Facts about Early Abortion

The safest method for the performance of an early abortion is a surgical procedure called vacuum aspiration. This procedure ends an early pregnancy by gently suctioning the lining of the uterus and removing all of the tissues of the pregnancy. Old Pueblo offers this method of abortion through the 12th week of pregnancy, counting from the first day of the last menstrual period. This sheet will give you more information about the procedure and will explain each of the risks involved. Please remember that an Old Pueblo staff member is available to answer any questions or concerns that you may have before, during, and after your visit.

Before the Abortion
Once you check in at Old Pueblo, you will be asked to complete a medical history form and other paperwork. A counselor then will spend some time with you to explain the procedure, obtain your written consent, and answer any questions that you may have. A number of tests will be done, including a pregnancy test and a finger-prick blood test to check your Rh type and to make sure that you are not anemic. Various medications for pain relief will be discussed and offered to you in order to make you more comfortable during the procedure.

A little later, the doctor will go over your medical history and will examine your heart and abdomen. After a routine pelvic exam to check the size of your uterus, other tests may be performed. The physician will require a vaginal ultrasound examination prior to performing the procedure. The ultrasound more accurately determines the age of the pregnancy. The final decision as to whether the abortion will be performed in the clinic will depend on your medical history, your physical examination, and the results of your laboratory tests.

The Abortion Procedure
To begin the abortion, the doctor will give you a local anesthetic (numbing medicine) in your cervix, which will make the procedure more comfortable. The next step is to stretch gradually the opening of the cervix with a series of narrow instruments called dilators, each a little larger than the one before. When the cervix is open wide enough, a small plastic tube is inserted into the uterus and is connected to a suction machine. The tube is moved along the inside of the uterus for 40-50 seconds in order to remove all of the pregnancy tissue with gentle suction. During and after the procedure, you may feel cramping as the uterus shrinks down to its normal size. Immediately, after the procedure, the doctor will examine the pregnancy tissue to check whether it has been removed completely. The entire procedure takes approximately 3 minutes to complete.

After the Abortion
A short time after the abortion, you will be given the choice of staying in the exam room or being walked to recovery.You will be given follow-up instructions and an appointment for a check-up in 6 weeks. The physician will discuss your birth control plans with you, unless this was done earlier in the visit. When you feel comfortable, usually after 15 to 20 minutes you may leave. Because you may feel a little weak, it is necessary to arrange beforehand for someone to drive you home. Your ride must stay in the lobby area for the entire time you are here or you will not be able to receive sedation prior to your procedure.

Activity Restrictions
For the two days after the procedure (excluding the day of surgery) you should adhere mainly to bed-rest, moving only to take care of essential activities of daily living. It may be helpful to have a friend or family member stay with you. For 2 weeks, you are asked to avoid heavy lifting (>20lbs) or standing continuously for more than an hour at a time. If you wish, a note can be provided for work and/or school which describes your limitations without mentioning the type of surgery you had. Please let our staff know if you will have a problem following these instructions.

Possible Problems
Early abortion by vacuum aspiration is a very safe procedure. Fewer than 1 woman in 100 will have a serious complication following an early abortion. However, as with any surgery, there are certain problems that can arise during or after an abortion:

There is a 1 in 100 chance that an infection of the uterus will develop after the abortion. While this problem routinely is treated with antibiotics, there is a small chance that a repeat aspiration, a D&C, a hospitalization, or even surgery may be necessary.

In 1 in 100 cases, tissue is left inside of the uterus, leading to an "incomplete" abortion. This problem may lead to excessive bleeding, infection, or both. If this complication occurs, you could require a repeat aspiration or a D&C in a clinic or hospital, or other tests or treatment.

There is about a 1 in 500 chance that the uterus will be perforated (an instrument may go through the wall of the uterus and could damage internal organs such as intestines, bladder, or blood vessels). Treatment may consist of observation, laparoscopy, or abdominal surgery. The likelihood of hysterectomy (removal of the uterus) in this setting is 1 per 10,000 abortions.

Other risks include:
• Allergic reaction, which can be due to an allergy to the local anesthetic or to any other medications used. All medicines and drugs, including street drugs, may cause serious reactions alone or during anesthesia. It is important that you use only medically necessary drugs and avoid alcohol or other non-prescription drugs on the day of the abortion and that you tell the clinicians about all drugs you have taken;

• Hemorrhage (excessive bleeding), which may require treatment by medications, repeat aspiration, D&C, or rarely, surgery. Hemorrhage severe enough to require transfusion occurs in fewer than 1 per 1000 cases;

• Blood clots in the uterus, which may cause severe cramping and abdominal pain. The risk is about 1 in 100 cases and treatment is a repeat aspiration;

• Cervical tear, in fewer than 1 in 100 cases, which may be treated with medicines, or rarely, stitches in the cervix;

• Failure to end the pregnancy, which occurs in 1 per 500 cases and may be due to a divided uterus, very early pregnancy, or other causes. Another aspiration procedure is recommended when this happens. A tubal (ectopic) pregnancy is not ended by abortion and may require an abdominal operation to remove;

• An emotional reaction after the abortion. Emotional problems after abortion are uncommon, and when they happen, they usually go away quickly. Most women report a sense of relief, although some experience depression or guilt. Serious psychiatric disturbances (such as psychosis or serious depression) after abortion appear to be less frequent than after childbirth;

• Impact on future pregnancies, unlikely with uncomplicated early abortions;

• Death, which occurs in fewer than 1 per 100,000 abortions. This should be compared with the risk of death from a full-term pregnancy and childbirth, which is seven times greater than that from early abortion.

When you leave Old Pueblo after the abortion, you will be given a telephone number to reach the clinic should these or any other problems occur. Also, plan on returning to the clinic in 6 weeks for your follow-up exam. If follow-up is made after 10 weeks, there may be a charge. NO CHILDREN ARE ALLOWED TO ANY OFFICE VISIT.

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