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Types of procedures to terminate a pregnancy

Early Medication Abortion

Women who are 9 weeks (63 days) pregnant or less can choose an early medication abortion. Current studies show that this is safe and effective up to 63 days gestation.

A small number of women may have bleeding or spotting after taking the first medication but it is very unlikely that the pregnancy will abort after that alone. Most women start to experience pain and bleeding from 30 minutes to 2 - 3 hours after using the second medication, lasting for 6 - 8 hours and tapering off over the next 7 to 14 days.

For most women the bleeding will resemble a heavy period. For some it may be minimal, while a very small number will bleed extremely heavily. As with miscarriage the woman may identify pregnancy tissue. Cramping pain may range from minimal to severe labour-like pain. Women are provided with analgesia and are encouraged to use it early so it is more effective. Other side effects occurring in a small number of women include headache, nausea, vomiting, fever, flushes, and chills.

Surgical procedures

  • Dilatation of the cervix followed by suction extraction is used for pregnancies up to 14 weeks.
  • All women have pre-treatment of the cervix using medication tablets to facilitate dilatation and reduce the risk of damage or blood loss.
  • Women of 16 weeks gestation or more have pre-treatment of the cervix using medication tablets and cervical dilators. The dilators are inserted in the cervix following under light general anaesthesia. Further dilatation and evacuation of the pregnancy is carried out up to 24 hours later. Antibiotic cover is provided for these two step procedures.
  • Transvaginal ultrasound scan is carried out at the end of the procedure to ensure the pregnancy has been removed and no tissue remains in the uterus.

Anaesthetic

A specialist anesthetist is in attendance. Procedures are generally carried out using a combination of paracervical block and intravenous sedation. The level of anesthesia is tailored according to the woman’s needs.

Women are required to fast on the day of operation.

Post operation

Women are ready for discharge from the Pregnancy Advisory Centre when they satisfy criteria covering orientation, blood loss, pain, vomiting, and ingestion of fluids. This is usually about 2 hours post-operatively. Most women spend 4 - 5 hours at the Pregnancy Advisory Centre, longer when their gestation is higher.

Complications

Post-operative (surgical or early medication) complications are infrequent. Women having problems with pain or bleeding are encouraged to contact the Pregnancy Advisory Centre in the first instance. Wherever possible, post-operative complications are managed by the Pregnancy Advisory Centre. However, in some situations women may be referred to public hospital emergency departments.

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