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Early Abortions (Up to 8 weeks LMP)
AWC offers the option of Medical (non-surgical) abortions or Early Surgical abortions using ultrasound guidance.
Surgical Abortions (5 - 16 weeks LMP)
The standard method used to perform an abortion procedure in the first trimester and early second trimester is called vacuum aspiration. AWC offers the option of being awake with local anesthesia or "twilight sleep" with intravenous sedation.
| Surgical Abortion | | Non-Surgical Abortion | | Medications | | Possible Complications |
| What to Expect After Your Abortion |
| Post Abortion Instructions |
| PA Abortion Control Act |
SURGICAL ABORTION
Explanation of the Procedure
At the procedure visit you will talk with a counselor about your decision, aftercare, and birth control. You will receive a medication to help with cramps if you are having surgery. A nurse or assistant will escort you to a pre-operation room to take your vital signs before bringing you to a private procedure room. Prior to surgery you will meet the doctor and have an opportunity to ask him or her any last minute questions.
If you have chosen to be awake for the procedure, you have the option of receiving an additional medication to help reduce pain and ease anxiety. If you choose to take this medication, a nurse will give you a shot in the arm approximately 20 minutes prior to the start of the abortion. If you have chosen to be "asleep", a nurse anesthetist will place a needle in your arm, which will deliver a pain-blocker and sedatives intravenously. You will not feel anything or remember anything.
A female nurse or assistant will accompany you into the procedure room. The doctor begins the procedure with a pelvic exam, followed by an injection of a local anesthetic into the cervix (the lower part of the uterus). If you are awake, you may feel a pinching or burning sensation.
The opening of the cervix is then stretched with a serious of progressively sized metal rods called dilators. Some patients need a special dilator, called laminaria, which is inserted in the cervix 1-2 hours prior to the start of the procedure. You may experience mild to severe cramps during the dilation process.
When the cervical opening is large enough, a blunt-tipped tube (a cannula) is inserted into the uterus. The cannula is attached to a vacuum aspirator, and a light suction removes the pregnancy tissue from the uterus. A spoon-shaped instrument (a curette) may be used for a final cleaning of the uterine lining.
The surgery usually lasts about 3 - 8 minutes. If you are having IV sedation, you will experience a "twilight sleep" for about 8 -10 minutes. Afterwards, you will rest in the recovery room, where a nurse will monitor your vital signs for about 30 to 60 minutes.
You can expect to spend 2 - 5 hours at AWC on the procedure day if you are awake, or 3 - 6 hours if you are under sedation. Since few physicians provide this service, we schedule as many patients as we can. If one patient needs extra time, you can be assured that we will offer you that same courtesy. Therefore, much of your time could be spent waiting.
A staff person is on call 24 hours a day for emergencies.
Call us first if you have a problem.
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MEDICAL (NON-SURGICAL) ABORTION
Medical abortion is a way to end pregnancy without surgery. It is done at AWC with medication up to 56 days (8 weeks) after the the last period begins. AWC is the only abortion provider in Northeast Pennsylvania offering the most effective method of non-surgical abortion using a pill called Mifeprex™.
Consultation and Screening
You will speak with a telephone counselor who will talk to you about your options and assess if this type of abortion is best for you. Not all women are eligible for medical abortion, and all patients must go through a careful screening process.
The telephone counselor will schedule an appointment for you to either come into the office for a consultation visit or talk with one of our physicians by phone about both surgical and medical abortion, at least 24 hours before your first appointment. This is required by a Pennsylvania law called the Abortion Control Act.
Medical Abortion with Mifeprex and Misoprostol (the "abortion pill")
Visit One - Day 1
First, you will need to give us a urine sample so we can check glucose and protein levels. You will fill-out a medical chart, get blood work drawn and have a transvaginal ultrasound done. You will discuss your decision with a counselor and talk more about the medications, side effects, and risks outlined in the Medication Guide. You will read and sign the Patient Agreement and consents for medical abortion. After payment, you will schedule your return appointments to the clinic.
Next, a nurse or assistant will take you to a pre-operation room where you will wait and she will take your vital signs (blood pressure, heart rate, and temperature). She will then take you to a private room where you will meet the physician and he or she will examine you. The physician will ask you about your decision and if you have any questions. The physician will then give you one Mifeprex tablet (200 mg mifepristone) and you will swallow it.
