Comprehensive Health of PPKM

Before you have an abortion, be sure you understand the information we have given you. This client information sheet lists the possible problems that can happen with early abortion and the danger signs you should watch for. If you have any questions as you read, we will be happy to talk about them with you.

There are three options for women who become pregnant. These are parenthood, adoption, and abortion. Other alternatives for surgical abortion include referral for an abortion under general anesthesia or an abortion in a hospital, now or later in the pregnancy.

Tests used to diagnose pregnancy have a very small possibility of being inaccurate.

The clinician will use her/his best judgment in diagnosing pregnancy, but there is a very small possibility of having this procedure performed in the absence of pregnancy.

The safest method for the performance of an early surgical abortion is a procedure called vacuum aspiration. This procedure ends an early pregnancy by gently suctioning the lining of the uterus and removing all of the tissues of the pregnancy. Comprehensive Health of Planned Parenthood offers this method of abortion through the end of the 14^th week of pregnancy, counting from the first day of the last menstrual period. This sheet will give you more information about the procedure and will explain each of the risks involved.

Once you check in at Comprehensive Health of Planned Parenthood, you will be asked to complete a medical history form and other paperwork. An educator will spend some time with you to explain the procedure, answer any questions that you may have and obtain your written consent. A number of tests will be done, including a blood test to check your Rh type and to make sure that you are not anemic. Various medications for pain relief to make you more comfortable during the procedure will be discussed and offered to you.

A little later, a medical provider will go over your medical history and will examine your heart and abdomen. In some cases, an ultrasound examination will be done prior to performing the procedure. This is done using a scanner that is passed over the abdomen or into the vagina. This will determine the age of the pregnancy. Whether the abortion can be performed in the clinic will depend on your medical history, your physical examination, and the results of your laboratory tests.

To begin the abortion, the doctor will place a local anesthetic (numbing medicine) in your cervix that will make the procedure more comfortable. The next step is to gradually stretch the opening of the cervix with a series of narrow instruments called dilators, each a little larger than the one before. When the cervix is open wide enough, a small plastic tube is inserted into the uterus, and is connected to a suction machine or a syringe to obtain a vacuum. The tube is moved along the inside of the uterus for 2 - 3 minutes in order to remove all of the pregnancy tissue with gentle suction. During and after the procedure, you may feel cramping as the uterus shrinks down to its normal size. The doctor may do a final check with a spoon-shaped instrument called a curette. Later, someone will examine the pregnancy tissue to check whether it has been removed completely.

A short time after the abortion, you will be taken to the recovery area for a rest and observation period. You will be given follow-up instructions and an appointment for a check-up in 3 weeks. A counselor or nurse will discuss your birth control plans with you, unless this was done earlier in the visit. When you feel comfortable, usually after 30-45 minutes, you may leave. As you may feel a little weak, it is best if you arrange beforehand for someone to drive you home. If you have medication IV sedation for your abortion, you will definitely need someone to drive you home.

Early abortion by vacuum aspiration is a very safe procedure. Fewer than 1 woman in 100 will have a serious complication following an early abortion. However, as with any surgery, there are certain problems that can arise during or after an abortion:

There is a 1 in 100 chance that an infection of the uterus will develop after the abortion. While this problem is routinely treated with antibiotics, there is a small chance that a repeat aspiration, a D&C, a hospitalization, or even surgery may be necessary.
In 1 in 100 cases, tissue is left inside of the uterus, leading to an "incomplete" abortion. This problem may lead to excessive bleeding, infection, or both. If this complication occurs, you could require a repeat aspiration or a D&C in a clinic or hospital, or other tests or treatment.
There is about a 1 in 500 chance that the uterus will be perforated (an instrument may go through the wall of the uterus and could damage internal organs such as intestines, bladder, or blood vessels). Treatment may consist of observation, laparoscopy, or abdominal surgery. The likelihood of hysterectomy (removal of the uterus) in this setting is 1 per 10,000 abortions.
Other risks include:
- Allergic reaction, which can be due to an allergy to the local anesthetic or to any other medications used. All medicines and drugs, including street drugs, may cause serious reactions alone or during anesthesia. It is important that you use only medically necessary drugs and avoid alcohol or other non-prescription drugs on the day of the abortion and that you tell the clinicians about all drugs you have taken;
- Hemorrhage (excessive bleeding), which may require treatment by medications, repeat aspiration, D&C, or rarely, surgery, including possible hysterectomy. Hemorrhage severe enough to require transfusion occurs in fewer than 1 per 1000 cases;
- Blood clots in the uterus, which may cause severe cramping and abdominal pain. The risk is about 1 in 100 cases and the treatment is to repeat the aspiration;
- Cervical tear, in fewer than 1 in 100 cases, which may be treated with medicines, or rarely, stitches in the cervix;
- Failure to end the pregnancy, which occurs in 1 per 500 cases and may be due to a divided uterus, very early pregnancy, or other causes. Another aspiration procedure is recommended when this happens. A tubal (ectopic) pregnancy is not ended by a surgical abortion procedure and may require an abdominal operation to remove;
- An emotional reaction after the abortion. Emotional problems after abortion are uncommon, and when they happen, they usually go away quickly. Most women report a sense of relief, although some experience depression or guilt. Serious psychiatric disturbances (such as psychosis or serious depression) after abortion appear to be less frequent than after childbirth;
- An impact on future pregnancies with an uncomplicated early abortion, this risk is unlikely;
- Death, which occurs in fewer than 1 per 100,000 abortions. This may be compared with the risk of death from a full-term pregnancy and childbirth, which is seven times greater than that from early abortion.

No guarantee is made regarding the results that may be obtained from this procedure.

If emergency medical care is needed in a hospital or from a provider other than Comprehensive Health of Planned Parenthood, you will be responsible for paying for that care.

You will be given a telephone number to reach the clinic or a nurse in the event that these or any other problems occur. You also should plan on returning to Comprehensive Health of Planned Parenthood for a follow-up visit as instructed by the clinic staff.

CLIENT INFORMATION FOR INFORMED CONSENT EARLY SURGICAL ABORTION