- Vacuum aspiration (suction curettage, dilatation & curettage (D&C)
- Dilatation & evacuation (D&E)
- Manual vacuum aspiration (MVA)
- Pre-operative dilatation of the cervix
- Anaesthesia and pain relief
- After the abortion
Vacuum Aspiration, also known as Suction Curettage, or Dilatation & Curettage (D&C) is the commonest method of abortion used in New Zealand. It can be performed from 5-6 weeks after the last normal mentrual period (LMP). Most centres use treatment to soften the cervix prior to this procedure (see below).
The operating doctor begins by rinsing the vaginal area with an antiseptic solution and checking the size of the pregnancy and position of the uterus (womb) with an internal (bi-manual) examination. The doctor then numbs the cervix (the opening to the womb), with a local anaesthetic. Some women notice a pinching feeling which does not last for long as the local anaesthetic starts to work straight way.
The cervix is gently dilated (stretched) with metal dilators over about 3 minutes to 1-1.4 cm diameter. The woman may feel cramping similar to menstrual period pains. Slow, even breathing helps to lessen the discomfort of the dilatation. The pre-operative medication (see below) softens the cervix and makes the dilatation much easier to do. An experienced nurse/midwife will support the woman throughout.
The doctor will insert a small plastic tube (cannula) through the cervical opening into the uterus. The tube is attached to a mild suction pump, and is used to carefully remove the contents of the uterus (fetus, placenta, and lining of the uterus). The suction part of the procedure usually lasts 1-3 minutes. For larger pregnancies tissue forceps may be used as well to lift out the pregnancy tissue. This will take a little longer.
Most women feel pain similar to menstrual cramps. For others, abortion is more uncomfortable. Slow, even breathing again helps to ease the cramping. The doctor or nurse/midwife assisting will check the pregnancy tissue and if there is any problem, will send a small piece of the tissue to the laboratory to check for abnormality.
Taking the products of the pregnancy home is an option which can be discussed with the counsellor, doctor, or nurse/midwife.
Dilatatiion and Evacuation (D&E)
This is the term often used for pregnancies over 14 weeks. The procedure is little different from the Vacuum Aspiration described above except that, as well as aspiration, removal of the tissue with forceps is usually routine. The cervix may require more dilatation.
Manual vacuum aspiration
This is also known as MVA. The uterus is emptied with gentle suction using a manual syringe. It is often used for very early surgical abortion. It can be done as soon as the woman knows she is pregnant and up to 10 weeks after the last normal menstrual period.
Pre-operative dilatation of the cervix (cervical priming)
Most commonly in New Zealand a drug called misoprostol or Cytotec® is given 1-3 hours before surgery to soften the cervix (either taken by mouth or inserted into the vagina).
Misoprostol is a synthetic prostaglandin E analogue which has a direct effect on the uterus and cervix, causing uterine contractions and cervical dilatation. It is one of the drugs used in medical abortion and starts the abortion process sometimes giving pain and bleeding. Misoprostol can cause fetal abnormalities, so it is important that the woman does not change her mind about abortion after this pill is taken.
Medicines are generally registered in New Zealand for specific purposes, and misoprostol is not registered for use in abortion. However, it has a long-established safety record when taken by mouth. Research has showed it is a sufficiently safe and effective medicine which can be used prior to a termination procedure.
Also known as the "abortion pill" or Mifegyne®. This is used for medical abortion but is also registered for use prior to surgical abortions. It is more effective than misoprostol but takes longer and is much more expensive.
With later pregnancies sometimes in a two-stage procedure the cervix is treated with laminaria (small rods of seaweed) which absorb fluid and swell over 12-24 hours to slowly dilate the cervix. Other hydrophilic (water absorbing) material can also be used. These are more commonly used with later pregnancies and have been to some extent been replaced by prostaglandin and/or mifepristone use.
When termination takes place later in the pregnancy (e.g. after 24 weeks), almost always for severe fetal anomaly, there is an additional process called fetocide recommended so that the baby is not born alive.
In New Zealand this is done by giving the woman Fentanyl IV (a strong short-lasting narcotic sedative) and then injecting Fentanyl and lignocaine into the cord of the fetus under ultrasound guidance before delivery. This method ensures that the baby does not feel pain. Sometimes, as the Fentanyl given to the woman has been shown to cross the placenta and give the baby adequate pain relief, intra-cardiac injection of lignocaine alone or potassium chloride is used to cause fetal death..
Anaesthesia and pain relief
Most early abortions in New Zealand are performed with local anaesthetic which is injected in and around the cervix (neck of the womb). For some patients this is not felt, but others feel it as a short-lasting unpleasant sensation, like local anaesthetic used by dentists. The most commonly used drug is lignocaine (Xylocaine®).
Analgesia and "conscious sedation"
Many clinics use some form of pre-operative pain relief and/or sedation. This may be a mixture of tablets given in the hour before the operation or drugs given intravenously (into a vein) just before the procedure. When drugs are used which alter consciousness by making the woman significantly drowsy this is called "conscious sedation". This is usually enough to make the patient feel more relaxed and experience minimal pain from the procedure. The use of "conscious sedation" requires closer monitoring of the patient during the time that consciousness is altered.
A number of different drugs are used and the details can be obtained from the individual clinic. Some drugs which may be used are:
- Non-steroidal anti-inflammatory drugs (NSAIDs) like Nurofen, Synflex, Voltaren
- Benzodiazepines such as Midazolam or Diazepam
- A mild narcotic such as codeine
- Short-acting stronger narcotics like Fentanyl
Some hospitals perform the whole procedure under a general anaesthetic with the patient fully asleep.
After the abortion
After the abortion in the clinic
- After early abortion the woman will rest in a recovery room for up to an hour. For later abortions, or if there are any difficulties, she may be required to stay longer.
- If she has an Rh-negative blood type, she will receive an injection to protect future pregnancies.
- She will receive written after-care instructions and instruction for how to access care if she experiences any complications.
- If the woman has had any sedative medications, she will not be safe to drive a car for 12-24 hours following the operation.
- It is common for women have mixed emotions immediately after an abortion. Sometimes it is helpful for them to talk about these feelings to a counsellor, or the clinic will arrange an appointment for post-abortion counselling if this is required.
- Contraception must be arranged before leaving the clinic.
After discharge home
- Women can expect to bleed off and on for up to two weeks.
- Some women continue to experience cramps and can pass a few large blood clots for up to 10 days.
- Sanitary pads should be used - not tampons.
- Most women need to relax for the rest of the day of the abortion but they can usually return to work or other normal activities the next day. Recovery after late abortions may take longer.
- The use of baths, douches or vaginal medications is not recommended until the bleeding has completely stopped (usually one to two weeks).
- Women should not have vaginal intercourse or insert anything into the vagina until the bleeding stops.
- Women can get pregnant very soon after the abortion. Birth control options (contraception) must be discussed with the clinician before discharge.
- A doctor should be consulted if there is heavy bleeding, pain or fever.
- A routine follow-up appointment is advised in one to two weeks. (The free follow-up visit from a GP is only paid for in the first 2 weeks after the abortion).
- Abortion begins a new menstrual cycle. A regular period should resume in four to eight weeks.
Last Updated: 13 August 2014