Abortion Methods: Vacuum Aspiration or Suction Abortion

What is a Vacuum Aspiration or Suction Abortion?

Vacuum aspiration, also known as suction abortion, is the most common type of abortion during the first trimester. They are typically done up until 12-14 weeks after the woman’s last menstrual period (LMP). [1] This type of abortion does not work up to 5% of the time, or in up to 1 in 20 women. [2] It is more effective than medication abortion, which does not work up to 7% of the time. [3]

History of Vacuum Aspiration Abortion [4]

Early Vacuum Aspiration

The tools that would later be used for vacuum aspiration abortions were first developed in England in the late 1800s to sample tissue from the lining of the uterus or womb. These tools were not used for vacuum aspiration abortions until the 1920s in Russia. Their use later spread to China and the United States.[5]

After World War II ended, medical professionals from countries all over the world agreed on what is called the Nuremberg Code. [6] The Nuremberg Code states that new medications or procedures should be tested on animals, instead of experimenting on human beings. Unfortunately, this did not happen with vacuum aspiration abortions, and American women suffered.

Harvey Karman

In the early 1950s,  while abortion was still illegal, an American psychologist named Harvey Karman performed an abortion on a woman in a hotel room. He did not have any formal medical training, and the woman died of complications. He went to jail for several years, but when he was released he continued to work to make abortion more accessible for women.

In the early 1970s, when abortion was still illegal, he created a flexible, disposable, plastic device called the Karman cannula that used suction to remove everything that would normally be shed during a menstrual period. This procedure was called menstrual extraction, and it was performed so that women did not have to undergo a menstrual period, and also in cases of first trimester miscarriage. The Karman cannula was also used for abortions because it was safer for the woman than the traditional dilation & curettage (D&C) method, which uses a sharp scraping tool to remove baby parts from the uterus. The Karman cannula is still in use today. [7] Unfortunately, Harvey Karman was again connected to the abortion-related deaths of over a dozen other women in the 1970s but did not go back to jail.

What Percentage of Abortions are Suction Abortions?

The Centers for Disease Control (CDC) collect abortion data each year, and the results of their data collection are available online through the year 2014. [8] Abortion data since 2014 have not yet been published. States and several large cities like Washington D.C. and New York City have the option to report their data to the CDC each year or not. For 2014, California, Maryland, and New Hampshire abortion numbers were not reported. In the CDC report, abortion methods are classified as surgical or medical (medication). Exact numbers on how many of these surgical abortions were suction abortions are not available because most of the states that report their data to the CDC did not provide this information.

What happens during a Suction Abortion?

Prep for Abortion

The prep work includes a pregnancy test, blood tests, physical exam, testing for sexually transmitted infections, and usually an ultrasound to confirm that the woman is pregnant and that she does not have an ectopic pregnancy. An ectopic pregnancy is when the fertilized egg implants outside of the uterus, also known as the womb. An ectopic pregnancy can be dangerous because often the fertilized egg implants inside a fallopian tube, and as it grows the fallopian tube can burst. This can cause life-threatening bleeding for the mother.[9]

Dilation

If the woman is far enough along in her pregnancy, she may need to have her cervix, or the opening to her womb or uterus, opened wide enough to have the fetal parts suctioned out. This is most often done with long, thin rods of sterilized seaweed called laminaria that soak up amniotic fluid in the womb and make the cervix widen. The laminaria are left in place for a period of time and then removed before the abortion.

Procedure

Just before the actual procedure, she will be given Ibuprofen or a stronger pain pill. She may receive anti-anxiety medicine also. She will lay on the exam table with her feet up in stirrups like she would for a pelvic exam. A gripping tool called a speculum will be inserted in her vagina to spread the walls apart. A tool called a tenaculum may be used to keep it open for the abortion. A numbing shot will be given into the cervix. [10]

Then, a syringe is inserted through her vagina, past the cervix, and into the uterus. The fetal tissue is aspirated or suctioned out either with a syringe (manual aspiration) or a plastic or metal catheter hooked to suction on the wall (electric aspiration). Wall suction is about 10-20 times stronger than a vacuum’s force. [11]

Monitoring after Abortion

The whole abortion takes about 5-10 minutes from start to finish. The woman is typically monitored for an hour afterwards. Her heart rate, temperature, oxygen level, and blood pressure will be checked occasionally during this time.  She cannot drive herself home if she has taken anti-anxiety medication or certain types of pain pill.

At what point does the Fetus die?

Typically, the fetus dies from being detached from the placenta by the suction catheter or syringe.

What are the Side Effects of Vacuum Aspiration Abortions?

Expected side effects include:

  • Cramping
  • Nausea
  • Fainting
  • Sweating[12]

Vacuum aspiration abortions are considered safer than dilation & curettage (D&C) abortions because the risk of serious side effects is less. [13] The World Health Organization specifically states that vacuum aspiration abortions and not D&C abortions should be performed in developing countries because of the difference in safety for the mother. Women most at risk for suction abortion complications include teenagers, women who have had a cervical surgery before, and women who have an abnormal cervix. [14] Still, serious complications from vacuum aspiration abortion include:

  • Hemorrhage
  • Blood clots
  • Infection
  • Uterine perforation, or tearing of a hole in the wall of the uterus

Vacuum Aspiration + D&C

In some cases, after the uterus is suctioned out, the abortionist scrapes the uterus to be sure that no baby body parts or other uterine contents are left behind. If this happens, the woman is at risk for complications of a more dangerous D&C abortion. These include:

  • Injury to the cervix or uterus leading to preterm labor or miscarriage in future pregnancies[15]
  • Injury to the bladder or bowel or other organs caused by the curette breaking through the wall of the uterus
  • Asherman syndrome[16]– [17] bands of scar tissue form inside the uterus. This can stop a woman from having cycles when scar tissue blocks the exit of blood from the uterus. It can also lead to infertility, or to complications during future pregnancies like miscarriage or placenta previa

How often do Complications occur?

Less than 1% of women who have a basic vacuum aspiration abortions experience one of the serious complications listed above. [18] Virtually all women who have a vacuum aspiration abortion will have one or more of the less serious side effects listed above. The rate of serious complications from a D&C abortion is significantly higher. (See D&C article)

[2] Niinimaki M et al. Immediate complications after medical compared with surgical termination of pregnancy. Obstetrics and Gynecology, 2009, 114:795–804.

[5] Meckstroth, K and Paul, M. (2009) First Trimester Aspiration Abortion. In. Paul, M., Lichtenberg, S., Borgatta, L., Grimes, D., Stubblefield, P., and Creinin, M. Management of Unintended and Abnormal Pregnancy: Comprehensive Abortion Care. Pp. 135-152. Blackwell Publishing Ltd: United Kingdom. Accessed May 24, 2017. https://www.prochoice.org/pubs_research/publications/downloads/professional_education/TextbookCh10.pdf

[14] Grimes DA, Schulz KF, Cates WJ. Prevention of uterine perforation during currettage abortion. Journal of the American Medical Association, 1984, 251:2108–2112.

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