Note: AWC uses a treatment regimen that differs from the FDA protocol, which recommends 600mg of mifepristone (or 3 Mifeprex tablets). Evidence-based research has shown that 200mg of mifepristone is as effective as 600mg of mifepristone, and it is what our physician recommends as the best treatment regimen for you.
You will then receive a packet containing 800 micrograms of misoprostol (4 Cytotec tablets) which you will insert into your vagina approximately 48 hours after taking Mifeprex. This medication is necessary to complete the abortion and expel the pregnancy. If you start bleeding before inserting the tablets, call our office. You should complete the abortion within 4 to 24 hours of inserting the Cytotec tablets. 75% of women using this method of abortion pass the pregnancy within the first 24 hours of inserting the Cytotec tablets. An AWC staff person may call you to see how you are feeling.
Note: AWC uses a treatment regimen that differs from the FDA protocol, which recommends 400mcg of misoprostol(or 2 Cytotec tablets)taken orally in our office. Evidence-based research has shown that 800mcg of misoprostol taken vaginally at home works faster and produces less gastro-intestinal side effects than 400 mcg taken orally. Our physician recommends this regimen as the best treatment regimen for you.
Visit Two - Follow-Up - Day 10-14
Approximately 10-14 days after your first visit you will return to AWC for a repeat vaginal ultrasound. If the abortion is complete, you will meet with a counselor to discuss birth control options and future care. If you are still pregnant, you will most likely need surgery to complete the abortion. If you need surgery, there is a $100 additional charge and you will need to return for another follow-up exam in 2-3 weeks.
IT IS VERY IMPORTANT THAT YOU UNDERSTAND THAT ONCE MIFEPREX HAS BEEN TAKEN, THE PREGNANCY TERMINATION MUST BE COMPLETED. About 5-8% of women using this method will not abort and MUST undergo termination by the standard suction aspiration method. The drugs used in this type of abortion may cause birth defects. If the pregnancy is not expelled, surgical abortion must be performed.
HOW TO USE CYTOTEC AND WHAT TO EXPECT
- The day before inserting Cytotec, eat lightly - avoid rich, spicy, or fried foods. Do not drink alcohol or take drugs. Fill your prescription for pain pills and make sure you have plenty of maxi pads on hand. Keep your body hydrated by drinking plenty of fluids (water and juice).
- One half hour before you plan to insert the Cytotec tablets into your vagina, take 800mg of Advil, Motrin, or Ibuprofen.
- Wash your hands well. Lie down and using your middle finger, push the tablets, one at a time, deepinto your vagina. Rest on your back for at least 30 minutes.
- Cramps and bleeding will begin 2-4 hours after inserting the tablets.
- During this time period, continue to drink plenty of fluids and eat lightly.
- If you received a prescription for Tylenol with Codeine #3, you may take one when cramping begins and one every 4 hours thereafter. This medication may cause constipation and drowsiness. DO NOT take any additional or alternative pain medications without speaking to us first.
- Pregnancy tissue: You should pass the pregnancy tissue in the next 4-48 hours. The embryo may be embedded in a blood clot or it may be more recognizable as a small white form the size of a grain of rice or smaller.
Side Effects of Medical Abortion
Bleeding: You should expect very heavy bleeding and you may pass some large clots (the size of a baseball or bigger). Clots may look bigger in the toilet, so do not panic. If you are soaking* through 2 or more pads per hour for 2 hours in a row, call AWC immediately. Bleeding may continue off and on for several days and can range from a light flow or spotting to heavier, like a period. DO NOT USE A TAMPON OR TAKE A BATH WHILE YOU ARE BLEEDING. Your bleeding should slow down after you pass the pregnancy. If you do not begin bleeding within 24 hours, please call the clinic.
*Soaking = filling a pad with fresh, bright red blood from side to side and front to back (not including clots). If you hold up the pad, it will drip.
Cramping: Cramping is an indication that the medical abortion is working and is normal with this type of abortion. Cramps may at times be quite painful and much worse than a period. You may take 800mg of Ibuprofen (Advil, Motrin, Nuprin, etc.) every 6-8 hours and 1 tablet of Tylenol with Codeine every 4 hours as needed. If nothing helps, call our office. DO NOT TAKE ASPIRIN.
