A surgical abortion is a medical procedure that involves minor out-patient surgery. A point to note here is that surgical abortions cannot be performed any earlier than 6-7 weeks after the first day of last menstrual period. A surgical abortion usually requires 3-4 visits to the doctor. The first visit will be a long one, 1-2 hours, and will include verification of the pregnancy, an ultra-sound to identify the date of conception, blood test, STD test and counseling to explain the procedure. In the second visit the doctor will perform the abortion. Usually the patient will be given a sedative to ease the nerves and diminish the pain. The doctor will slightly dilate the cervix in order to insert a small straw like suction device and start operating to remove the embryo. During the process, slight cramping may be experienced by the patient. The whole process normally takes 10-20 minutes. Then after a week a third visit to the doctor will be needed to find out whether the abortion was successful. Sometime the doctor may ask the patient to come for another visit after the normal menstrual cycle operation reinstates.
The Method:
In the first 12 weeks, suction-aspiration or vacuum abortion is the most common method of surgical abortion. There are two types of vacuum abortion - Manual Vacuum aspiration (MVA) and electric vacuum aspiration (EVA). While MVA abortion consists of removing the fetus or embryo, placenta and membranes by suction using a manual syringe, EVA abortion uses an electric pump. These techniques are comparable, and differ in the mechanism used to apply suction, how early in pregnancy they can be used, and whether cervical dilation is necessary. Vacuum Abortion is also known as mini-suction and menstrual extraction and it can be used in very early pregnancy. This technique does not require cervical dilation.
Dilation and curettage (D&C), is the second most common method of abortion. After the first-trimester until approximately the second-trimester, dilation and evacuation (D&E) is generally used. D&E consists of opening the cervix of the uterus and emptying it using surgical instruments and suction. WHO recommends that D&C, also known as sharp curettage, to be applied only when the stage for MVA is unavailable.
Medicinal or Surgical Abortion? The Dilema:
Vacuum Aspiration (Suction evacuation) is the most commonly-used method for termination of early pregnancies. However, being a surgical technique, it is associated with risks of infection, perforation of uterus, incomplete abortion and post-procedure uterine synechiae formation (Asherman's Syndrome).
The success of abortion with drugs depends on multiple factors including the regimen used, dosage schedule, route of administration and gestational age.
Mifepristone with misoprostol is favorable if pregnancy is less than 7 weeks.
Surgical abortion is preferred if patient desires concurrent tubal ligation.
If a woman fulfills the criteria for selecting either method, final choice to be given to the woman as per law.
[PS: According to Indian MTP Act only registered medical practitioners are authorized to prescribe and perform Surgical Abortions. Initial workup, counseling, prescription and administration could be in a Government or private clinic or in the consulting room with an access to 24-hours emergency services.]