Abortion Procedures | Frequently Asked Questions
What are the most common methods of Abortion?
How is a chemical Abortion, non-surgical abortion, RU486, Abortion Pill,
Abortion by pill, instrument-free (Medical Abortion) performed?
What is the most common abortion medication used in the United States?
Up to how many weeks can the Abortion Pill Procedure (Medical Abortion, RU486) be performed?
Are the Early Term Abortion medications safe to use?
How will I know if I am having some type of complication with the medical abortion (abortion pill) procedure?
What is the chance of the Medical Abortion Procedure (RU486) working if it fails the first time?
How will I know the abortion is complete after the Medical Abortion (abortion pill) procedure?
If the Medication Abortion (Abortion Pill) Procedure does not work, can patients decide not to go through the abortion procedure?
Is there another abortion medication pill that I can take besides RU486?
Can Abortion by Aspirin Be Done?
Where can I get the Abortion Pill?
Could you briefly describe the abortion process that occurs in your facilities?
What happens during an abortion?
How is a surgical abortion performed?
How effective is the surgical abortion?
How will I feel after the surgical abortion?
How long does the procedure take?
How will I know if the abortion procedure was successful?
Which procedure is better, the surgical or the chemical?
Which procedure is less painful?
Abortion Procedures
What Are the Most Common Methods of Abortion?
Some of the most common methods of Abortion are the following:
- Menstrual Extraction: This method is used in early pregnancy (3 to 6 weeks) where a hand held manual suction device along with a sterile curette is inserted inside the cervix and the pregnancy tissue is removed.
- Dilation and curettage (D&C): This procedure is performed between 3 to 12 weeks gestation. The patient electively receives IV Sedation, Deep Sedation, Advanced IV Sedation, or General Anesthesia. The cervix is anesthetized with Lidocaine and then dilated with sterile dilators followed by insertion of a sterile curette the size of a straw inside the uterus and the pregnancy tissue is gently removed. The procedure is a 3 minute pain free safe abortion.
- Dilation and Evacuation (D&E): This procedure is performed between 12.5 to 24 weeks gestation. This can require cervical preparation where the cervix is dilated and softened using Laminaria and prostaglandins. Laminaria is sterile seaweed that is placed generally over night that allows dilation of the cervix to occur. This reduces the incidence of cervical tears, bowel and bladder problems, and uterine perforation from occurring during the procedure. The procedure is described as in number 2 above, plus there may be special forceps used to help to manually evacuate the pregnancy tissue inside the uterus. Patients that are further than 21 weeks will also undergo fetal intra-cardiac injection with Digoxin which stops the fetal heartbeat instantly on day one of the D&E procedure.
- Prostaglandin or Oxytocin Inductions: This procedure is performed in patients that are 17 weeks and beyond. Both of these medications cause the uterus to contract which allows the cervix to open and within several hours there is passage of the fetal tissue.
- Hysterotomy: Rarely performed but occurs where there is a small incision made on the mother’s abdomen and the uterus is opened and the fetus is removed.
- Medical Abortions: Early Medical abortions are generally performed between 3 to 14 weeks gestation. Late Medical abortions can occur between 15 and 24 weeks.
How is a chemical Abortion, non-surgical abortion, RU486, Abortion Pill, Abortion by pill, instrument-free (Medical Abortion) performed?
A chemical abortion is also referred to as an instrument-free, non-surgical abortion, RU486, Abortion Pill, Abortion by pill, or Medical” abortion because surgical instruments are not used. Medical Abortions (Abortion Pill) are performed over a course of one to three weeks requiring weekly visits. During the first visit the physician will perform a sonogram to determine the length of the pregnancy. The patient is given an oral form of Methotrexate, RU486, or Tamoxifen, or an intramuscular injection of Methotrexate which will stop further development of the pregnancy in the majority of cases.
You will insert a medication called Misoprostol into the vagina on the same day or up to 96 hours (5 days) (normally 48 to 72 hours) after your initial visit to the office. This medication will be in the form of small tablets and will cause the cervix to dilate without the need for surgical instruments. Within 2 to 6 hours after the tablets have been inserted, the patient will experience bleeding and cramping similar to a menstrual period. On the second visit (generally 1 week after the first office visit) the physician will perform a sonogram to determine that all of the pregnancy tissue has been eliminated. The success rate of a chemical abortion is approximately 94 to 99%. The earlier the pregnancy, the higher the success rate for a complete abortion to occur. Should the physician determine that the procedure was incomplete, a patient has two options: She may have the Misoprostol reinserted to encourage further elimination of the pregnancy tissue, or she may have a vacuum aspiration procedure performed.
What is the most common abortion medication used in the United States?
The most common medication used in the United States is RU486 which is also known as Mifeprex, Mifepristone, Abortion Pill, or French pill. RU486 was approved by the FDA in 2001 specifically for termination of pregnancy. It works by altering the blood flow to uterine lining of the uterus as well as causing an increase in the intrauterine pressure that leads to inadequate blood flow to the pregnancy and uterine contractions which leads to spontaneous vaginal bleeding and miscarriage. There is approximately a 40 percent chance of the loss of pregnancy with the use of RU486 alone if used in pregnancies less than 6 weeks gestation. The RU486 pill has been found to be very safe and highly effective with a 96 percent success rate of termination of pregnancy up to 9 weeks gestation and near 100 percent for pregnancies less than 6 weeks gestation.
