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 mid-trimester D & E 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. The other alternatives to D & E abortion include referral for an abortion under general anesthesia or an abortion in a hospital, now or later in the pregnancy.

A "D & E" (Dilatation and Evacuation) is a method of abortion done between the 14th and 24th week of pregnancy. An ultrasound will be done to determine the age of the pregnancy. This Planned Parenthood center offers D & E abortion through the end of the 23^rd week of pregnancy. D & E is a two-part procedure requiring one or two days to dilate (open) the cervix and a final visit to the clinic to empty the uterus.

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, and 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, the clinician will go over your medical history and will examine your heart and abdomen. After a routine pelvic exam to check the size of your uterus, other tests may be performed. 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 will be performed in the clinic will depend on your medical history, your physical examination, and the results of your laboratory tests.

Insertion of Osmotic Cervical Dilators or Use of Medication to Stretch or Soften the Cervix

Osmotic dilators will be used and/or the medication misoprostol will be given to slowly stretch or soften the opening of the cervix. If either of these is to be used, you will also be given more information.

You also will be given written instructions for your care. The instructions include a telephone number so that you can get in touch with the clinic staff should any problems arise.

Before the procedure is started, a needle will be inserted in your vein. It will stay there during the time you are in the clinic. All the medications that you need will be given through this needle. These medications may include drugs to reduce discomfort and help you relax.

If gauze and dilators were used, they will be removed. The doctor will give you a local anesthetic (numbing medicine) in your cervix, which will make the procedure more comfortable. The cervix may need to be stretched more, which will be done gradually with a series of narrow instruments called dilators, each a little larger than the one before. When the cervix is open wide enough, a plastic tube is inserted into the uterus and is connected to a suction machine. The contents of the uterus is then removed by a combination of suction and instruments, usually taking 5 - 15 minutes. 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, the doctor 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 2-3 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 45-60 minutes, you may leave. As you may feel a little weak, you should arrange beforehand for someone to drive you home.

Mid-trimester abortion is more complex than abortion performed earlier in pregnancy. With D & E, there is a greater risk of perforating the uterus or injury to the cervix than with early abortion. However, compared with the other methods available after the 16th week of pregnancy (injection of saline or prostaglandins inside the uterus), there is less risk with D & E of bleeding, infection, and incomplete abortion.

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 (suction), 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.
About 3 in 1000 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). Hospitalization is required, and an abdominal operation is usually performed to repair the damage. The likelihood of hysterectomy (removal of the uterus) in this setting is fewer than 1 per 1000 D & E 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 abdominalpain. The risk is about 1 in 100 cases and the treatment is to perform suction;
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 psychoses or serious depress) after abortion appear to be less frequent than after childbirth;
an impact on future pregnancies. With an uncomplicated mid-trimester abortion, this risk is unlikely; and
death. The risk of death from D & E about equal to that of death from full-term pregnancy and childbirth.

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.

When you leave Comprehensive Health of Planned Parenthood after the abortion, you will be given a telephone number to reach the clinic or nurse in the event that these or any other problems occur. You should plan on returning to the clinic as advised by the staff or your clinician for your follow-up exam.

CLIENT INFORMATION FOR INFORMED CONSENT MID-TRIMESTER D & E ABORTION