Background Information:

What are the other Names for the Procedure?

• D & C for Medical Termination of Pregnancy
• Dilatation and Curettage for Medical Termination of Pregnancy
• Suction Curettage for Medical Termination of Pregnancy

What is Medical Termination of Pregnancy surgical procedure?

A Medical Termination of Pregnancy (Suction Curettage) procedure involves the surgical removal of a fetus and the tissues surrounding it. It is performed before the gestation period reaches 12 weeks.

What part of the Body does the Procedure involve?

The procedure involves the uterus, placenta, and the vagina.

Why is the Medical Termination of Pregnancy surgical procedure Performed?

The reasons for performing a Medical Termination of Pregnancy (Suction Curettage) procedure include:

• Miscarriage
• Death of the fetus inside the uterus
• Medical termination of pregnancy
• Complications during pregnancy

What are some Alternative Choices for the Procedure?

• The fetus may be medically terminated, until about the 7th week of pregnancy, using suitable oral medications
• After the 7th week this method of termination of pregnancy is ineffective and not advised; surgical removal is the best option
• However, it must be noted that a Medical Termination of Pregnancy through surgical procedures can be employed, only if the pregnancy is less than 12 weeks

What are the Recent Advances in the Procedure?

A recent advance in the procedure is known as Vacuum Aspiration, which avoids the use of sharp curette that may harm the uterine walls. It is also believed to be a cost effective procedure.

What is the Cost of performing the Medical Termination of Pregnancy surgical procedure?

The cost of Medical Termination of Pregnancy (Suction Curettage) procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused by the information regarding Medical Termination of Pregnancy (Suction Curettage) procedure and on what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist and also recommend another physician, if required
• They can also choose to approach another physician independently. Besides, if the procedure has many alternatives, the patient may take a second opinion to understand and choose the best one

What are some Helpful Resources?

http://www.michigan.gov/mdch/0,1607,7-132-2940_4909_6437_19077-46301--,00.html (accessed on 04/24/2013)

http://www.atlasofpelvicsurgery.com/5Uterus/2SuctionCurettageandAbortion/chap5sec2.html (accessed on 04/24/2013)

Prior to Medical Termination of Pregnancy surgical procedure:

How is the Medical Termination of Pregnancy surgical procedure Performed?

• During a Suction Curettage, the cervix is dilated or widened using medical instruments
• A suction tube is then passed through the vagina, the cervix and into the uterus to create a gentle suction that removes the fetus and placenta
• The tube is withdrawn and to ensure complete removal of placental tissue, the surgeon uses a curette (a type of instrument) to scrape the uterine walls, thereby effectively terminating the pregnancy

Where is the Procedure Performed?

The procedure is usually performed in an out-patient surgery center facility or a hospital. Normally, the person can go home once the procedure is completed (or as advised by the physician).

Who Performs the Procedure?

A Medical Termination of Pregnancy (Suction Curettage) procedure is performed by an obstetrician and/or a gynecologist.

How long will the Procedure take?

A Medical Termination of Pregnancy (Suction Curettage) procedure normally takes about 30 minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the surgical procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

No particular preparation is required before a Medical Termination of Pregnancy. However, your physician may study your medical history and perform a physical examination before performing the procedure.

What is the Consent Process before the Procedure?

A physician will request your consent for the Medical Termination of Pregnancy procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Medical Termination of Pregnancy surgical procedure?

Before proceeding with a Medical Termination of Pregnancy procedure, the physician may suggest certain tests, which could be as follows:

• Routine blood and urine analysis
• Pregnancy test
• Psychological counseling (if required)
• Further tests maybe suggested depending on the health and medical history of the patient.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Medical Termination of Pregnancy (Suction Curettage)?
• What does the procedure involve?
• How soon should I get it done? Is there an emergency?
• What are the alternatives I have?
• Can oral medication help in terminating the pregnancy?
• Will there be any problem, if I want to get pregnant in future?
• What are the risks involved?
• Will there be any complications during or after the procedure?
• How long will it take to recover? When can I resume normal work?
• What is the cost of the procedure?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• How many procedures have you (the physician) performed?

During the Medical Termination of Pregnancy surgical procedure:

What kind of Anesthesia is given, during the Procedure?

Local anesthesia is administered, which is sometimes combined with sedation.

How much Blood will you lose, during the Procedure?

The amount of blood lost may vary depending on the number of weeks of pregnancy. The blood lost usually exceeds the amount of blood lost during menstruation. Bleeding may continue for an average of 7 to 10 days post-procedure and occasionally, women may pass blood clots too.

What are the possible Risks and Complications during the Medical Termination of Pregnancy surgical procedure?

The possible risks or complications that may arise during the procedure are:

• Excessive bleeding
• Infection
• Accidental injury to the uterine walls
• Pain

What Post-Operative Care is needed at the Healthcare Facility after the Medical Termination of Pregnancy surgical procedure?

At the healthcare facility, generally there is no requirement for any post-procedure care, unless any complications arise. 

After the Medical Termination of Pregnancy surgical procedure:

What are the possible Risks and Complications after the Medical Termination of Pregnancy surgical procedure?

Post Medical Termination of Pregnancy procedure, the following complications may arise:

• Infection of uterus or fallopian tubes
• Psychological problems
• Intrauterine adhesions

What is the Prognosis after the Surgery?

The prognosis after the surgery is usually good and the patient may suffer minor side effects, like cramping, dizziness, and bleeding.

When do you need to call your Physician?

Do contact your physician if you notice any of the following symptoms:

• Excessive vaginal bleeding
• Abdominal swelling
• Foul vaginal discharge
• Fever
• Nausea
• Dizziness
• If any new signs of infection or discomfort are observed

What Post-Operative Care is needed at Home after the Medical Termination of Pregnancy surgical procedure?

At home, the following post-operative care is recommended, after Medical Termination of Pregnancy (Suction Curettage) procedure:

• Avoid sex for few weeks after the procedure, until advised otherwise by the physician
• Complete the prescribed course of oral medication
• It may be required to use sanitary napkins (for bleeding) for about a week or more
• Use stool softeners to avoid constipation

How long does it normally take to fully recover, from the Procedure?

It normally takes anywhere between 1-2 weeks to completely recover from the procedure.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue may be taken for further examination and later disposed, as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue that is removed is processed in the laboratory under a pathologist's supervision
• The slide(s) are prepared once the tissue is processed, and this is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Medical Termination of Pregnancy surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility charges and the physician charges. Alternatively, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• The outpatient facility or hospital
• An obstetrician or gynecologist
• A pathologist (if the tissue was sent for analysis)

The patient is advised to inquire and confirm the type of billing, before Medical Termination of Pregnancy (Suction Curettage) procedure is performed. 

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA