The female reproductive system is made up of the following:

• Vagina: a muscular, hollow tube that leads from the outside of the body to the uterus.
• Cervix: the entrance (neck) of the uterus, where the vagina meets the uterus.
• Uterus (womb).
• Fallopian tubes are tubes that extend from the uterus, one on each side. They each open near an ovary and carry the eggs (ova) from the ovaries to the uterus.
• Ovaries are two small glands that contain and release your eggs (ova).

Pregnancy occurs when an egg is fertilised by a sperm, which then lodges (implants) in the lining of the uterus (the endometrium).

A surgical abortion involves the removal of the pregnancy (sometimes known as the ‘contents of the uterus’) via the vagina by surgical means. To have a surgical abortion, the cervix must be opened wide enough to allow the surgical instruments into the uterus.

Preparing for a surgical abortion

Always check with your clinic, but general instructions before undergoing an abortion include:

• Don’t smoke, eat, or drink (not even water) for about 6 hours before the operation.
• Expect to be at the clinic for at least 2 hours.
• Bring sanitary pads, your referral letter, your blood group card, your Medicare card, and any health care card you have.
• Arrange for someone to drive you home.

Anaesthetic for a surgical abortion

The clinic you go to for an abortion will tell you about what type of anaesthetic it can offer you and how you should prepare for it.

Anaesthetic choices may include:

• General anesthetic: this makes you completely unconscious. Any operation involving a general anaesthetic carries risk. There is a danger of choking if fasting isn’t properly undertaken beforehand.
• Nitrous oxide gas, or a similar gas. This puts you in a state of ‘twilight sleep’. You are awake but sedated and calm.
• Local anaesthetic – An anaesthetic is injected into your cervix to make the area numb so that you don’t feel anything during the operation (this is known as a paracervical block).
• Local anaesthetic with intravenous sedation is a combination of intravenous sedation (sedative medication is put into your vein using an intravenous line) and local anaesthetic injected directly into your cervix.

Method of surgical abortion

Most abortions are performed using suction (vacuum) aspiration’ or suction curettage’. To have this procedure, you must be in your first trimester (first 3 months or 12 weeks) of pregnancy.

Your cervix is gradually widened with rods of increasing size, and a slim tube is then inserted into your uterus. The pregnancy (the fetus and the placenta) is withdrawn with gentle suction. Another instrument called a curette is used to check if the uterus is empty.

During the abortion, it is also safe to have contraception such as an intrauterine device (IUD) or contraceptive implant (Implanon NXT) inserted if you would like.

This operation takes less than 15 minutes.

Surgical abortion after 12 weeks of gestation

For an abortion in the second trimester, from 13 weeks gestation to 24 weeks gestation, the surgery is called a ‘dilatation and evacuation’ (D&E). The procedure is similar to that of a first-trimester abortion with additional instruments and may involve extra steps to prepare your cervix:

• Hormone-blocking tablets may be used to help soften your cervix before surgery. These tablets (‘misoprostol’) may be taken by mouth or inserted into your vagina, and take about 2 hours to take effect. Another tablet,’mifepristone’, may also be used 1-2 days before an abortion to prepare the cervix in some cases.
• A special device may be inserted into your cervix to help it widen. This device swells over several hours until the cervix is opened wide enough to allow the abortion to occur. Medications may also be used. The abortion is usually performed one or 2 days later.

Complications of a Surgical Abortion

Complications occur in around 3 per cent of surgical abortion cases. The risk of complications depends on how many weeks pregnant you are. Abortions performed in the first trimester are the safest.

Complications of surgical abortion can include:

• Haemorrhage: bleeding after an abortion should be similar to a menstrual period. If heavy bleeding occurs, this can show that the abortion may not be complete and there is some of the pregnancy tissue is still inside the uterus (‘retained products of conception’). This may need treatment with tablets or surgery like a suction curettage. Blood transfusions are rarely required.
• Infection: a fever (high temperature) may indicate that you have an infection. This can be caused by an incomplete abortion or a sexually transmitted infection. Sometimes, women can develop a chronic infection called pelvic inflammatory disease (PID). Treatment for infection is with antibiotics.
• Injury to the uterus: the walls of your uterus are muscular but soft. Sometimes the surgical instruments used for an abortion can injure (or ‘perforate’) the uterus. In rare instances, this can cause an abdominal infection (peritonitis) and severe blood loss. This complication is infrequent and, if it occurs, will usually be recognised and treated right away.
• Injury to the cervix: the cervix is stretched during an abortion. If you have multiple procedures, the cervix can weaken. This is sometimes called an ‘incompetent’ cervix and can cause problems in later pregnancies if the cervix is too weak to remain fully closed under the weight of a growing pregnancy.

These last 2 complications are rare when surgical abortions are undertaken by experienced surgeons.

After a surgical abortion

Be guided by your clinic as to how to care for yourself and reduce your risk of infection after a surgical abortion. Generally, the following suggestions apply for 2 weeks after your procedure, or a few days after the bleeding has stopped:

• Shower instead of taking a bath.
• Avoid vaginal intercourse.
• Use sanitary pads instead of tampons or menstrual cups.
• Avoid going swimming.

When to seek medical advice after a surgical abortion

See your clinic, GP or a hospital emergency department immediately if:

• your bleeding becomes heavy, such as passing clots larger than golf balls or soaking through a maxi pad every 30 minutes for 2 hours
• you develop a fever
• you experience severe cramping or abdominal (tummy) pain.