There are different methods to perform abortions: the suction method which can be performed with local or general anesthesia and the medical abortion. Risks and complications are rare with all methods. Abortions can always be performed on a day case basis within the first three months of pregnancy. The woman can go home a few hours after the procedure, but she should have someone with her. Only in case of serious medical risks she has to stay in hospital overnight for the abortion.
There are two different methods to perform an abortion: the suction method (vacuum aspiration) and the medical abortion.
Within the first three months of pregnancy most of the abortions are performed by vacuum aspiration. A suction cannula is inserted into the womb through the vagina to remove the pregnancy tissue. This procedure is performed under either local or general anesthesia. As in other gynecological examinations, a speculum is inserted into the vagina to keep it open and to uncover the cervix. The cervix is then widened (up to 6-12 millimetres, depending on the gestational age) by inserting thin metal rods increasing in diameter. Then a metal or plastic cannula is inserted and the pregnancy tissue is removed.
Depending on the type of cannula and the experience of the gynecologist, a curettage may be performed thereafter. That means the doctor will check with a spoon-like instrument whether the womb has been emptied entirely. All in all the procedure takes about ten minutes.
For local anesthesia, the anesthetic will be injected into the cervical area, comparable to a dental procedure. The injection itself causes only very little pain. With local anesthesia the widening of the cervix will cause no or only little pain. During the aspiration you will have cramps like during menstruation, which may be more or less painful, but they will stop soon after the end of the aspiration.
With general anesthesia you will get an injection into a vein in your arm. You will sleep for 15 minutes and experience nothing during the procedure. For most of the women, the local anesthesia is completely sufficient. The advantage is that they consciously experience, that the procedure is a relatively small one. They may be relieved, as most women believe that an abortion is very detrimental to their body. Nevertheless, the procedure is not entirely painless. We recommend general anesthesia for those women who do not want to experience the abortion at all or for those who want to have no pain during the procedure. In some cases, the doctors offer sedation instead of general anesthesia. Some patients feel comfortable with sedation during the abortion procedure, whereas others experience unpleasant states of feeling helpless and paralyzed, but still feel anxiety or pain. We therefore think the general anesthesia to be better for scared patients.
Most women have only light bleeding during the first days after a vacuum aspiration. After 4-5 days, heavier bleeding and cramps may occur which in most cases last for no more than a day. Thereafter, light bleeding may continue for some time (from a few days to three weeks). You should rest for a couple of days. The doctors can write you a sick certificate.
After 10 to 14 days you should go to a follow-up examination to rule out possible infections or remaining tissue inside the womb.
The vacuum aspiration can be performed until the 14th week after the last menstruation. Some doctors will not do it before the 7th week of pregnancy, the reason being a slightly higher risk of an ongoing pregnancy. However, the procedure can be carried out earlier if careful controls of the removed tissue or an ultrasound scan are done to ensure the complete removal of pregnancy tissue.
The administration of certain drugs a couple of hours before the vacuum aspiration can cause the cervix to open slightly and facilitate the procedure. Sometimes these drugs may cause pain and bleeding.
In most cases you will be prescribed antibiotics to prevent infections. Another option is to perform testing for vaginal infections and clamydia infections before the intervention. In this case antibiotics are only given if an infection is diagnosed. Routine testing for clamydia infections is covered by health insurance.
Almost 10% of abortions in Germany are performed through curettage. This method has a higher rate of complications than the vacuum aspiration and should be avoided.
The medical abortion takes a few days.
On the first day, the woman takes three pills of Mifegyne® which stops the further development of the pregnancy, often followed by light bleeding. The law states that Mifegyne® has to be taken in presence of a doctor.
Two days later the women takes a second drug (a prostaglandin) that causes the expulsion of the pregnancy tissue. Mostly Cytotec® is given orally or vaginally, but some doctors use Gemeprost suppositories instead. About one hour after taking the prostaglandin, cramps will start, which can be more or less heavy, together with bleeding which is usually stronger than menstrual bleeding. Some women may have nausea, diarrhoea or vomiting. It may take between 2 hours and one or two days, until the pregnancy tissue is completely expelled.
After taking the prostaglandin you should stay in a clinic for a few hours. Some doctors may let you go home earlier if you wish, or may give you the prostaglandin to take it at home. In this case you should be very well informed about what will happen during the next days and be able to contact your doctor any time - whenever you are worried.
A medical abortion can be performed until the end of the 9th week or the 63th day after the beginning of the last menstruation.
How long will I have bleeding after the medical abortion?
For one or two days the bleeding may be stronger than your menstruation. After that the bleeding is usually like your period for a few days. Light bleeding may continue for another one to three weeks.
Since in about 5% of all cases the pregnancy tissue does not or not completely come out, and sometimes the pregnancy even continues to develop, it is essential to have a follow-up examination after 8-10 days including an ultrasound scan. Despite heavy bleeding, some or all of the tissue may remain in the womb. Only with an ultrasound examination can you make sure that the abortion is complete. If the pregnancy tissue has not come out, the abortion has to be completed with vacuum aspiration. If only a small amount of tissue remains, it is possible to wait whether it will be expelled with the following menstruation.
Abortion procedures are very safe. As in many countries abortions and complications are statistically recorded, these complications have been studied extensively. In countries with well developed health care systems less than 1 out of 100,000 women die during or after these procedures. Moreover, negative effects on the fertility or future pregnancies are very unlikely.
About 1% of vacuum aspirations may be complicated by an infection. The risk is even less after medical abortions. Infections have to be treated with antibiotics. The risk of remaining pregnancy tissue is around 1 % with vacuum aspirations and 5 % with medical abortions. Often this tissue comes out with the following bleeding. But a further vacuum aspiration or curettage may be necessary in rare cases. In rare cases (1-2 cases per 1000 women), the womb may be damaged during vacuum aspiration. In this case observation in a hospital may be necessary, but the wound nearly always heals without any complication. Heavy bleeding can also make hospital treatment necessary.
In Germany, abortions are not often performed after the 3rd month. German law allows them only for medical reasons. In the majority of cases the reason is a fetal malformation. But sometimes a woman realizes only after the 3rd month that she is pregnant. After the 3rd month pregnancies are mostly terminated in hospitals. Drugs are given to open the cervix and to induce contractions. Pain during the contractions can be relieved with drugs or sometimes with spinal-cord anesthesia. It takes some hours, sometimes up to two days, until the fetus comes out. Thereafter, a curettage is performed to remove remaining placental tissue.
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