Understanding Surgical Abortion: A Step-by-Step Guide

"I was overjoyed when I found out I was pregnant again! My first child came after years of waiting and hoping, so the idea of giving her a sibling felt like a dream come true. But my happiness was short-lived. At the end of my first trimester, a routine check-up revealed that my baby no longer had a heartbeat. Hearing that news felt like the ground had disappeared beneath me. I was told I needed a surgical abortion. The idea terrified me—not just the procedure itself, but the emotional weight of losing a child I had already imagined in my arms."

This is the story of Preeti, a mother of one, who has experienced both the joy of birth and the heartbreak of miscarriage. Like Preeti, many women face similar situations, feeling overwhelmed, scared, and numb as they prepare for a surgical abortion. The emotional and physical toll is heavy, and it’s hard to know what to expect.

Let's look at the step-by-step process of surgical abortion to understand what happens before, during and after the abortion procedure.  We'll also go through the emotional weight of the loss and how to make the coping process a little easier.

Abortion is a medical procedure used to end a pregnancy. It may be performed for various reasons, including personal choice, medical necessity, or fetal abnormalities. There are two primary techniques: medication abortion and surgical abortion.

Medication Abortion is a non-invasive method that uses prescribed medications to terminate a pregnancy. It offers privacy and gives patients more control over the process, making it most suitable for pregnancies up to 7 weeks.

Surgical Abortion involves the use of medical instruments to remove the pregnancy from the uterus and cervix through the vagina. This method is recommended when medication abortion is unsuitable, unsuccessful or when complications, such as heavy bleeding, occur.

In India, abortion is legal under the Medical Termination of Pregnancy (MTP) Act, which allows termination up to 20 weeks with the approval of a registered medical practitioner. In certain cases, the MTP Amendment Act of 2021 extends this limit to 24 weeks.

Let’s walk through the procedure step-by-step to help you understand the process more clearly.

Before your surgical abortion, the doctor will assess your overall health and confirm the pregnancy. This includes counselling, offering a supportive space to discuss your concerns, ask questions, and ensure you are mentally and emotionally prepared.

They will explain the procedure in detail, ensuring you fully understand and feel confident in your decision.

Clinical Assessment and Informed Consent

When Preeti went to see her doctor after the heartbreaking news, she was filled with questions: “What went wrong? I’m healthy—how could this happen?” The uncertainty was overwhelming. Her doctor reassured her by taking the time to explain the next steps. They gently walked her through her medical history, performed some tests, and helped her understand what had gone wrong.  

The first step in the process of a surgical abortion is a clinical assessment. Your doctor will ask about your health, your pregnancy, and any concerns you have. We are sure you might be wondering what went wrong and this is the moment when you get clarity and answers, not just about what has happened, but what the next steps are.

Whether it’s a medical or surgical abortion, your doctor will explain what’s best based on how far along you are and the condition of your pregnancy. Remember, it's okay to feel overwhelmed and have many questions.

This is your chance to ask any questions on your mind. The goal is to help you feel informed and confident in your decision. Your doctor will make sure you fully understand the process and only move forward with your consent. It’s a supportive step designed to give you a sense of control during this emotional time.

Counselling and Patient Education

Counselling is a vital part of your pre-abortion care, where a trained counsellor listens to your concerns and helps you gain clarity on what to expect.

We spoke with a few mothers, and here are some common questions they had. You may have more, but these can be a good starting point:

• How long will the procedure take?
• What will the recovery process be like?
• Will I need someone to help me after the procedure?
• How will this impact my future pregnancies?
• What emotional support is available after the surgery?

This session is not just about understanding the procedure but also about emotional healing and preparing for the journey ahead.

As you get ready for your surgical abortion, know that your healthcare team is here to support and guide you, explaining each step so you feel more at ease. You’ll be asked to avoid eating or drinking before the procedure, and having someone you trust by your side can make the day feel a bit easier. Remember, you’re not alone in this—you have people who care about your well-being, and they're here to help you through every step as you focus on your health and recovery.

Following these steps will help you feel ready and supported for the procedure:

• Take all prescribed medications, as instructed by your doctor.
• Have a trusted person accompany you for support and easy transportation.
• Avoid alcohol and smoking before the procedure.
• Stop eating 10 hours and drinking any fluids 4 hours before the procedure.
• Pack essentials like sanitary pads, loose clothing, and a heating pad for post-procedure care.
• Mentally prepare yourself and stay connected with your support system of trusted family members or friends.

As you get ready for your surgical abortion, know that your healthcare team is here to support and guide you.

