Facts about Mid trimester D&E Abortion

If You have had a C-section or any surgey on your uterus, press this Link C-section

A D&E (Dilatation and Evacuation) is a method of abortion done between the 14th and 24th week of pregnancy, counting from the first day of the last menstrual period. Old Pueblo offers D&E abortion through the 20th week of pregnancy. D&E is a two-part procedure requiring dilation (open) of the cervix and to empty the uterus. Both parts of the procedure can be done in several hours in most cases. In some cases (depending on your medical history), more time may be required.

Before the D&E
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 examination to check the size of your uterus, other tests may be performed. You also will have a vaginal or an abdominal ultrasound examination. The ultrasound more accurately determines the age of the pregnancy. The final decision as to whether the abortion may be performed in our office will depend on your medical history, your physical examination, and the results of your laboratory tests.

Insertion of Osmotic Cervical Dilators
Osmotic dilators may be used to slowly stretch the opening of the cervix. These small devices swell when they absorb water from the cervical fluids. The dilators remain in the cervix for several hours (sometimes overnight), kept in place by gauze inserted into the vagina.

Cytotec
Cytotec has been approved by the FDA to treat ulcers. It also has the effect of softening the cervix and causing the uterus to contract. Used in combination with dilators, Cytotec can make your abortion much quicker and less painful. You need to be aware that Cytotec is not approved by the FDA for use in abortion, and that there may be a small but increased chance of injury to your uterus, especially if you have a history of C-section or other surgery on your uterus. Please let our staff know if you have a history of C-section or surgery on your uterus.

The Abortion Procedure
Before the procedure is started, a needle will be inserted into your vein, and will stay there during the time you are in the clinic; once the needle is in place, all the medications that you need will be given through it. These medications may include drugs to reduce discomfort and help you relax.

If dilators were used to open your cervix, the gauze and dilators will be removed. The doctor may give you a local anesthetic (numbing medicine) in your cervix, which will make the procedure more comfortable. The opening of the uterus may need to be stretched more, which will be done gradually with a series of narrow instruments called dilators, each a little larger than the one before. When the cervix is open wide enough, a plastic tube is inserted into the uterus and is connected to a suction machine. The content of the uterus then is removed by a combination of suction and instruments, usually taking 5-15 minutes. During and after the procedure, you may feel cramping as the uterus shrinks down to its normal size. Later, the doctor will examine the pregnancy tissue to check whether it has been removed completely.

After the Abortion
After the abortion, you will be given the choice of recovering in the room or walking to the recovery area. 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 30 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.

Possible Problems
Mid trimester abortion is more complex than earlier abortion procedures. With D&E, there is a greater risk of perforating the uterus or injury to the cervix than with early abortion. However, compared with the other methods available after the 16th week of pregnancy (injection of saline or prostoglandins inside the uterus), with D&E there is less risk of bleeding, infection, and incomplete abortion. There is no hospital stay and costs are lower, unless complications occur.

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.

Complications may include, but are not necessarily limited to:
• 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.

• 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.

• 3 in 1,000 chance during D&E 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). Hospitalization is required, and an abdominal operation usually is performed to repair the damage. The likelihood of hysterectomy (removal of the uterus) in this setting is fewer than 1 per 1,000 D&E 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 1,000 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;

• 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 after abortion appear to be less frequent than after childbirth;

• impact on future pregnancies, is unlikely with uncomplicated abortions;

• the risk of death, is about equal to that from full-term pregnancy and childbirth.

When you leave Old Pueblo Family Planning after the abortion, you will be given a telephone number to reach the clinic should these or any other problems occur. You should 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.