Abortion Care
IMPORTANT PRE-OPERATIVE INSTRUCTIONS
For patients having abortion services at Hartford GYN, please follow these instructions:
1. For morning appointments: Nothing to eat, drink, smoke, chew after 12:00 am (midnight) the day of the procedure.
2. For afternoon appointments: Nothing to eat, smoke, or chew after 8am the day of the procedure. You may have clear fluids (water, black coffee/tea, cranberry juice) until 10am, after then, nothing to drink.
3. No recreational drugs or alcoholic beverages for 48 hours prior to surgery.
4. Please dress comfortably; no make-up, jewelry, contact lenses, or high heel shoes. Bring a first morning urine sample, a bathrobe or blanket, and a pair of slippers or socks.
5. Please do not bring children with you to the office. Make sure that you have a reliable escort to drive you home as it is illegal to drive after anesthesia.
6. If you take any prescription medications, please let us know when you schedule your appointment so we can give you exact instructions on when to take your medications.
7. If you are using insurance, please bring your insurance card and a valid state picture ID such as a motor vehicle ID or driver’s license.
Non-surgical Abortion
Non-surgical abortion is commonly called or known as “abortion by pill.” It is also referred to as medical abortion. It is a non-invasive procedure for terminating a pregnancy. The name of the abortion pill is Mifeprex, and it has also formerly been called mifepristone and RU-486.
Mifeprex is used with another medication called misoprostol (also called cytotec) to cause a process similar to miscarriage. There are three steps to non-surgical abortion, and the time it takes to complete the abortion varies. The non-surgical abortion requires at least 2 visits to our office. Hartford GYN Center offers the non-surgical abortion as an early option to terminate a pregnancy up to 8 ½ weeks.
The first step of the non-surgical abortion regimen is to take the Mifeprex pill orally during your first visit to Hartford GYN Center. This will stop production of the hormones necessary to sustain the pregnancy, and will cause the pregnancy to detach from the uterus.
The second step is to take two 100mg tablets of an antibiotic (Doxycycline is given to most patients), followed by misoprostol, taken orally 24 to 48 hours after taking the first medication. This step is done in the convenience of your own home. The misoprostol will cause the uterus to contract and you will begin bleeding in order to expel all the pregnancy tissue from the uterus. You will bleed anywhere from several days to 4 weeks. The bleeding will be heavier than a normal period.
The third step is to return to Hartford GYN Center one to two weeks after taking the Mifeprex pill. During this visit, the facility staff will run some tests to ensure all the pregnancy tissue has been removed, and that there are no current complications.
In the event that all pregnancy tissue is not expelled at the time of the follow-up visit, the Hartford GYN Center may give the patient more misoprostol to try to remove the remaining tissue or perform a surgical abortion. About 5-8 out of 100 women will need a surgical procedure to end the pregnancy.
Surgical Abortion
First Trimester Abortion (up through 11.6 weeks LMP)
A first trimester surgical abortion, which is measured up to 12 weeks from the first day of the last menstrual period (LMP), is completed by a procedure known as dilatation and evacuation. The procedure alone will take approximately 5 minutes, although the visit to Hartford GYN Center may take several hours.
The procedure will begin with the physician performing a pelvic exam to determine the size and location of the pregnancy in the uterus. The doctor will then insert a speculum into the vagina so that he/she can view the cervix. The cervix is the lower end of the uterus, and is located at the top of the vaginal canal. He/she will clean the vaginal canal with an antiseptic. Next, he/she will dilate, or open, the cervix by inserting a series of sterile metal rods, one by one, into the opening of the cervix. These rods, called dilators, gradually increase in width. Dilation for a first trimester abortion is minimal. Once the cervix is opened, the physician will be able to remove the pregnancy from the uterus. The doctor will insert a sterile, plastic, flexible tube called a cannula into the uterus. The cannula is attached by a tube to a machine called a vacuum aspirator, which creates a suction that removes the pregnancy. Once these steps are complete, the surgeon will clean the inside of the uterus with an instrument called a curette to ensure that all pregnancy tissue has been removed. The whole process generally takes about 5 minutes. After surgery, you will be monitored for about 30-45 minutes, or until you are medically cleared to return home. You are encouraged to have a check up two weeks after your surgery either at Hartford GYN Center or your private gynecologist’s office.
