The choice of the method of abortion depends on the stage of the pregnancy and other patient factors. In general, the further along the pregnancy, the more complicated and difficult the abortion method.
An ultrasound exam may be needed to check the stage of pregnancy before an abortion can be done.

Early Medication Abortion Method - (Early pregnancy, up to 7-9 weeks gestation)

A woman in very early pregnancy may have the option of an abortion that uses medicine instead of a surgical abortion. The woman must see a health care provider to get the medicine. She will need to see the health care provider at least one more time to make sure the medication abortion is complete. If it is not, she may need to have a surgical abortion. If a woman chooses to have a medication abortion, it is very important that she take the medicine exactly as the health care provider tells her to take it.

Suction Curettage (Aspiration) - (Early Pregnancy 6-14 weeks gestation)

The vagina is cleaned with a liquid soap. A shot to numb the cervix is given. Then the cervix is dilated (opened by stretching). A tube attached to a suction machine is put into the uterus. The uterus is then emptied by suction. Next, a tool called a "curette" is used to scrape the wall of the uterus. This removes any products of pregnancy (fetus and afterbirth) that remain in the uterus.
After the abortion, a woman with Rh-negative blood will be given a shot of immune globulin. This prevents blood type problems in future pregnancies. Antibiotics may be ordered to prevent infections of the uterus. Other medicines may be used to reduce bleeding. This method takes about 15-30 minutes.

Dilation and Evacuation - (Early Pregnancy 12-24 weeks gestation)

This is the most common method used after 12 weeks of pregnancy. The vagina is cleaned with a liquid soap. The cervix is usually prepared by putting natural sponges called "laminaria" into the opening of the cervix. They soak up moisture and swell. This causes the slow stretching and opening of the cervix over a period of hours. In some cases, other methods may be used at the time of the procedure to stretch and open the cervix. A numbing shot along with intravenous (I.V.) medicine or a general anesthetic may be used to control pain. When the cervix has been opened, tools and suction tubes are put into the uterus to remove the products of pregnancy.

After the abortion, a woman with Rh-negative blood will be given a shot of immune globulin. This prevents blood type problems in future pregnancies. Antibiotics may be ordered to prevent infections of the uterus. Other medicines may be used to reduce bleeding. This method takes about 45 minutes.

D. Induction of Labor - (Advanced Pregnancy)

Emptying of the uterus by induction of labor is usually done in the hospital. First, the cervix must be prepared by making it softer. Several methods can be used. Laminaria may be placed into the opening of the cervix. They soak up moisture and swell. This causes the slow stretching and opening of the cervix over a period of hours. Or prostaglandin medications may be put into the vagina for a number of hours.

After the cervix is softened, labor is started (induced). Several medicines such as prostaglandin or oxytocin can be used to start contractions or labor may be started by injecting medicine through the abdominal and uterine walls into the "bag of waters" (amniotic sac). In this case, a shot to numb the skin is given. Most women who are induced deliver in 10-20 hours.

If the dilation and evacuation method of abortion is used, there is almost no chance the pregnancy will survive. Later in pregnancy, chemicals may be injected into the uterus before the abortion is completed. In this case, the pregnancy will not survive the abortion. If labor induction is used, there is a slight chance that the fetus could live for a short time. The chance of the fetus living outside the uterus increases with the length of the pregnancy.

Sometimes all tissue is not emptied out of the uterus by the labor process. If not, it may be removed by using special tools to clean the walls of the uterus. These tools are inserted into the uterus through the vagina. A numbing shot along with I.V. medicine or a general anesthetic may be used to control pain. After the uterus is empty, I.V. medicine may be used for a time to control bleeding.

After the abortion, a woman with Rh-negative blood will be given a shot of immune globulin. This prevents blood type problems in future pregnancies. Antibiotics may be ordered to prevent infection of the uterus. Other medicines may be used to reduce bleeding.

E. Hysterotomy / Cesarean Delivery - (Advanced Pregnancy - after 24 weeks gestation)

In rare cases where the induction method fails or cannot be used, a surgical method called "hysterotomy" must be used. "Hysterotomy" means to cut open the uterus. It is like a Cesarean delivery and has the same risks.

After the abortion, a woman with Rh-negative blood will be given a shot of immune globulin. This prevents blood type problems in future pregnancies. Antibiotics may be ordered to prevent infection of the uterus. Other medicines may be used to reduce bleeding.

References

• Hatcher, R.A., Trussell, J., Nelson, A. L., Cates, W., Stewart, F.H., and Kowal, D. (2011). Contraceptive Technology (20th Ed.). New York: Ardent Media, Inc.
• Telinde, Richard W., Operative Gynecology 8th ed. (1997). J.B. Lippincott Company, Philadelphia.
• "Abortion - Making a Decision" - Commonwealth of Pennsylvania.
• "For Women, Adults and Adolescents Who are Pregnant." (DRAFT, 1994). Nebraska Department of Health - Bureau of Family Health Service, Lincoln, Nebraska.
• Cunningham J. et al, Williams Obstetrics 21st ed. (2001). Appleton & Lange, Norwalk, Connecticut.
• SC Code of Laws, Section 44-41-10 et. Seq. (as amended, 1994).