Surgical termination of pregnancy

Before Termination of Pregnancy

At the first visit, the doctor confirms the pregnancy and its duration, orders necessary tests and, if needed, treatment, and counsels the person seeking a termination.

To avoid complications related to abortion, we recommend the patient agrees to the prescribed tests, examinations, and treatments.

It is important to inform the doctor confirming the pregnancy about:

• your current health status;
• all past and present illnesses;
• any medications being taken;
• any known drug allergies.

Surgical Termination of Pregnancy

Surgical abortion is the termination of pregnancy using a surgical method.

The procedure is preceded by a gynecological examination. Under short general anesthesia, the cervix is dilated and the pregnancy is terminated using vacuum aspiration. Sometimes, cervical preparation is required beforehand—medication is administered vaginally or sublingually.

On the morning of the procedure:

• Do not eat or drink;
• Do not chew gum or smoke;
• If you have a chronic illness (e.g., hypertension, asthma) and are on prescribed medications, you must still take your usual morning doses. A small sip of water for swallowing pills is allowed and safe. Some diabetes medications may be an exception and should not be taken without food;
• Empty your bladder before the procedure.

After the Procedure

After the procedure, the patient remains for a couple of hours in the operating unit on the second floor for observation until the effects of anesthesia subside and pain is under control. Before discharge, the nurse will remove the IV cannula. A sick leave certificate may be issued if needed.

Possible Complications of Surgical Abortion and When to Seek Emergency Help

Abortion is generally a safe procedure. However, the following complications are possible:

• Ongoing pregnancy (occurs in <1:100 cases) — the procedure must be repeated;
• Incomplete abortion (2:100)‒ Incomplete abortion (2:100) — the procedure must be repeated;
• Bleeding >500 ml (risk of transfusion-requiring bleeding is <1:1000);
• Uterine perforation (1–4:1000);
• Cervical injury (<0.2:100);
• Pelvic inflammatory disease, usually caused by pre-existing sexually transmitted infection (can increase risk of future tubal infertility or ectopic pregnancy). To reduce this risk, STI testing is done before the abortion, and treatment or prophylactic antibiotics are recommended if needed;
• Anesthesia-related complications, primarily drug hypersensitivity (0.5:10,000).

In rare cases (e.g., cervical injury, uterine perforation, significant bleeding), surgical intervention (laparoscopy or open surgery) may be required.

Seek emergency gynecological care or visit the 24/7 emergency department of a tertiary care hospital if you experience:

• Severe or increasing pain;
• Bleeding heavier than a normal period or lasting more than two weeks;
• Fainting;
• Vomiting;
• High fever (>24 hours), chills;
• Foul-smelling or purulent vaginal discharge.

If you suspect the pregnancy may be continuing (e.g., breast tenderness and enlargement, nausea/vomiting, fatigue, changes in appetite, frequent urination), contact a gynecologist immediately.

After Surgical Abortioni

The need for a follow-up visit is determined by the doctor, taking the patient’s wishes into account.

If the abortion proceeds without complications, a follow-up visit may not be necessary.

For two weeks after the abortion, we recommend avoiding unprotected sex, tampons, baths, and swimming.

Your next menstrual period should start within 4–6 weeks. If it does not, consult a gynecologist.

Avoiding Unintended Pregnancy

Fertility returns immediately after a pregnancy termination, so to prevent a new pregnancy, it is essential to begin using an effective contraceptive method either before or immediately after the abortion.
Hormonal contraceptive methods (such as pills, patch, vaginal ring, mini-pills, implant, or injectable progestogens) are typically started on the same day as the abortion.
An intrauterine device (IUD) may also be inserted by a doctor during the abortion procedure.
You can discuss suitable contraceptive options with your doctor prior to the abortion.