How is an abortion performed?

Pre-abortion Consultations: What They Involve

Pre-abortion consultations are medical appointments that take place before a voluntary termination of pregnancy (VTP). Their purpose is to inform and advise the person seeking an abortion about the various options available to them and the consequences of a VTP.

These consultations can be carried out by a general practitioner, a gynecologist, a midwife, or a family planning counselor. The aim of the pre-abortion consultations is to assess the situation of the person requesting a VTP, to answer their questions and to inform them about the different stages of the VTP, the methods available, the risks and benefits associated with each method.

Pre-abortion consultations must also ensure that the person requesting a VTP is fully informed of their rights and has given their free and informed consent. Healthcare professionals are required to maintain the confidentiality of information exchanged during these consultations.

In short, pre-abortion consultations are an important time to inform, advise and support people who wish to have an abortion, enabling them to make an informed decision and ensuring their safety and well-being.

The First Pre-abortion Consultation

The first pre-abortion consultation is a medical appointment that takes place before any intervention. It is generally offered to the person seeking an abortion as soon as they contact a healthcare professional or a VTP center.

During this first consultation, the healthcare professional will take into account the person's medical and gynecological history, as well as the circumstances of the unwanted pregnancy. They will also explain the different abortion methods, their advantages and risks, and answer any questions the person may have.

The healthcare professional must also ensure that the person is fully informed of their rights and has given their free and informed consent. They may also offer psychological counseling if the person expresses the need.

Finally, during this first consultation, the healthcare professional will offer a gynecological examination to check the stage of the pregnancy and the possible presence of an infection. They may also perform an ultrasound scan to determine the gestational age and ensure that the pregnancy is intrauterine.

When is the second pre-VTP consultation?

The second pre-VTP consultation must take place at least 48 hours after the first consultation. This means that you cannot have a VTP on the same day as your first consultation.

The second pre-abortion consultation is intended to provide you with additional information about the VTP and to give you a final opportunity to ask questions or discuss your options with the doctor. It is important not to miss this consultation as it is a mandatory step before any VTP.

If you have any questions or concerns about the VTP or the consultation process, it is essential to discuss them with your doctor or counselor before your second pre-abortion consultation.

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What does medical abortion involve?

Medical abortion is a way of voluntarily terminating a pregnancy that uses medication rather than surgery to end the pregnancy. It is also known as medical abortion or the abortion pill.

Medical abortion generally takes place in two stages. The first involves taking a pill called mifepristone which blocks the action of the progesterone hormone, necessary for the continuation of the pregnancy. Mifepristone causes the death of the embryo or fetus in the uterus.

Then, 24 to 48 hours later, a second pill, called misoprostol, is taken to induce uterine contractions that will expel the pregnancy tissue.

Medical abortion can be performed up to 9 weeks of pregnancy (or about 63 days after the last menstruation), but the medication is generally more effective when used earlier in the pregnancy.

Medical abortion is generally considered safe and effective, although some women experience pain or heavy bleeding after taking the medication. It is necessary to discuss with a doctor or reproductive health counselor the risks and benefits of medical abortion before making a decision about voluntary termination of pregnancy.

What is the timeframe for a medical abortion?

Medical abortion can be performed up to 9 weeks of pregnancy (or about 63 days after the last menstruation). However, it should be noted that the earlier a medical abortion is performed, the more likely it is to be effective. The medications used in medical abortion are generally more effective when taken in the early weeks of pregnancy.

It is therefore recommended not to wait too long to resort to medical abortion if you are considering this option. Discuss with a doctor or reproductive health counselor as soon as possible to obtain information on all available abortion options and to make an informed decision about voluntary termination of pregnancy.

What are the contraindications for a medical abortion?

There are certain contraindications to medical abortion, which may make this option unsuitable or dangerous for some women.

These contraindications may include:

• An ectopic pregnancy (embryo developing outside the uterus);
• A known allergy to one of the medications used in medical abortion;
• A disease or treatment that affects blood clotting;
• Severe liver failure;
• Severe kidney failure;
• Severe cardiovascular disease;

In addition, certain medical conditions may make medical abortion riskier or require close medical supervision, including:

• Asthma;
• Diabetes;
• High blood pressure;
• Epilepsy;
• Inflammatory bowel disease;
• Severe anemia;
• Current anticoagulant therapy;

It is crucial to consider each patient's medical history before proceeding with a medical abortion. Pre-existing medical conditions such as heart disease, blood clotting disorders, liver or kidney disease can increase the risks associated with using medication to end a pregnancy. Therefore, a prior consultation with a doctor or reproductive health counselor is strongly recommended to assess the patient's health and determine if medical abortion is the best option for her. Healthcare professionals can also discuss other available abortion options and provide information on support and post-procedure follow-up resources.

Is medical abortion painful?

