D&C Abortion

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What is it? A dilation and curettage abortion is a surgical procedure and is known more commonly as a D&C. This abortion can be done between 6 and 12 weeks from the first day of your last period, although some doctors use the procedure up to the 14th week. A D&C abortion is usually done at an abortion clinic or a hospital setting since it can require machinery and usually requires general anesthesia.

What happens? First a pregnancy test is given, a pelvic exam is performed, and an ultrasound may be done as well. Once the pregnancy has been confirmed, you disrobe and lie on an examining table with your feet in stirrups. You will most likely be given either general or twilight anesthesia. Misoprostol may be given to help the cervix dilate, and oxytocin may be given to make the uterus contract. The doctor will then insert a speculum into your vagina and clamp it open so that your cervix is in plain view. He or she will then swab your vagina with an antiseptic to prevent infection. A tenaculum (which looks somewhat like long, skinny pliers) will be used to grasp your cervix and hold it in place.

strong tugging sensation as the curette scrapes against the uterus. The cramping and pain will lessen once the procedure is over. You may also feel nauseated or faint, and you may break out in a sweat. The doctor will then remove the curette and examine the contents of the bowl on a tray to be sure that everything has been removed. If something is missing, he or she may continue with more curettage or may use a tube attached to a suction machine to vacuum the surface of the uterus a few times. Once the doctor has determined that everything has been removed, he or she will remove the curette or tube from your uterus and cervix and then remove the tenaculum and speculum. Your uterus will then be inspected by pelvic examination to check for firmness and size.

Once the abortion is complete, you can expect to wait approximately 1 hour before being sent home. Acetaminophen or ibuprofen will be given or recommended for use, and antibiotics may be prescribed to prevent infection from occurring. You will most likely continue to bleed or spot for the next 2 weeks off and on, as well as experience cramping for the rest of the day and possibly for 2 to 3 days following the abortion. You will be instructed to not have intercourse or use tampons for at least 1 week. You can return to normal activities the next day if you feel up to it. A follow-up exam will be scheduled for approximately 14 days after the abortion in order to confirm that the abortion has been completed and that there are no complications. An ultrasound or a pelvic examination, as well as blood work, should be done at this appointment to verify that everything was removed.

What does it cost? A D&C abortion will cost between $350-600 but can cost as much as $3000 in some hospitals. The price will depend on anesthesia used, the size of the baby, and the location of the procedure (hospital versus clinic). Some insurance policies will cover the cost of a D&C abortion.

What should I consider?

A D&C abortion can be done safely between the 6th and 12th weeks of pregnancy. If done before the 6th week, there is a higher chance of a failed abortion, and if done after the 12th week there is a higher risk of complications.
This method is the least-common first trimester surgical abortion procedure because it is riskier than the other procedures
You should plan on taking the remainder of the day to relax and recover after having a D&C abortion done.
A D&C abortion is successful in ending the pregnancy 98% of the time, and if it should fail, either another D&C or a vacuum aspiration will be done with your approval. If, upon hearing the abortion has failed and the baby is still developing, you do not want another abortion, contact a local pregnancy center to help you find an OB/GYN to examine you. As always, the decision to abort is up to you.
This method is sometimes used when a medical abortion has failed, but a vacuum aspiration is preferred.
There is less bleeding with this procedure than with a medical abortion, since most of the blood is removed during the procedure.
A D&C abortion can only be done after the 6-7th week from the first day of your last period, so if you want an abortion any earlier than that you will either have to wait or choose a different form of abortion (RU-486, methotrexate, or manual aspiration).
As with any abortion procedure, there is a chance that you could become pregnant immediately following the abortion, so take precautions to prevent another unplanned pregnancy.
You can request to have anesthesia for a D&C abortion, and if you choose to do so you must bring someone to the clinic to drive you home.
A D&C abortion may be offered if your physician is in a rural area, does not have up-to-date equipment and information, or is not highly experienced with abortion.
A D&C abortion cannot be compared to D&Cs done for therapeutic reasons when referring to risks because the pregnant uterus is much softer than one being operated on for other reasons.