Nausea, vomiting, and diarrhea: If you experience severe nausea and vomiting, call AWC. We will phone in a prescription for Tigan suppositories.
Fever: A temperature of 101°F or higher can be normal after taking Cytotec. Your temperature should return to normal about one hour after the bleeding starts. Monitor your temperature each hour over the next three hours. Drink lots of fluids. If your fever does not return to normal in three hours, call the clinic. If you get a fever of above 100.4°F after day 4, please call our office immediately.
RESTRICTIONS:
- DO NOT take aspirin.
- DO NOT use tampons.
- DO NOT douche or swim.
- DO NOT take any prescription or non-prescription medications that AWC did not prescribe.
- DO NOT have sexual intercourse until after your follow-up exam.
- Avoid strenuous activity and heavy lifting until after your follow-up.
IF YOU EXPERIENCE A PROBLEM, CALL AWC FIRST! 610-264-5657 OR 800-372-8500 OR 877-DIAL AWC
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MEDICATIONS
Ibuprofen: This medication is given pre-operatively to help with cramps. Extra-strength Tylenol is given if you are allergic to Ibuprofen.
Nubain or Stadol: This medication may be given in addition to local anesthesia to patients who request it. These medications help reduce anxiety and pain during the procedure.
Doxycycline: This antibiotic is dispensed routinely to help prevent infection. Take the medication with your evening meal, at least 1 hour before bedtime.
Methergine (Ergonovine Maleate): Some patients may be given this medication by injection (shot) or by pill to help slow down bleeding and contract the uterus. It may cause cramping. Follow the package instructions.
Misoprostol (Cytotec): This medication is sometimes prescribed to help dilate the cervix and contract the uterus before or after an abortion. It may be administered orally or vaginally.
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POSSIBLE COMPLICATIONS
Complications are rare. Approximately 1% of women experience complications as a result of this surgery. In general, the earlier in the pregnancy, the fewer the complications. Vacuum aspiration abortion is one of the safest surgical procedures. As with any type of surgery, however, there is a chance of a complication. The following are complications that can occur:
INFECTION: of the uterus, which may require antibiotics, hospitalization, and rarely can lead to infertility.
INCOMPLETE ABORTION: In rare cases, the abortion procedure may not remove all of the pregnancy tissue. The retained tissue may be passed spontaneously or the procedure may have to be repeated (either here or in the hospital). If tissue is passed, it should be saved so a laboratory can examine it.
RETAINED CLOTS: Sometimes clots cover the opening of the cervix, causing blood to fill in the uterus. This is accompanied by severe crams. Often a heating pad or hot shower and abdomen massage will provide relief. If the clots cannot be passed, a repeat procedure may be required.
CONTINUING PREGNANCY: Rarely, the surgery fails to end a pregnancy. This may be due to multiple pregnancies, a double uterus, or a pregnancy outside of the uterus (ectopic pregnancy). A failed abortion requires re-evacuation. An ectopic pregnancy requires hospitalization and surgery.
HEMORRHAGE: Extremely heavy bleeding that requires an evaluation to determine the cause of the bleeding.
PERFORATION: An injury to the uterine wall may occur once in 1,000 abortions. Although most perforations heal themselves, hospitalization and surgery may be required. Rarely, removal of the uterus occurs.
LACERATION: A tearing of the cervix which could require suturing.
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What to Expect After Your Abortion
Will I bleed or feel pain? Most women experience some bleeding after this type of procedure. The flow can vary and may last a few days to a few weeks. You may not bleed at all or bleed only lightly, or have a flow similar to a period. You may bleed and stop, then start again several days later.
A common bleeding pattern is to experience cramping and passing clots (which may be larger) or experience an increase in flow, 3-5 days after the procedure. The cramping may occur before passing clots. Clots are normal, and may be passed off and on for a few weeks.
In 2-5% of abortions, for unknown reasons, clots may cover the opening of the cervix, causing blood to fill in the uterus. This is accompanied by severe cramping and little or no bleeding, and can occur within hours or up to 5 days after the abortion. Often a hot shower with abdominal massage will provide relief and sometimes alleviate the problem. Rarely, it is necessary to re-evacuate the uterus, which provides almost immediate relief.