Up to how many weeks can the Abortion Pill Procedure (Medical Abortion, RU486) be performed?
Most Physicians in the U.S. do not perform the Abortion Pill Procedure after 10 weeks from the last menstrual period. European medical literature indicates that the Abortion Pill procedure can be safely performed up to 13 to 14 weeks on an outpatient basis; however, there is a higher incidence of failure. There are Physicians in our facility that may allow a patient who meets certain criteria to have the Abortion Pill procedure performed on an out-patient basis up to 14 weeks.
We are able to perform the Abortion Pill Procedure from 3 to 24 weeks in 24 hours or less in 99% of cases with minimal to no complications. The process is highly efficient, safe and effective.
Are the early term abortion medications safe to use?
The medications used to terminate pregnancies in early term have been studied since the early 1980’s which means that they have been used for this indication for close to thirty years. There is less than a 1 percent chance of complications that occur. The most common is failure of the medications to work and the pregnancy continues to grow. Rarely does such heavy bleeding occur that a blood transfusion is required. Other complications include the possibility of retained tissue with possible uterine infection. There have been a few reported deaths related to a rare infection but there is no direct evidence that the deaths were directly caused by the medications that were taken.
How will I know if I am having some type of complication with the medical abortion (abortion pill) procedure? The complications that are seen with the abortion pill procedure are the following which occur less than 1%:
- Heavy Bleeding. This occurs less than 1 percent of the time and usually resolves almost immediately when a surgical D&C is performed. It is very rare that a blood transfusion is required.
- Prolonged Bleeding. Bleeding with the abortion pill normally lasts anywhere from 5 days to 2 weeks. It can last more than 30 days but this is seen in less than 1 percent of cases.
- Severe cramps. This can indicate that there is retained tissue (incomplete abortion) in which additional Misoprostol is used or a surgical D&C is performed to get rid of the tissue.
- Elevated temperature. Usually with temperature there is pelvic pain and possibly cramps. This indicates a high probability of infection. Patients are normally given a course of antibiotics and they undergo a surgical D&C.
- No bleeding or cramping. The number 1 reason for this is a failed procedure. There is a choice of repeating the Misoprostol dosage or performing a surgical D&C.
What is the chance of the Medical Abortion Procedure (RU486) working if it fails the first time?
The abortion pill procedure has a 94 to 99 percent success rate. No one knows why the procedure is not 100 percent effective. When patients return and either have an incomplete abortion or a failed abortion, they are offered more Misoprostol tablets to take as our experience shows that there is high percentage of success with the second dosage. If the patient decides that she does not want to take the Misoprostol tablets, then we proceed with the surgical abortion.
How will I know the abortion is complete after the medical abortion (abortion pill) procedure?
You will not know 100 percent until you return for a sonogram to see that there is no presence of fetal or gestational tissue.
If the Medication Abortion (Abortion Pill) Procedure does not work, can patients decide not to go through the abortion procedure?
Methotrexate and Misoprostol are known to be fetotoxic. In essence, they can cause severe fetal abnormalities and so therefore once these medications are used, one must continue with the abortion procedure. There have not been any fetal toxic problems reported with RU486 in the literature. It is known for patients less than 6 weeks, there is approximately a 40 percent chance of an abortion occurring without the use of Misoprostol.
Is there another abortion medication pill that I can take besides RU486?
Yes. There are actually two pills that have been studied extensively in the medical literature. The first is Methotrexate and the second is Tamoxifen. Methotrexate has been used extensively since the late 1980’s in combination with Misoprostol to terminate pregnancies between 3 and 9 weeks gestation. This combination is 90 to 94 percent effective in causing termination of pregnancy. Tamoxifen has been used since the early 90’s to terminate pregnancies from 3 to 9 weeks gestation. Its success rate is equivalent to
Methotrexate. Both medications are very safe and efficient in terminating early pregnancies and can be used as a substitute or if the patient is allergic to RU486.
Can Abortion by Aspirin Be Done?
Aspirin is an anti-inflammatory medication that can cause thinning of blood such that it helps to reduce chance of blood clotting. There are no studies that show that taking aspirin will cause an abortion in early pregnancy. As a matter of fact anti-inflammatory medications have been used to help stop premature labor, and they are also used in early pregnancy along with Heparin to prevent miscarriages in patients who have had multiple losses of pregnancies and are found to have connective tissue disorders. Taking high doses of aspirin can lead to gastrointestinal bleeding and maternal death.
Where Can I Get the Abortion Pill?
