Surgical Abortion

You will find information below about the types of surgical abortion procedures offered by Planned Parenthood of New York City. Please remember that a PPNYC staff member is available to answer any questions or concerns that you may have before, during, and after your visit. To reach PPNYC, call (212) 965-7000 or (800) 230-PLAN.

Before an Abortion

Once you check in at a PPNYC health center, you will be asked to complete a medical history form and other paperwork. A number of tests will be done, including a blood test to determine if you are Rh postive or negative (click to learn more about Rh status), and to make sure that you are not anemic. An ultrasound examination will be performed prior to the procedure. This is done by moving a scanner over your abdomen or inserting a probe into the vagina to accurately determine the size of the pregnancy.

A counselor will then spend some time with you to explain the procedure, go over your medical history, obtain your written consent, and answer any questions that you may have. The final decision as to whether the abortion will be performed in the center will depend on your medical history, your physical examination, and the results of your laboratory tests.

Choosing Local Anesthesia or Deep Sedation Anesthesia

At our health centers, you have the option to choose local anesthesia (if your pregnancy is 12 weeks or under) or deep sedation anesthesia for your procedure. (See Pain Management Options for Abortion.) A counselor will review these choices and help you choose which is right for you. Some physical or medical conditions may limit the type of anesthesia available to you.

Clients who choose local anesthesia (if your pregnancy is 12 weeks or under) may have a light meal before the procedure. However, in order to avoid complications, clients who choose deep sedation anesthesia must not have anything to eat or drink (not even water, candy, or gum) after midnight the night before the procedure is performed. Also, since the anesthetic can interact dangerously with any other drugs in the body, it is very important for you to tell us if you're using anything at all, from aspirin to street drugs.

Abortion Procedure

A short description of each of the three surgical abortion procedures offered by PPNYC follows. Remember, if you have any questions, a PPNYC staff member is available to talk to you before, during and after your visit.

Surgical Abortion up to Seven Weeks

Manual vacuum aspiration (MVA) is a surgical abortion technique used to terminate a very early pregnancy. It requires only a handheld vacuum syringe that creates suction without electricity or the noise of an electric suction machine. PPNYC offers MVA as early as a pregnancy can be identified by ultrasound and up to the seventh week of pregnancy, counting from the first day of the last menstrual period and measuring the size of the pregnancy by ultrasound.

In the procedure room your medical provider will examine your heart, lungs and abdomen, perform a routine pelvic exam to check the size of your uterus and do some other tests. The clinician swabs the vagina with antiseptic and then inserts a small instrument called a speculum to hold the walls of the vagina apart. The medical provider then uses an instrument to take hold of your cervix (the lower part of your uterus) to keep it steady through the rest of the procedure. If you're having a local anesthetic, it is injected into the cervix to numb the area.

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. While this is going on (it takes about two minutes), you may feel something like menstrual cramps.

When the cervix is open wide enough, a plastic tube, which is attached to a syringe, is inserted into the uterus. A vacuum is created in the syringe that causes the pregnancy tissue to be gently suctioned out of the uterus. The uterus is emptied and the tissue is collected in the syringe. The tissue is then examined to confirm that the pregnancy has been terminated and another sonogram, using the vaginal probe, is done to determine that the pregnancy tissue has been completely removed. The pregnancy tissue may be sent to a lab for further evaluation. The actual abortion procedure usually takes between five and ten minutes.

Surgical Abortion up to 14 Weeks

One of the safest methods for performing an early abortion is a surgical procedure called suction curettage. This procedure ends an early pregnancy by gently suctioning the lining of the uterus and removing all of the tissues of the pregnancy. PPNYC offers this method of abortion from 6 weeks of pregnancy through the end of the 14th week of pregnancy, counting from the first day of the last menstrual period and measuring the size of the pregnancy by ultrasound.

