Dilation and sharp curettage (d & c)
in this type of procedure, the cervix is slowly opened and the fetus, placenta and membranes are scraped from inside the uterus with a sharp instrument.
Vacuum aspiration
this is the most common abortion procedure in the first trimester, with 97% of all abortions during that time period being performed in this manner.
The cervix is opened enough to allow the insertion of a suction catheter (tube).
The fetus, placenta and membranes are then removed by the use of the specially designed suction catheter or vacuum device.
This method generally takes approximately 5 minutes after the cervix has been opened. The procedure used for cervical dilatation can take several hours.
Dilation and evacuation
this procedure is performed under local anesthetic between 13 and 20 weeks of pregnancy.
It involves the gradual opening of the cervix and removal of the fetus, placenta and membranes by alternating suction and sharp curettage.
This is currently the most common method used in the second trimester.
Intra-amniotic instillations
solutions of hypertonic urea and a prostaglandin may be instilled into the amniotic sac after partial removal of the amniotic fluid.
Urea kills the fetus, and prostaglandin helps ensure expulsion.
Contractions begin within 8 to 12 hours and may last 48 hours before the fetus, placenta and membranes are expelled.
Intact dilation and extraction (partial birth abortion)
in this procedure, the physician pulls the fetus feet-first out of the uterus into the birth canal, except for the head which is kept lodged just inside the uterus.
The base of the fetus’s skull is punctured with a sharp instrument such as a long scissors or pointed metal tube.
A catheter is inserted into the wound and removes the fetus’s brain with a powerful suction machine. This causes the skull to collapse, and allows for the expulsion of the fetus.
Sources:
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deitra leonard lowdermilk, rnc, phd, faan; shannon e. Perry, rn, phd, faan; irene m. Bobak, rn, phd, faan
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julie c. Novak, dnsc, rn, cpnp; betty l. Broom, phd, rn
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elizabeth jean dickason, rn, ma, med; bonnie lang silverman, rnc, ms, nnp; judith a. Kaplan, rn, acce, phd
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"dilation and extraction for late second trimester abortions" in "second trimester abortion: from every angle"; fall risk management seminar, sept. 13 - 14, 1992 dallas, tx; martin haskell, md
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f. A. Davis company
philadelphia, pa
published 2001
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robert a. Hatcher, james trussell, felicia stewart, willard cates jr., gary k. Stewart, felicia guest, deborah kowal
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