Tests Before the Procedure

Before a surgical abortion, your doctor will recommend several tests to confirm pregnancy and determine your fitness for the procedure. These tests include:

• Pelvic exam & hCG levels: Confirms pregnancy and estimates how far along you are.
• Blood tests: Check your blood type, haemoglobin, or hematocrit levels to rule out anaemia.
• Ultrasound: Determines the location of the fetus and gestational age.
• Rhesus (Rh) factor testing: Identifies if you have Rh-negative blood, which may require treatment to prevent complications in future pregnancies.
• HIV testing and STI screening: Detects infections, including sexually transmitted diseases, that may need treatment before the procedure.
• Cervical screening: Identifies any abnormalities in the cervix.
• Kidney & liver function tests: Assess your overall health, especially if medical conditions are present.

Before your surgical abortion, your healthcare team will explain the available anaesthetic options and help you choose the best one for your procedure.

Your doctor will recommend the most suitable option based on the number of weeks, patient's health, parity and other factors.

You will lie down on the OT table with your feet supported to allow access to your vagina and cervix. Your doctor will confirm the pregnancy location using an ultrasound and perform baseline health checks like pulse rate and blood pressure.

Your doctor will administer anaesthesia and/or sedation, depending on the option discussed previously. Intravenous (IV) access will be established for added safety.

To prepare your cervix for the procedure, your doctor may use small tapered rods called dilators or laminaria (medical seaweed sticks). These may sometimes be placed a day before the procedure to gently stretch the cervix open.

If dilation is expected to be challenging, osmotic dilators or medications like misoprostol or mifepristone may be used for gradual cervical opening. These can be taken orally or inserted into the vagina.

Suction aspiration

For pregnancies up to 12 weeks, suction aspiration, also called vacuum aspiration, is usually preferred. During this procedure, a manual or electric vacuum is gently used to remove pregnancy tissue from the uterus. Ultrasound is used to confirm that the uterus is empty, ensuring both safety and effectiveness. The procedure usually takes 5-10 minutes to complete.

Dilatation and evacuation (D&E)

For pregnancies beyond 14 weeks, dilatation and evacuation (D&E) is performed by experienced clinicians. This procedure involves using ultrasound to locate fetal parts, guide instruments, and ensure the uterus is completely empty. Ultrasound helps minimise the risk of uterine perforation, making the procedure both precise and safe. D&E typically takes 15-30 minutes to complete.

Generally, the recovery time following a surgical abortion takes anywhere from a few days to a couple of weeks, though it can vary for each individual. Your doctor will guide you through recovery to ensure an uneventful healing.

Immediate Steps

Your doctor will prescribe antibiotics to prevent infection and painkillers to manage discomfort. As the sedatives may leave you feeling drowsy, have someone accompany you home. Resting for a few days and avoiding strenuous activities is essential to give your body time to recover.

Aftercare

It's normal to experience bleeding, similar to a period, which may include blood clots or light spotting, lasting up to a few weeks. However, if you experience very heavy bleeding—soaking through two pads an hour for at least two hours in a row—contact your doctor immediately.

Your period will typically return within 4 to 8 weeks after the procedure. It's advisable to refrain from sexual activity for up to 2 weeks as you heal.

Follow-Up Appointments

A follow-up visit 7 to 14 days after the procedure will help your doctor to:

Check on the healing progress

Discuss contraceptive options and methods

Provide emotional support

Address any remaining questions or concerns

Complications from surgical abortions happen in less than 3% of cases, with the risk varying depending on the stage of pregnancy. Possible complications include:

Haemorrhage: Bleeding should resemble a menstrual period. Excessive and prolonged bleeding may indicate retained pregnancy tissue, requiring further treatment.

Infection: A fever could signal an infection, often due to incomplete abortion or infections.

Rare Complications

Uterine Injury: Though uncommon, surgical instruments can occasionally perforate the uterus. If perforation occurs, it is treated immediately.

Cervical Injury: The cervix may be stretched during the procedure. Repeated procedures can weaken the cervix, leading to issues in future pregnancies, such as an "incompetent" cervix, which may cause early pregnancy loss.

Surgical abortion is a safe procedure, and complications are less likely when performed by experienced surgeons.

If you’re considering an abortion, it’s essential to make an informed decision with the support of a reliable team of healthcare professionals. Ensure that the procedure is performed by skilled clinicians in a government-approved, well-equipped facility to ensure your safety.

Remember that you are not alone. Like many women, Preeti faced this journey with uncertainty and fear, but she discovered the importance of leaning on others for support.Conclusion.