Different Types of Abortion: Procedures, Risks, and More

If you’ve just discovered you’re pregnant and it’s not what you planned, you’re probably researching your abortion options.

Before contacting an abortion clinic, it’s important to:

• Know the types of abortion procedures
• Understand when they can be done and what risks and side effects they may have
• Receive an ultrasound to confirm pregnancy viability and gestational age

This knowledge equips you to make a well-informed decision about your next steps. Keep reading to learn more about first-trimester abortions, second-trimester abortions, and what to expect!

First-Trimester Abortion Procedures

The first trimester spans from conception to the end of week 14. During this period, abortion providers typically offer medication abortions or suction/vacuum aspiration procedures.

What Is a Medication Abortion?

A medication abortion (commonly known as the “abortion pill”) uses two medications: mifepristone and misoprostol. It’s FDA-approved for use up to 10 weeks from a woman’s last menstrual period.[1]

The first medication, mifepristone, blocks the progesterone receptors and prevents the pregnancy from continuing to grow and develop. One or two days later, the second medication, misoprostol, causes the uterus to cramp and bleed which expels the pregnancy, usually within about 24 hours.[1][2][3]

The amount of bleeding and pain varies from person to person. It is important to be evaluated in person two weeks after the start of the procedure to check for complications and completeness.

What Is a Vacuum Aspiration Abortion?

A vacuum aspiration (or suction D&C) abortion is a surgical procedure available up to 14 weeks from a woman’s last menstrual period.[4]

Hours before or the day before the procedure, thin sticks made out of seaweed (laminaria) into the cervix, where they will absorb moisture and expand causing the cervix to soften and open a bit gradually or a medication is used to do this. Misoprostol may be given to soften the cervix.[5]

During the procedure, the abortion provider opens the cervix with dilators and inserts a suction device and turns on the vacuum. The suction pulls the embryo/fetus apart and out of the uterus into tubing and a container. Next, the abortionist uses a loop-shaped knife called a curette to scrape any remaining tissue or blood clots out of the uterus.[5]

Second-Trimester Abortion Procedures

The second trimester runs from week 14 to week 27. During this stage, dilation and evacuation (D&E) becomes the standard procedure due to the pregnancy’s advanced development.

What Is Dilation and Evacuation (D&E)?

A dilation and evacuation (D&E) is a surgical abortion most often performed in the second trimester.[6] It’s more complex than a suction abortion due to the fetus’s size and requires skilled providers.

Here’s how a dilation and evacuation works:

• Cervix Dilation: One or more days before the procedure, the abortion provider places thin sticks made out of seaweed (laminaria) into the cervix, where they will absorb moisture and expand causing the cervix to soften and open a bit gradually. Medication may also be used overnight to soften the cervix.[6]
• Procedure: D&E procedures typically take 10-30 minutes to complete. Anesthesia is used if available. The abortion provider removes the laminaria, dilates the cervix further  using metal rods and then locates the fetus’s leg using ultrasound. The water bag is broken and the operator uses a pliers-like surgical instrument to grasp, twist, and tear off the limbs, chest, and abdomen of the fetus. The head is usually crushed to ease removal through the cervix. A cannula is used to suction out the placenta, membranes and remaining tissue and blood clots.[6]

Cramping and bleeding may last up to two weeks. A follow-up visit is important to assess for completeness and check for complications.

Risks and Side Effects of Abortion

Every abortion type carries risks and side effects, including physical and emotional. Understanding these can help you weigh your options.

Medical Abortion Side Effects and Risks

After a medical abortion, vaginal bleeding or spotting lasts an average of 9-16 days, though it can last 30 days or longer in some cases.[2]

Other common side effects include[2]:

• Abdominal cramping
• Headaches
• Nausea and vomiting
• Diarrhea and digestive discomfort
• Chills or mild fever

Severe risks to watch for:

• Hemorrhaging: Heavy bleeding can occur that requires immediate attention.[7]
• Incomplete abortion: The procedure doesn’t always work, or if it is incomplete, tissue may remain which can cause bleeding and infection requiring emergency surgery.[8]
• Infection: “Not feeling well” possibly with fever, nausea, or vomiting that persists 24 hours post-misoprostol could indicate an infection, potentially requiring antibiotics or surgery.[2]
• Viewing fetal remains: Depending on the age of the pregnancy, identifiable parts may be visible resulting in emotional distress.

Surgical Abortion Side Effects and Risks

Suction D&C and D&E procedures carry risks such as:

• Heavy bleeding, or hemorrhage
• Incomplete abortion
• Damage to organs
• Uterine Perforation: An instrument may accidentally puncture the uterus, possibly needing surgical repair.[9]
• Bladder or bowel perforation: An instrument may accidentally puncture the uterus, possibly needing surgical repair.
• Asherman Syndrome: Scar tissue inside the uterus from repeated scraping procedures can impact future fertility.[10]
• Infection: can arise from bacteria introduced by surgical instruments; retained tissue; can cause uterine infection and spread to the pelvic organs and the reproductive tract.[11]
• Maternal death: 2nd trimester abortions are much riskier than early ones; in extreme cases, complications can lead to death. For pregnancies over 21 weeks, the risk of dying from a second trimester abortion is 12 women per 100,000.[12]

Emotional Side Effects

Abortion can also impact your mental health. Studies have found that after an abortion, women may experience[13][14]:

• Depression
• Anxiety
• Low self-esteem
• Substance abuse
• Suicidal behaviors

If you’re thinking about suicide, call the Suicide and Crisis Lifeline at 988 right away.

What Should I Do Before an Abortion?

It is crucial to receive an ultrasound before an abortion to confirm pregnancy viability and gestational age. This information helps you understand your pregnancy options and make a safe, informed decision.

What is Viability in Pregnancy?

In simplest terms a viable pregnancy is one where the embryo/fetus has a heartbeat. During an ultrasound, technicians look for signs like a fetal heartbeat. This usually appears between 6.0-6.5 weeks from a woman’s last menstrual period.[15]

If a heartbeat cannot be detected, it may indicate that a miscarriage (spontaneous loss of a pregnancy) is occurring. Also, if there is no sign of a pregnancy inside the uterus, this could mean that the pregnancy is growing in another location (ectopic). Both of these pregnancy conditions need alternative medical care. In the case of an ectopic, this is a life-threatening  situation that requires emergency care.

What is Gestational Age?

Gestational age refers to how far along you are in your pregnancy. Doctors measure it from the first day of your last period.

Knowing your gestational age is crucial because certain states place gestational age limits on abortion. Additionally, the abortion pill (mifepristone) is only FDA-approved for use up to 10 weeks of gestation.[16]

Have Questions About Abortion? Get the Facts at Pregnancy Decision Line.

If you’re exploring abortion, you don’t have to navigate it alone. Our compassionate team wants to provide you with the information you need to make the best decision for your health and your future.

We can connect you with a local pregnancy center that provides free, confidential services including:

• Pregnancy testing
• Ultrasounds to confirm pregnancy
• Pregnancy options education
• Referrals to community resources

Ready to take the next step? Give us a call to get started.

Please be aware that Pregnancy Decision Line does not provide or refer for abortion services.