In the procedure room your medical provider will examine your heart, lungs and abdomen, perform a routine pelvic exam to check the size of your uterus and do tests for gonorrhea and chlamydia. The clinician swabs the vagina with antiseptic and then inserts a small instrument called a speculum to hold the walls of the vagina apart. If you are having deep sedation anesthesia, it will be given by injection into a vein of your arm or hand. If you're having a local anesthetic, it is injected into the cervix to numb the area. The medical provider then uses an instrument to take hold of your cervix (the lower part of your uterus) to keep it steady through the rest of the procedure.

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. While this is going on (it takes about two minutes), you may feel something like menstrual cramps.

When the cervix is open wide enough, a plastic tube is inserted into the uterus. The tube is connected to a suction machine, which is then turned on. The tube is moved along the inside of the uterus for several minutes in order to remove all of the pregnancy tissue with gentle suction. If you are awake, you will feel this as a kind of pulling sensation inside you.

After removing the tube, the medical provider takes a long thin spoon-like instrument and glides it around the inside of the uterus to check that everything is out. Later, the pregnancy tissue is examined to check whether it has been completely removed, and it may be sent to a laboratory for further evaluation.

Surgical Abortion from 14 to 22 Weeks

A Dilatation and Evacuation or "D&E" is a method of abortion performed between the 14th and 24th week of pregnancy. PPNYC offers D&E abortion up to the 22nd week of pregnancy, counting from the first day of the last menstrual period. A D&E abortion is a two-part procedure usually requiring two days, one day to dilate (open) the cervix (the lower part of the uterus) and a second visit on the following day to empty the uterus.

D&E Abortion
Day One - Insertion of Osmotic Dilators

Osmotic dilators will be used to slowly stretch the opening of the cervix (the lower part of the uterus). These small devices swell when they absorb water from the cervical fluids. As they expand, they widen the cervical opening, very gently and gradually. The dilators remain in the cervix for several hours (usually overnight), kept in place by gauze inserted into the vagina. You will be given Ibuprofen for pain and a prescription for antibiotics to prevent infection. You also will be given written instructions for your care while the dilators are in place. The instructions include a telephone number so that you can get in touch with the center staff should any problems arise. Sometimes a second insertion of dilators is necessary. The abortion procedure is scheduled for the following day.

Day Two - The Abortion Procedure

If the pregnancy is over 18 weeks, a medication (Cytotec) will be placed in the cheeks of your mouth to help the osmotic dilators open the cervix.  In the procedure room, the anesthesia medication will be given by injection into a vein in your arm or hand and the gauze and osmotic dilators will be removed. The opening of the uterus 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 are removed by a combination of suction and instruments, usually taking five to 15 minutes. Later, the pregnancy tissue will be examined to check whether it has been completely removed and may be sent to a laboratory for further evaluation.

After an Abortion

A short time after the abortion, you will be taken to the recovery area for a rest and observation period. You will be bleeding a little, about as much as when you have your period and you'll be given a sanitary pad to absorb the flow. You may also experience some cramping. If you had conscious sedation or general anesthesia, you will probably feel groggy when you wake up; you may also feel a bit dizzy, shaky or faint. Some people feel sick or crampy for a while; others just feel a little drained because of the release from emotional strain. Many people feel surprisingly good and relieved.

At this point, if your blood is Rh negative, you will need a special shot. This will keep your blood from producing a new chemical component as a result of the pregnancy, something that could harm any future Rh positive baby you bear (click to learn more about Rh status). You will be given follow-up instructions and a counselor or nurse will discuss your birth control plans with you, unless this was done earlier. When you feel comfortable, usually one to two hours later, you may leave. Because you may feel a little weak, we strongly suggest that you arrange beforehand for someone to help you get home.

When you leave the center after the abortion, you will be given a telephone number to reach the center should any problems occur. You will also be given an appointment to return to the center for your follow-up exam. It's important for us to evaluate your condition after the abortion so please make sure you keep this appointment. It will also give you an opportunity to follow up on your birth control plans.

See Medication Abortion to learn about an alternative abortion procedure also available at PPNYC.