage
Termination of the pregnancy.
Recovery is rapid, with the patient usually returning home within hours.
Complications such as lacerations or tearing of the cervix, perforation of the uterus, and heavy bleeding may occur.
In some cases, a repeat procedure may be required.
POST PROCEDURE CARE
Following the procedure, rest quietly at home for the remainder of the day.
Heat helps. If you have pain, place a heating pad or hot-water bottle on the abdomen or back. Hot baths frequently promote muscle relaxation and relieve discomfort. Repeat the baths as often as they provide comfort.
You will probably experience intermittent bleeding for the next 10 to 14 days, which may be light or moderately heavy - decreasing with rest and increasing with standing, walking, or other activity. Use external sanitary pads for bleeding.
If contraception is desired, it can often be initiated shortly after the procedure. If you wish to take birth control pills, begin taking them either on the night you return from surgery or the next day. If you prefer an IUD, diaphragm or cervical cap, the fitting can be made during you next clinical appointment.
Your next menstrual period should begin 4 to 6 weeks after the procedure. If you take birth control pills, your first period will begin after you complete the first cycle of pills.
Prescription pain medication should generally be required for only 2 to 7 days following the procedure.
You may use non-prescription drugs, such as acetaminophen, for minor pain.
Antibiotics may be prescribed to reduce risk of infection.
Drugs such as methylergonovine (Methergine) or oxytocin (Pitocin) to keep your uterus tightly contracted may be necessary in some cases.
Normal activities may be resumed almost immediately.
You should have no vaginal sexual relations, inserting tampons, or douching for 1 to 2 weeks following the operation. Ask your health care provider for specific instruction pertaining to your individual situation.
No special diet.
NOTIFY YOUR MIDWIFE OR HEALTH CARE PROVIDER IF...
Any of the following occurs:
You experience increased frequency, amount, or duration of bleeding (heavier than the heaviest day of your period).
You develop fever, with a temperature of over 100°F orally.
You experience prolonged abdominal pain or pressure on the bladder or rectum.
You develop any new symptoms that cause you concern.
MoonDragon's ObGyn Womens Health Information: Abortion Index
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