types of abortions

Basically, abortion procedures are divided into "surgical" and "medical." Surgical methods are variants of the traditional D&C, or dilatation and currettage, performed for hundreds of years. Dilation means dilating -- opening, or stretching open -- the cervix to allow other instruments to be inserted into the uterus. Most women are familiar with the term "dilating" from labor, when the cervix dilates or opens to allow the baby to pass through. Once dilated for an abortion, currettage is then performed. This means "scraping," as whatever is in the uterus is scraped out and removed -- for visual examination, testing, or pathological exam. In the past, abortions were performed in precisely this manner, by stretching the cervix open and curretting out the pregnancy, which in medical parlance is referred to as "POC", or "products of conception. An abortion is a blind prodecure. It is done largely by touch; thus, training and experience are paramount. That is, the surgeon cannot see into the uterus to verify that all the POC or other tissue has been removed. Thus, in the past, there were a fair number or "incomplete abortions" where not all of the POC were removed, possibly leading to hemorrhage, infection, or other complications. Nowadays, most abortionists employ post-op ultrasound to "see into the uterus" to ensure that the procedure has been completed.

But even before the widespread use of ultrasound, another instrument was added to the physician's armamentarium to ensure completeness of the procedure. This was the suction/aspiration cannula. The cannula, usually made of sterile, disposable plastic (but it can be reusable stainless steel), is a long hollow tube analogous to a straw. By connecting the end of the cannula to a suction (or vacuum) apparatus, the POC can be aspirated or suctioned out of the uterus. The addition of the suction tip helped removed other pieces of tissue that the currette might miss, thereby making the abortion more complete, or successful, and lowering the chance of "retained products," a term for pregnancy tissue that has been inadvertantly left in the uterus. Nowadays, most early surgical abortions are done by the suction technique, though in some cases the metal currette is additionally used.

The term early abortion refers to procedures twelve weeks of less, dating from the first day of the last normal period (not the time of conception, which is usually two weeks less.) Beyond twelve weeks, the procedure may become a D&E, or dilatation and extraction. Here. the dilation remains the same, although it may be augmented by the overnight insertion of a substance called laminaria, which slowly, safely dilates the cervix. The extraction, however, differs from pure suctioning (which may also be employed.) An extraction forceps is used to grasp parts of the pregrancy and extract, or remove them, from the uterine cavity. Suctioning then removes the remaining tissue.

Medical abortion is a term applied to the use of medications to cause the patient to abort, or miscarry. Medical abortions are most effective when done within the first seven weeks of pregnancy, or forty-nine days from the last normal menstrual period. But medical abortions are not simply one magic pill after which poof, the pregnancy is gone. Rather, they are a series of pills administered two days apart. The first series of pills, called mifepristone (or RU-486,) interferes with the pregnancy's viability. The second medications, called misoprostol (or Cytotec,) causes the uterus to contract, and thus the pregnancy is expelled.

Many factors, both medical and emotional, determing whether the patient opts for the medical or traditional surgical method. Your doctor should thoroughly discuss these with you to arrive at a decision.