What are the risks? Side effects are common and normal, and consist of abdominal cramping, pain, nausea, sweating, and feeling faint during the procedure if not having anesthesia, cramping and pain for 2-3 days following the procedure, as well as bleeding for up to 2 weeks. True complications occur in approximately 5% of D&C abortions.

Allergic reactions to anesthesia or other medications given can occur. It is very important that you report any over-the-counter or prescription medications as well as illegal drugs so that the anesthetics can be adjusted accordingly.
Bacterial infection can occur during the procedure when surgical tools enter the uterus, while symptoms won't occur for 2 to 3 days after the procedure. This happens most frequently when there is an underlying STD that is not diagnosed at the time of the abortion. Therefore, it is vitally important that you be tested for STDs prior to the abortion. Infection is the most common post-abortion complication.
Hematometra (a uterine blood clot) can occur if the uterus does not contract (cramp) to expel all of the lining. There will be severe abdominal cramping and nausea if this occurs.
Heavy bleeding can occur if the uterus fails to contract and may lead to a uterine blood clot, as mentioned above. Heavy bleeding may require medication, a repeat abortion, surgery, and/or transfusion.
Heavy blood loss can also occur during the procedure itself, since the placenta is separated from the uterine wall too slowly during a D&C. This can require a blood transfusion.
A cut or torn cervix can occur when the doctor grabs the cervix with the tenaculum or inserts the curette into the uterus. This may lead to a weakened cervix - making carrying a future child to term difficult.
Cervical damage can also occur with the excessive dilating required for a D&C, also leading to a weakened cervix. The cervix needs to be dilated much less if having a vacuum aspiration.
The uterus may be perforated (punctured) during the abortion when the doctor presses the curette against the walls of the uterus, causing heavy abdominal bleeding and/or infection. You may require surgery to repair the puncture, and rarely you may need a hysterectomy (removal of the uterus) to stop the bleeding. The risk of this happening with a D&C abortion is considerably higher than with a vacuum aspiration, since the pregnant uterus is extremely soft and easy to pierce with the sharp curette.
Scarring of the uterus may occur, resulting in "Asherman's Syndrome." This scarring can occur as the doctor scrapes the curette against the walls of the uterus and can cause future fertility problems.
An incomplete abortion, where the pregnancy has been terminated but the baby or other tissue does not get expelled, can occur in an additional 1% of cases, especially those done before 6 weeks since only 50-60% of the uterine wall is scraped during a D&C. This causes severe cramping and excessive bleeding that continues for over a week following the abortion.
Emotional or psychological distress can occur after the abortion, including depression, guilt, regret, anger, and/or sleep disturbance.
Maternal death occurs in a reported 1 out of every 100,000 abortions (this includes all types of abortion).

Once your cervix is open, the doctor will insert cervical dilators into the opening of your cervix. These dilators are pictured at right. This process takes 5-10 minutes and consists of the doctor inserting the smallest rod and progressively inserting larger rods until reaching the largest, which is about the width of a dime. You will most likely experience mild to strong cramping throughout dilation if you choose to be awake for the procedure. The doctor will then take measurements of your uterus to be sure that he or she uses the correct curette size. Then he or she will insert a metal instrument called a curette (one type is pictured at right). A curette is a long steel rod with a loop at the tip. This loop has sharp grooves on it, which are used to scrape away the lining of the uterus. The doctor will begin to press the tip of the curette along the surface of your uterus to dislodge the placenta and the sac that contains the baby. The lining of your uterus, the placenta, and the developing human will be removed in pieces and collected in a bowl just under your vagina. The process takes approximately 10 minutes once the curette has been inserted. If you choose to be awake for the abortion, you can expect moderate to strong cramping and abdominal pain throughout the procedure and a

D&C Abortion