Second Trimester Abortion (up through 19.6 weeks LMP)
A second trimester abortion take place from 12 weeks from the first day of the last menstrual period (LMP) through 19.6 weeks LMP. A second trimester surgical abortion is performed in the same manner as a first trimester abortion; however, the cervix must be dilated, or opened, prior to surgery. So, beginning at 14 weeks, a second trimester abortion will take two days. On the first day of the procedure, the cervix is dilated through the administration of a medication called misoprostol (cytotec) and/or laminaria/lamicel insertion. The misoprotol is either taken as a pill orally or inserted into the vagina. Laminaria or lamicel must be inserted by the physician into the cervix. Laminaria are made of sterilized seaweed and look like tiny tampons. Lamicel are similar, but made of a synthetic material. The laminaria/lamicel act like a sponge by absorbing the moisture in the vagina and expanding. As the laminaria or lamicel expand, the cervix is slowly dilated. Depending on the gestational age of the pregnancy and the patient’s medical history, the physician will decide on the best method of dilation with misoprostol (cytotec) and/or laminaria or lamicel. On the second day of the procedure, the physician will perform the surgical abortion in a manner similar to the method described for first trimester abortion. You are encouraged to have a check up two weeks after your surgery either at Hartford GYN Center or your private gynecologist’s office.
Types of Anesthesia for Surgical Procedures
Both first and second trimester surgical abortions can be performed with various types of anesthesia – local anesthesia, twilight, and general anesthesia. These methods can help to control pain and discomfort during the procedure, and each will have benefits and drawbacks. The doctor and facility staff will aid each patient in determining which method is best for her.
If the procedure is performed under local anesthesia, the patient will be awake and conscious as normal during the procedure. Patients will be able to see and hear as usual during the procedure, and will be able to remember everything that happened during the surgery after it is over. While local anesthetics can be administered differently, generally speaking the physician will inject the anesthetic into the patient’s cervix. This will lessen the pain, but the patient will still experience cramping and discomfort during the procedure. Sometimes medications, such as ibuprofen, are also offered both before and after the surgery to ease pain. Breathing exercises may also be used in conjunction with local anesthetic to minimize discomfort. Local anesthesia allows women to remain alert during the process, which may be more empowering for some individuals. In addition, this method allows women to avoid some of the side effects and risks often associated with sedation methods of twilight anesthesia and general anesthesia explained below.
Twilight anesthesia, sometimes called light sedation or conscious sedation, will be administered by a qualified anesthesiologist or certified registered nurse anesthetist. Twilight anesthesia may contain a combination of medications, usually given through an intravenous (IV) needle inserted into the hand or arm. Twilight anesthesia will relax and partially sedate the patient. She will have no memory of the procedure, but may appear conscious or partially asleep, and will usually be able to respond to simple requests. The patient will remain in this state for a couple of minutes up to a few hours depending on how much medication is administered.
If the procedure is performed under general anesthesia or deep sedation, the patient will be completely sedated, and she will not see, hear or feel any part of the surgery and will not remember anything about the surgery afterwards. General anesthetics are usually administered through an IV, in the same manner described above. While this is an optimal method for women who wish to decrease pain, it may not be appropriate for obese women or women with certain medical conditions. Sedation may also cause side effects such as nausea, dizziness, and feeling cold. The general anesthesia also takes longer time to wear off entirely and the patient will feel drowsy for several hours or a full day. This means the patient will be required to have a friend or family member escort her home after surgery. You are encouraged to return to Hartford GYN Center for a follow up visit two weeks after your surgery.
For more information on abortion services, or to make an appointment, please call Hartford GYN Center at 860.525.1900 or toll-free at 800.877.6335. For more information on abortion care, you can also visit AbortionUSA.com.