As the uterus returns to its normal size, you may experience cramps for several days after the abortion, or not at all. You may take medications listed in the Post Abortion Instructions section of this pamphlet for cramps.
Should I take it easy? Listen to your body. Get extra rest if you feel you need it, if you are easily fatigued, or if you have cramps or heavy bleeding. You may resume normal activities as soon as you feel up to it. You should avoid heavy lifting (more than 25 lbs.) and strenuous exercise for at least one week. We can provide excuses for school or work if needed.
When will I get my period? You can expect to get a normal period about 4 to 8 weeks after the abortion. We cannot predict exactly when you will get your period because pregnancy and abortion affect you menstrual cycle.
Why should I have a follow-up exam? It is extremely important to have a follow-up examination and repeat urine pregnancy test 2-3 weeks after the abortion to be sure you are completely healed and discover and treat any problems that may have developed. AWC provides this exam at no charge if scheduled within 4 weeks of the abortion. Keep this appointment, even if you are still bleeding. If you go to your own doctor for follow-up, it is important to tell us about your progress, especially any problems that develop.
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Post Abortion Instructions
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It is important to know what is normal to expect after this procedure and what might indicate a problem.
RESTRICTIONS:
To help prevent infection, for 2 weeks after your abortion:
- DO NOT have sexual intercourse.
- DO NOT insert anything into the vagina,
including tampons.
- DO NOT swim or douche.
- Take showers instead of baths
(plain water baths are OK)
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CALL US IMMEDIATELY (DO NOT EMAIL!!) if you have any of the following:
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- FEVER of 100.4 degrees or higher. You should take and record you temperature every morning and evening for about a week after the abortion.
- HEAVY BLEEDING that consists of soaking 2 or more full-size pads in 1 hour, or bleeding much heavier than a normal period.
- SEVERE CRAMPING OR PAIN unrelieved by: 1) a non-aspirin pain reliever such as Ibuprofen, Advil, Nuprin, or Motrin (up to 800mg every 6-8 hrs); Aleve (up to 660mg every 8 hrs); or Extra-strength Tylenol (up to 1000mg every 4-6 hrs); 2) placing a heating pad over the lower abdomen or back or taking a hot shower; and 3) massaging the abdomen. If nothing helps, call us. DO NOT TAKE ASPIRIN or other medications we have not prescribed because it may increase bleeding.
- NO NORMAL PERIOD within 8 weeks after the abortion.
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EMERGENCY CONTACT INFORMATION:
CALL 24 HOURS A DAY, 7 DAYS A WEEK FOR EMERCENCIES
(610)770-9077 OR (877) 342-5292 (877 DIAL AWC)
After hours: Listen to the message. Choose option 8. After the tone, leave your name, area code and phone number, and briefly describe your problem. Speak loudly and clearly. Leave your phone lines open and our staff person will call you back. If you do not get an immediate response, please call again.
CALL US FIRST with any problems. We can best determine how to handle your case and often can help you avoid costly and unnecessary hospital bills.
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Pennsylvania's Abortion Control Act
In order to comply with the Abortion Control Act, each patient must receive state-mandated information from a physician at least 24 hours before the procedure starts. There are three ways to get this information: at a consultation visit in the office; speaking with one of out physicians by phone; or by asking your own doctor or clinic to give you the information.
Pennsylvania law also requires that a parent or guardian give consent for a patient under 18. If a patient is unable or unwilling to get a parent's consent, our staff can help her meet with a judge to determine that she is mature and able to give consent for herself. Our telephone counselors can give you more information about this option.
If you would like to talk with your own doctor or clinic, please click on the 24-Hour Consent Form link below and print out the consent form, complete it with your physician, and bring it with you to your appointment. This could save you a trip to our center.
24-Hour Consent Form
The Consultation Visit at AWC:
If you choose to get the 24-hour consent at AWC, there will be a group information session during which a physician explains the procedure, complications, and alternatives. A counselor discusses contraceptive options and reviews the surgical consent. You will complete a medical chart, blood work and an ultrasound. You have the option of meeting with a private counselor to ask questions and discuss your decision. After making an initial deposit, you will be given instructions and an appointment for surgery. This visit usually takes 1˝ to 2 hours.
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