How is surgical abortion performed and why is it dangerous?

What is surgical abortion

Surgical abortion is a method of terminating pregnancy in which the embryo or fetus is removed from the uterus mechanically using instruments.

In Western practice, surgical abortions are subdivided into two types.

1. Vacuum aspiration. It is also a vacuum abortion, when the contents are removed from the uterine cavity using a manual or mechanical aspirator, similar to a pump.
2. Dilatation of the cervical canal and curettage (CR). During this procedure, the surgeon opens the cervix, inserts a special surgical instrument (curette) into it and scrapes out the embryo or fetus along with the mucous surface of the uterus. Another name for RV is the method of dilatation (expansion) and curettage.

However, in Russian practice, vacuum aspiration accepted be considered as a separate type of intervention – the so-called mini-abortion. Surgical abortion means curettage of the uterine cavity. In our material we talk specifically about the latter type of procedure.

When can you have a surgical abortion?

Actually, almost never. WHO classifies this method of abortion as unsafe. AND insiststhat RV, at the slightest opportunity, should be replaced by vacuum aspiration or medical abortion.

Russian doctors also admitthat cervical dilatation and curettage is an outdated method of surgical abortion and is not recommended for termination of pregnancy at less than 12 weeks.

But, unfortunately, in Russia, surgical abortion, even at shorter periods, is still a common practice.

So, in 2015, using the method of dilation and curettage was carried out over 80% of abortions in the country. Although gradually the situation seems to be improving. For example, in 2018, like reports Ministry of Health of the Russian Federation, 34% of all abortions were medical, that is, the proportion of instrumental interventions has decreased.

From the point of view of evidence-based medicine, the RV method acquitted except for periods over 15 weeks, when neither vacuum aspiration nor medications will be effective, but for some reason it is necessary to terminate the pregnancy.

If we talk about late pregnancy termination, in Russia a woman can receive a referral for an abortion after 12 weeks Maybe only by medical or social indications. These include, for example:

• Frozen pregnancy.
• Severe fetal developmental anomalies.
• A mother’s health condition that prevents her from carrying a pregnancy to term. We can talk about both diseases (leukemia, various types of tuberculosis, rubella, HIV) and vital treatment – for example, chemotherapy.
• Pregnancy resulting from rape. By the way, this is the only social indication that exists today.

A full list of indications can be found out from a gynecologist. The decision on the possibility of terminating a pregnancy beyond 12 weeks is also made by a doctor, usually as part of a medical council.

How is surgical abortion performed?

Dilatation and curettage are performed only in a hospital setting, where the pregnant woman is referred by a gynecologist. This happens after the woman has been examined and passed all the tests prescribed by the doctor.

The procedure itself is performed under anesthesia. The operation usually takes 10 to 20 minutes, but additional time may be required to dilate the cervix. Previously, metal dilators were used for dilatation. But this method is recognized as traumatic, and WHO recommends open the cervix with the help of special medications.

Next, the doctor, using a curette, scrapes out the contents of the uterus. In late pregnancy, when the fetus is already large, other surgical instruments, such as forceps, may be needed.

After the operation, the woman remains in the hospital for several hours, under the supervision of doctors. Then, if everything went without complications, she is discharged home.

Is it painful to have a surgical abortion?

WHO calls this method of abortion the most painful. That is why the operation carry out under anesthesia.

Why is surgical abortion dangerous?

The dilatation and curettage method has the greatest number of complications. By data WHO, they occur two to three times more often than with vacuum aspiration.

Here are the most common complications:

• Infections and the inflammatory processes caused by them in the genital organs.
• Cervical ruptures. As a rule, they are corrected by suturing immediately after the abortion. However, this may affect the ability of the cervix to dilate during subsequent births.
• Perforation of the uterus. This happens if the instrument accidentally pierces the wall of the uterus. This situation is dangerous due to internal bleeding and sepsis;
• Uterine bleeding. Sometimes it is so great that the woman requires a blood transfusion.
• Incomplete removal of the fertilized egg. In this case, the uterus continues to contain remains of the fetus or embryo, which can provoke an inflammatory process.
• Allergic or adverse reactions to medications. That is, for those drugs that were used for anesthesia and dilation of the cervix.

When to see a doctor as soon as possible

Call your gynecologist or consult an ambulance by calling 103 if you have such problems after a surgical abortion. symptoms:

• Heavy bleeding from the vagina. You can talk about it if you have to change the gasket every hour.
• The appearance of clots larger than 5 cm. It is especially dangerous if such discharge continues for more than two hours.
• Unusual vaginal discharge with a distinct unpleasant odor.
• Pain or cramping that gets worse even though more than 48 hours have passed since surgery.
• Temperature over 38 °C.
• Lack of menstruation for 2 months.