Medical abortion can cause pain and cramps similar to menstrual cramps, as well as heavier bleeding than menstruation. Pain and bleeding can vary from woman to woman, but are generally more intense in the hours following the second pill (misoprostol).

Some doctors also prescribe analgesics to help relieve pain associated with medical abortion.

It is important to note that pain and bleeding can last for several days, or even up to two weeks after medical abortion. Women who choose this option should be prepared to cope with these side effects and take measures to protect themselves against possible infection.

It is recommended to discuss the possible side effects of medical abortion with a doctor or reproductive health counselor before making a decision about voluntary termination of pregnancy.

What does surgical abortion involve?

Surgical abortion, also known as aspiration abortion or instrumental abortion, is a medical procedure that involves removing the contents of the uterus to terminate a pregnancy.

There are two types of surgical abortion:

• Manual Vacuum Aspiration (MVA): This method is often used up to 14 weeks of pregnancy. It involves dilating the cervix and using a manual or electric pump to aspirate the contents of the uterus. This method is generally performed under local or general anesthesia;
• Electric Vacuum Aspiration (EVA): This method is often used for more advanced pregnancies, up to 24 weeks. It involves dilating the cervix and using an electric machine to aspirate the contents of the uterus. This method can be performed under local or general anesthesia;

In both methods, surgical abortion is generally considered a safe and effective procedure for terminating an unwanted pregnancy. However, as with any medical procedure, there are associated risks, such as bleeding, pain and infection. It is essential to discuss with a doctor or reproductive health counselor all available options and make an informed decision on the most appropriate abortion method for each individual case.

What is the timeframe for instrumental surgical abortion?

The timeframe for surgical abortion, also called instrumental abortion, depends on the regulations of the country where the procedure is performed and the policy of the healthcare facility. In general, this method is performed up to 12 to 14 weeks of pregnancy, although some clinics may offer it up to 24 weeks.

In Tunisia, the maximum time allowed for abortion is 12 weeks.

It should be emphasized that the abortion procedure can become more difficult and riskier to the patient's health as the pregnancy progresses. With this in mind, it is best to make an appointment with a doctor or reproductive health counselor quickly to review available abortion options and deadlines. Indeed, the decision to have an abortion may be difficult to make, but it must be remembered that the choice belongs to the patient alone and that she must be thoroughly informed so that she can make the best decision for her own health and well-being.

What are the contraindications for surgical abortion?

The contraindications for surgical abortion, also called instrumental abortion, may vary depending on the patient's individual health and the health facility's policy.

However, certain conditions can make surgical abortion riskier or impossible, including:

• Ectopic pregnancy: when the fertilized egg implants outside the uterus, which can lead to serious complications;
• Active genital infections: untreated genital infections can increase the risk of infection after the procedure;
• Blood clotting disorders: certain conditions such as thrombocytopenia or blood clotting disorders can increase the risk of excessive bleeding during surgical abortion;
• Severe heart or lung disease: these conditions can increase the risk of complications during the procedure;

Any medical condition or ongoing treatment should be discussed with the doctor or reproductive health counselor before undergoing surgical abortion to assess the risks and benefits of the procedure.

Is surgical abortion painful?

Surgical abortion, also called instrumental abortion, can be painful for some women, but this will depend on many individual factors such as pain tolerance and the method of anesthesia used.

During manual vacuum aspiration (MVA), which is often used up to 14 weeks of pregnancy, local or general anesthesia is generally used to reduce pain and cramping during the procedure. Patients may experience cramps similar to those of menstruation and some pressure or suction during the procedure.

For electric vacuum aspirations (EVA), which are often used for more advanced pregnancies up to 24 weeks, local or general anesthesia is also used to reduce pain and cramping during the procedure. Patients may experience more intense cramping and pressure during the procedure.

It is necessary to discuss with a doctor or reproductive health counselor all available anesthesia options and to take into account individual factors to choose the most appropriate option for each patient.

Essential Post-VTP Follow-up Consultation

The post-VTP follow-up consultation is an important step to ensure that the procedure has gone without complications and to offer emotional support to the patient. This consultation should be scheduled with a healthcare professional approximately 2 to 3 weeks after the VTP.

During the follow-up consultation, the healthcare professional will assess the patient's physical health by performing a gynecological examination and verifying that all pregnancy tissue has been evacuated. They may also prescribe appropriate contraception for the patient's situation to prevent future unwanted pregnancies.

In addition to the physical examination, the follow-up consultation also provides an opportunity for the patient to discuss their experience of the VTP and to receive emotional support if necessary. Healthcare professionals can also provide information on available resources for emotional support and contraception.

It is crucial to note that the follow-up consultation is an essential element of post-VTP care, even if the procedure has gone without apparent complications. It ensures that the patient recovers well and has all the necessary information and resources for future reproductive health.

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