Abortion is defined as the termination of a human pregnancy from within the intrauterine (womb) cavity with the intent not to produce a live birth. The way abortions are carried out in the first trimester of pregnancy is either 1) medical abortion where RU486 or methotrexate are given the first day a patient visits the medical office or clinic. Misoprostol (cytotec) is given on the same day or up to 48 hours after the initial visit which causes the uterus to contract and expel its content. 2) Suction Dilation and Curettage or a Vacuum Aspiration surgical procedure. The Surgical Abortion procedure will be the focus of this article.



The patient presents to the medical office and fills out several forms that pertain to having the . She is taken to the lab where a small amount of blood is taken along with a urine sample to confirm blood type, hematocrit (checking for anemia), a positive pregnancy test, urinary tract infections, or other problems that can be detected with a urinalysis test. A counselor goes over the benefits and risks of the surgical procedure.. Birth control is offered for patients who are not on birth control. It is discussed and confirmed that the patient is making the decision on her own to terminate her pregnancy and that she is not being forced. IV sedation is discussed. Deep Sedation can be also given for patients who do not want to remember or feel any discomfort during the surgical procedure. All consent forms are signed.

The patient is taken to a exam room where she sees the Physician and a discussion about the procedure takes place prior to the examination. If the patient is not 100%percent certain that abortion is the right thing for her, then the patient should be sent home to consider other options. Once the Physician is comfortable with the patients decision to stay and have the procedure performed, an ultrasound (sonogram) is performed. An ultrasound is a machine that produces a image of internal organs. In this case, it is able to visualize the pregnancy in the uterus and measurements are made to determine the weeks of pregnancy.

Once the ultrasound confirms the pregnancy between 3 and 12 weeks gestation, the patient is placed on the table as if she is going to have a Pap Smear performed. IV or Deep sedation is given to the patient if she chose to receive it. A pelvic exam is performed which consists of examining the uterus, fallopian tubes, and ovaries for abnormalities or masses (abnormal growths). A speculum is placed inside the vagina which is used to hold the vaginal walls apart. The cervix (lower portion of uterus) is anesthetized with a anesthetic agent followed by dilating (opening) the cervix with serial dilators. Laminaria (sterile seaweed) may be placed inside the cervix which absorb fluid from the cervix which swell up causing the cervix to open and become softer. Misoprostol (cytotec) taken by mouth, sublingually (placed under the tongue) bucccally (placed between the cheek and teeth) or inserted vaginally is used to cause the cervix to open by causing the uterus to contract, and also causes changes take

place in the cervix which allows it to soften. Laminaria and misoprostol have been studied extensively and found both made it easier for the dilators to open the cervix. Reduction of cervical tears, uterine perforation (hole made in uterus), retained (uterus not emptied) pregnancy tissue, uterine infection, and bleeding is noted.

A sterile suction curette (a small tube) is placed inside the uterus and the pregnancy tissue is removed manually with a hand-held vacuum aspirator, or a suction machine. The procedure normally takes 3 to 5 minutes. She is escorted to the recovery room and observed from 20 to 30 minutes on average. The patient is discharged with a instruction sheet and a 24 hour number to call for questions or problems. She to return for a two or three week check-up, or follow-up with her personal Physician.