Abortion means the intentional induction of a miscarriage. Abortion is a secure surgical process, with some estimates suggesting that it is 10 times safer than childbirth. However, all surgery carries a degree of risk. Some of the complications of abortion can include infection, damage to parts of the reproductive system, and excessive bleeding.
Female reproductive system
The female reproductive scheme is made up of the vagina, uterus, fallopian tubes and ovaries. The vagina is a muscular canal that leads to the entry of the uterus, which is called the cervix. The uterus is a muscular organ, shaped like an upside-down pear. Fallopian tubes extend from the uterus, one on each side. They both open near an ovary, and carry the eggs from the ovaries to the uterus. A fertilized egg lodges in the lining of the uterus, called the endometrium. To abort a foetus, the cervix must be opened a little wider to allow the surgical instruments into the uterus.
Always check with your clinic, but general instructions before undergoing an abortion include:
- Don't eat, drink or smoke for six hours before the operation.
- Allow for at least two hours at the clinic.
- Bring sanitary pads, your referral letter, blood group card, Medicare card and any health care card.
- Arrange for someone to drive you home.
Most women prefer general anaesthetic. All types of anaesthesia require fasting for six hours beforehand. This means no food or drink, not even water. The range of anaesthetic choices includes:
- General anaesthetic - which induces complete unconsciousness? Any operation involving general anaesthesia carries risk. There is a danger of choking if fasting isn't properly undertaken beforehand
- Nitrous oxide - or similar gas, to offer what's known as a 'twilight sleep'. The woman is awake, but sedated and calm.
- Local anaesthetic with intravenous sedation - a combination of intravenous sedation and analgesia with a paracervical block
- Local anaesthetic - anaesthetic is injected directly into the cervix.
Most abortions are performed using what is called suction aspiration. The woman needs to be in her first trimester (first three months) of pregnancy, which means 12 weeks pregnant or less. The cervix opening is widened with rods of increasing size, and a tube is then inserted into the uterus. The fetus and placenta are vacuumed out. The uterus is then scraped with an instrument called a curette to make sure that no products remain behind. This operation takes less than 15 minutes. If the woman is more than 12 weeks pregnant, she needs to have a mid-trimester abortion.
Complication of abortion
Estimates vary, but complications can occur in around three per cent of cases. The risk of complications greatly depends on gestational length (length of the pregnancy), since abortions performed in the first trimester of pregnancy are the safest. Another major safety factor is the doctor's level of experience and training. Complications of abortion can include:
- Haemorrhage - bleeding after an abortion should be similar to the bleeding experienced during a normal menstrual period. Heavy bleeding may indicate that pieces of the placenta remained inside the uterus. The treatment for this is to do a repeat suction curettage of the uterus. Blood transfusion is rarely required.
- Injury to the uterus - the walls of the uterus are muscular but soft. A suction tube or knife can puncture the uterus, potentially causing abdominal infection (peritonitis) and severe blood loss.
- Injury to the cervix - the cervix opening is stretched during an abortion. This can occasionally cause the cervix to become weakened, or 'incompetent'. An incompetent cervix can cause problems in later pregnancies, because it might be too weak to remain fully closed under the weight of a growing foetus.
- Infection - a fever (high temperature) may indicate pelvic inflammatory disease (PID), or infection of the uterus and fallopian tubes. Damaged fallopian tubes increase a woman's risk of experiencing a future ectopic (tubal) pregnancy, which means her fertilized egg lodges in the fallopian tube instead of the uterus. If a woman already has the sexually transmitted disease chlamydia, her risk of PID increases. Retained pieces of placenta can also cause local infection. Treatment includes antibiotics.
After the operation
Be guided by your clinic. Generally, post-operative suggestions to reduce the risk of infection include:
- Shower instead of taking a bath.
- Don't have sexual intercourse.
- Use sanitary pads instead of tampons.
- Don't go swimming.