What is an induced termination of pregnancy?
Termination of pregnancy (TOP) is the ending a pregnancy by choice. It uses surgery or medicine to prevent the live birth of a baby. It may also be called an induced or therapeutic abortion.
When is it used?
Most often, TOP is done because the pregnancy is unplanned or unwanted. Sometimes there are health reasons for doing a TOP, for example:
- You have a medical condition such as cancer, heart disease, or severe infection that would make it dangerous for you to give birth.
- Your baby will be born with a serious birth defect.
- Your mental health is at risk because the pregnancy happened as a result of rape or sexual abuse.
Specially trained counselors can help you explore your choices and answer questions. The goal of counseling is to provide information that will help you make the decision.
How do I prepare for this procedure?
Dealing with an unplanned or unwanted pregnancy is very hard. Talking with your healthcare provider, partner, family, school counselor, teachers, or clergy may help you think through the options and decide what to do. It may not be easy to talk about, but you need good information to make good choices. If you choose to end the pregnancy, waiting too long can put you at risk or make this option no longer a choice.
Most states require that parents be notified before a TOP. Some states require the parentsâ€™ permission if you are under the age of 18.
If you decide to have a TOP:
- Plan for your care and a ride home after the procedure.
- You may or may not need to take your regular medicines the day of the procedure. Some medicines (like aspirin) may increase your risk of bleeding during or after the procedure. Tell your healthcare provider about all medicines and supplements that you take. Ask your provider if you need to avoid taking any medicine or supplements before the procedure.
- Tell your healthcare provider if you have any food or medicine allergies.
- Follow your provider’s instructions about not smoking before and after the procedure. Smokers may have more breathing problems during the procedure and heal more slowly.
- Follow any other instructions your healthcare provider gives you.
- Ask any questions you have before the procedure. You should understand what your healthcare provider is going to do. You have the right to make decisions about your healthcare and to give permission for any tests or procedures.
What happens during the procedure?
The type of procedure used for a TOP depends on the stage of pregnancy and state and federal laws. You should discuss your options with your healthcare provider. Laws about TOPs may be different, depending on which state you live in.
- Menstrual extraction
This procedure may be done very early in pregnancy (within 5 to 6 weeks after the first day of your last period). It can be done in your healthcare provider’s office. Your provider will put a speculum into your vagina (just like when you have a PAP test). Your provider will then put a small tube into your uterus through the cervix. The tube will be attached to a vacuum pump. The pump will suction the pregnancy tissue out of your uterus.
- Medicines used early in pregnancy
You may be given medicine to take by mouth to end a pregnancy. It may be used within 7 weeks after the first day of your last period. The medicine blocks one of the hormones you need to stay pregnant. You will start having vaginal bleeding 1 or 2 days after you take this medicine. Usually you will take a different medicine 2 days after taking the first medicine. The second medicine causes cramping and helps empty the uterus. After you have taken both medicines your healthcare provider may want you to have an ultrasound scan to make sure that all pregnancy tissue is gone.
- Vacuum curettage (suction D&C)
Vacuum curettage is a surgical procedure that can be done in an operating room, emergency room, or sometimes in your healthcare providerâ€™s office. Itâ€™s also called a suction dilation and curettage, or suction D&C. It may be done 7 to 13 weeks after the first day of your last menstrual period.
Before the procedure, you will be given a local or regional anesthetic to keep you from feeling pain. Local anesthesia numbs the part of your body where you will have the procedure. Regional anesthesia numbs part of your body while you stay awake. You may also be given medicine to help you relax.
Your healthcare provider will dilate (open up) your cervix with medicine or a tool, and place a small tube into your uterus through the cervix. The tube will be attached to a vacuum pump. The pump will suction the pregnancy tissue out of the uterus. Your provider may also use a spoonlike tool called a curette to scrape the walls of your uterus and make sure that all pregnancy tissue has been removed.
- Dilation and evacuation (D&E)
A D&E is a procedure that may be done if you are 13 to 21 weeks pregnant. Because the baby is larger at this stage of the pregnancy, your cervix may need to be prepared 24 to 48 hours before the procedure. To prepare the cervix, your healthcare provider will gently place some special material inside the cervix that will swell and cause your cervix to gently open up. You will usually go home for a day or two while your cervix opens enough.
The D&E is done in an operating room. You will be given a general anesthetic to keep you from feeling pain. General anesthesia relaxes your muscles and you will be asleep. Your cervix may be gently opened more with metal rods, and the pregnancy tissue will be removed with instruments and suction. You will then be given medicine through an IV to contract the uterus and help it to go back to its normal size.
- Medicines used for second-trimester TOPs
Certain medicines may be used for TOPs after the 14th to 16th weeks of pregnancy if your baby has a severe birth defect. These medicines cause you to go into labor. The medicine is usually given at the hospital. You will be given a local or regional anesthetic to keep you from feeling pain during the procedure. Your healthcare provider will put the medicine in your vagina until the baby and other pregnancy tissues are delivered. It may take up to 24 hours after starting the medicine before the baby is delivered.
After any of these procedures, you may need to have a dilation and curettage (D&C) to remove any pregnancy tissue left in the uterus.
What happens after the procedure?
You may stay in a recovery area for at least a few hours or overnight, depending on what was done during the procedure.
Itâ€™s normal to have some cramping for a few days after the TOP while your uterus goes back to its normal size. Itâ€™s also normal to have a small amount of vaginal bleeding for several days. Recovery time may be longer if the TOP was done after 16 weeks of pregnancy.
Ask your healthcare provider:
- How long it will take to recover
- If there are activities you should avoid and when you can return to your normal activities
- How to take care of yourself at home
- What symptoms or problems you should watch for and what to do if you have them
Make sure you know when you should come back for a checkup.
What are the risks of this procedure?
Every procedure or treatment has risks. Some possible risks of this procedure include:
- Problems with anesthesia
- Infection or bleeding
- Damage to your uterus or other organs
- An unsuccessful procedure that does not end the pregnancy
- Trouble getting pregnant again
Ask your healthcare provider how these risks apply to you. Be sure to discuss any other questions or concerns that you may have.
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This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.
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