There are some people who may order their Abortion Pills online from facilities or pharmacies outside of the United States. The problem with this is that patients are getting medications that are potentially unregulated and may or may not even contain the necessary medication, or the medication in the appropriate dosages. Without being under the care of a Physician and taking the Abortion Pills can be very dangerous in that if a serious complication occurs and one is not under the care of a Doctor, the patient could end of having a dire emergency which could be a matter of life or death for the patient. It is always advised to get the Abortion Pill from a licensed Medical Physician who is trained to perform surgical termination of pregnancies in case there is a medical problem. In addition; a sonogram should be performed on all patients to assure the exact gestation of pregnancy. The complication rate for medical abortion increases for pregnancies greater than 13 to 15 weeks gestation. There are many women where their pregnancy does not match their last menstrual period which can lead to very serious problems if the patient is not under the supervision of an experienced Physician.
Would you please describe the Abortion Process that occurs in your facilities?
Because it may be comforting to discuss the procedure prior to coming in for your appointment, we encourage you to call us with any questions. You are also welcome to visit our office ahead of time to become familiar with our location and staff.
Your appointment will include the following:
- If you did not print and fill out the necessary forms online prior to your appointment, we will give them to you when you present to our receptionist.
- Lab work to measure your hemoglobin and determine your blood type and a urine test to perform pregnancy test, and documentation of vital signs
- Personal Abortion counseling to discuss the benefits and risks of the abortion procedure and Birth control education
- The abortion procedure and recovery
What happens during an abortion?
The patient is taken to an exam room where she is placed on the exam table and gets into the same position as if a Pelvic Exam and Pap Smear are going to be performed. If she has elected to have IV Sedation, Advanced IV Sedation, Deep IV Sedation or General Anesthesia, that process is started. After the patient is noted to be comfortable, the remainder of the procedure occurs.
The cervix is anesthetized with Lidocaine, which is similar to Novocaine. The cervix is then dilated to allow for access to the uterus. A curette (hollow plastic tube comparable to a drinking straw) is inserted into the uterus, and the contents are then removed by manual or machine suction aspiration.
After a certain number of weeks pregnant, your cervix will need to be dilated (opened) with Laminaria (sterile seaweed), or Cytotec (medication that causes the uterus to contract) which causes the cervix to open. You may be asked to go home or to a hotel to return the following day for the actual surgery. Sometimes it may take 3 days in order for the cervix to dilate adequately before surgery is performed by removing or evacuating the pregnancy tissue with oval forceps suction aspiration.
How is a surgical abortion performed?
The cervix is anesthetized with Lidocaine, which is similar to Novocaine. The cervix is then dilated to allow for access to the uterus. A hollow plastic tube comparable to a drinking straw is inserted into the uterus, and the contents are then removed by manual or machine suction aspiration.
After a certain number of weeks pregnant, your cervix will need to be dilated (opened) with Laminaria (sterile seaweed), or Cytotec (medication that causes the uterus to contract) which causes the cervix to open. You may be asked to go home or to a hotel to return the following day for the actual surgery. Sometimes it may take 3 days in order for the cervix to dilate adequately before surgery is performed.
How effective is the surgical abortion?
In over 99% of cases, a surgical abortion is completely effective. A small percent of patients may experience pain, bleeding, fever, or retained tissue (pregnancy tissue remaining inside the uterus). This will require the surgical procedure to be repeated (re-aspiration). It is rare for a perforation of the uterus, bowel damage, bladder damage, or maternal death to occur.
How will I feel after the surgical abortion?
It is during the first 10 to 15 minutes after surgery that patients have the most discomfort. This is caused by the uterus contracting and is comparable to menstrual cramps. There are a small percentage of patients that have cramps after leaving the office which is usually relieved by the post-operative pain medications provided. Tylenol, Advil and other over the counter anti-inflammatory medications can be used as well. For patients less than six weeks, you may have intercourse the following day after your procedure. For patients more than six weeks, they may not use tampons, have intercourse, or douche for 2 to 3 weeks after the abortion procedure.
How long does the procedure take?
Depending on the length of your pregnancy the actual procedure may take from only 3 to 7 minutes.
How will I know if the abortion procedure was successful?
Your pregnancy symptoms (nausea, vomiting, and decrease or increase appetite) will go away almost immediately. It may take a week or two for the breast tenderness and sensitivity to completely subside. If there is no bleeding greater than 2 pads an hour, a temperature greater than 100.4, or severe abdominal pain, then you can be fairly certain that the procedure was successful. If there are any questions or problems, you can always call the office at any time.
Which procedure is better, the surgical or the chemical?
This is an individual decision. Some women feel the surgical procedure is better because it is not drawn out over the course of a two to three week period. Other women feel the medical abortion procedure may be more advantageous because it can be done earlier in pregnancy, they do not want to undergo surgery or have pelvic exams, and they feel that the abortion pill offers more privacy since the procedure is generally completed at home. The insertion of the Misoprostol is taken with the patient’s companion, friend, or family member around which can be very important for the patient. Each woman may decide which procedure is best suited for her individual needs.
Which procedure is less painful?
The level of discomfort varies from person to person because every individual has a different degree of pain tolerance. Most women feel that because the chemical procedure is less invasive, it is therefore less painful. If you are found to be less than 6 weeks gestation, the early surgical procedure has the advantage of immediate completion. You are able to return to your normal activities and have sex the following day.
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