Surgical abortion can be performed in an office or hospital setting. The success rate of surgical termination is 99%. It is usually a single-step process that requires one visit to the practitioner. In early pregnancy (less than 7 weeks), a small flexible plastic cannula (5-6 mm) is inserted into the uterus under sterile conditions. Plastic syringes (50 ml) are used as the vacuum source and the uterine contents are suctioned out. Adequate pain relief is provided by injecting local anesthetic into the cervix and administering intravenous sedation and analgesics.
After 7 weeks, a larger rigid plastic cannula (8-10 mm) is used with an electric pump as the vacuum source. After 18 weeks, a dilation and evacuation (using larger bore cannulae) usually must be performed under general anesthesia.
Typically, seaweed (laminaria) or a synthetic version is inserted into the cervix to prepare it for the procedure. The seaweed absorbs water, swells, and gently dilates the cervix over a 24-hour period. This facilitates the use of a cannula to extract the fetus and placenta at the time of the procedure.
The risks associated with pregnancy termination increase with gestational age and the use of general anesthesia. Risks include hemorrhage, infection, and perforation of the uterus if a surgical instrument slips through the uterine wall. Uterine perforation can cause bladder, bowel, or vascular injury necessitating further surgery for repair. The most common complication is uterine infection (0.1-4.7%).