TERMINATION OF PREGNANCY

The earlier in the pregnancy that the operation is performed, the easier it is and the shorter the hospital stay. If the pregnancy is less than 12 weeks the operation will usually be done as a day case. Most women can go back to work within 2 days. In some cases pessaries containing type of hormone called prostaglandin may be put into the vagina before the operation to soften the cervix (see below) and antibiotics may be given to reduce the risk of infection after the operation. It is important for the surgeon to know the accurate size of the pregnancy before the operation. A scan may be done to check this. Blood tests will be done and the doctor must know the Rhesus blood group. If Rhesus negative, an injection is given after the operation to prevent antibodies forming. Such antibodies can produce blood-cell damage in subsequent newborn children (causing jaundice and anaemia).

What happens when a Pregnancy is terminated

The procedure is similar to a dilatation and curettage (D&C). The cervix (neck of the womb) is stretched and a small plastic tube is inserted into the womb. The tube is attached to a vacuum pressure pump which sucks out the contents of the womb. A general anaesthetic is preferred but a local anaesthetic is possible. If the pregnancy is later than 3 months it may be too late to remove safely in this way. This means that the pregnancy has to be terminated by drugs to make the womb contract, as in labour. The drugs used are called prostaglandins. They are most commonly given as vaginal pessaries. Labour usually starts within a few hours but mat take longer in some women. Painkillers are given as necessary and a close relative should be there for support. Once the pregnancy is delivered, a D & C may still be needed. Many women find that suction termination of an early pregnancy is very much less unpleasant than the later prostaglandin labour. It is very important that all terminations are done before 12 weeks where possible. Prostaglandin pessaries can also be used in combination with a drug called Mefipristone for an early type of medical termination. This is done before 9 weeks of pregnancy. The Mefipristone is taken orally as a tablet and the prostaglandins inserted as a pessary into the vagina two days later. This will cause most women to expel the pregnancy as if they were having a miscarriage. A small number of women will need a D&C following this. In most cases an operation will not be necessary. Not all hospitals offer this type of termination. A very few hospitals may offer a D&C as late as 20 weeks. This is called a dilatation and evacuation. It requires special skills and should only be done by a very experienced surgeon.

Possible complications during pregnancy termination

Early termination of pregnancy is very safe: probably safer than having a baby. There is a very slight risk of anaesthetic complications but the operation is very short. There is a small risk of making a hole in the wall of the womb during surgical termination. If this happens it may be necessary to do an operation through a cut on the abdomen to make sure that there is no internal bleeding or damage to other organs such as the bowel. Because the wall of the womb is made of thick muscle it will usually seal off any small holes without the need to operate on the womb itself. Pain, heavier bleeding and a temperature are signs that there may be an infection in the womb or tubes. This might affect future fertility and should be treated with antibiotics. A further D & C may be required. You may feel guilty and depressed after an abortion. This depression is commoner in late abortions for abnormal babies and may recur at the time when the birth would have been expected.

Afterwards

Bleeding should stop after an early termination within a few days. After a late termination bleeding may continue for a week or 10 days. The first period should come in about 4 weeks if there is normally a regular monthly cycle. Consult the doctor if there is any sudden increase in the bleeding within 4 weeks. Advice should also be sought if a temperature develops or clots of blood are passed. Return to work is possible in most cases after 48 hours. Tampons should be avoided until the next period comes. Many women start to take the contraceptive pill the day after the operation. A coil can be inserted at the same time as surgical termination of pregnancy is performed. In this is done an appointment with your GP or family planning clinic should be made to check that it has not been expelled from the womb before relying on it for contraception after the termination. You can start to have intercourse when you feel like it emotionally: this may take some weeks. Women whose pregnancy has been terminated because of an abnormality often want to replace the baby as soon as possible. It is sensible to wait for two or three cycles before conceiving but it is not essential.

If a pregnancy is not terminated

This has to be considered very carefully by all who consider termination. Experienced, sympathetic pre-abortion counselling is offered by most hospitals and clinics. The decision should be made as early as possible: in many women it is based on the lesser of two evils.