Last updated:  8 July 2015

The aim of this information on surgical abortion is to fully inform women and the public in general on what happens in these procedures in the clearest but least graphically confronting way possible. There are no photographs of aborted babies included on this page or anywhere else on this site out of consideration for women who have already had an abortion, their partners and family members.  However medical illustrations have been included at the end of the page after all the procedures have been listed and described.  You will be given the choice to view these illustrations and will see warnings before they come into view.  We strongly recommend you do not view these images if you have already had an abortion.  They have been included however for information and educational purposes because they are an accurate representation of what actually happens that cannot be fully appreciated by simply reading a description. 

 

What Are Surgical Abortions and Where Are They Performed?

Types of Surgical Abortion Procedures

First Trimester - Performed up to end of 13 weeks (since LMP)

"Curettage"

Manual Aspiration (also referred to as 'Menstrual Extraction')

Vacuum Aspiration

Suction Curettage 

Dilation and Curettage (D & C)

Sharp Curettage in the First Trimester

Second Trimester Abortions - Performed from 14 weeks to 27 weeks (since LMP)

Dilation and Evacuation (D & E) 

Sharp Curettage in the Second Trimester

Surgical Abortion After Potential Viability (the baby could survive if born): from 22 weeks since LMP

(Intact) Dilation and Extraction (IDX)

Induction of Labour

Hysterotomy

Hysterectomy

Cord Occlusion Techniques

Third Trimester Abortions - Performed from 27 weeks (since LMP) to birth

 

What Are Surgical Abortions and Where Are They Performed?

Surgical abortions are surgical procedures whereby instruments are used to remove the embryo or fetus from the woman's uterus or in delivery.  In most countries where abortion is legal, surgical abortions may be performed at any time during a pregnancy but available statistics show they occur least frequently in the mid-late second and third trimesters.1  Some countries or states or territories restrict abortions after certain time in a pregnancy, such as after 20 weeks gestation (since LMP) usually with exceptions (e.g. risk to woman's life or if the baby has an abnormality).

 

 

Surgical abortion is an invasive procedure on a woman's reproductive organs, shown below for your information:

 

 

Types of Surgical Abortion Procedures

Surgical abortion methods include 'Manual Aspiration' (also called 'Menstrual Extractions'), 'Vacuum Aspiration''Suction Curettage''Sharp Curettage''Dilation and Curettage (D&C)''Dilation and Evacuation (D&E)''Dilation and Extraction' (IDX) - also referred to as 'Partial Birth Abortion', 'Induced Abortion''Hysterotomy''Hysterectomy' and Cord Occlusion (Blocking) Techniques.

Surgical methods are described below according to the stage in pregnancy they may be used.

 

First Trimester - Performed up to end of 13 weeks (since LMP)

A first trimester abortion is one which is performed within the first 3 months of pregnancy.  Since a woman will not normally know if she is pregnant until at least the 4th week of pregnancy, most abortions are usually performed between 4 and 14 weeks since last menstrual period (LMP)2.

First trimester development (weeks since LMP): From fertilization: a new human embryo exists, already a boy or girl. 5 weeks: heart is beating and brain is developing. 6 weeks: baby has head, chest and abdomen, is ½ cm long and arms and legs have started to develop. 7th week: baby's brain has all the divisions, subdivisions and cavities as in an infant's brain; face and fingers are taking shape and when face is touched, embryo reflexively moves away. 8 weeks: he/she is 1cm long. 9 weeks: baby can move hands and neck and may get hiccups.  10 weeks: baby is almost 1¼ inches, makes startle movements and general movements of whole body; all fingers and toes are fully formed, hairs on eyebrow and other areas of face appear. 11 weeks: baby is a fetus, can sigh, stretch and starts sucking thumb.  His/her face, palms of hands, and soles of feet are sensitive to light touch. 12 weeks: baby is 3 inches long with all major body parts and apart from the tiny size, closely resembles a newborn. 13 weeks: baby can make complex facial expressions and by end of this week will be almost 4 inches, having grown almost an inch every week since 10 weeks. 

 

"Curettage"

'Curettage' refers to any abortion which involves the use of a 'curette' - an instrument which 'cleans' the woman's uterus by removing the embryo or fetus, placenta and amniotic fluid.  

A suction curette refers to a plastic piece of tubing called a cannula which has a pointed, scoop shaped tip and is used when attached to a suction machine.  

A metal curettage is an instrument made out of metal and likewise has a sharp spoon shaped tip and is how surgical abortions were traditionally performed before vacuum and suction machines became available more recently.

While hard, sharp metal curettes may still be used today in 'Dilation and Curettage' and 'Sharp Curette' procedures, softer, flexible plastic curettes (cannulas) as used in 'Vacuum Aspirations', 'Manual Aspirations' or 'Suction Curettage' procedures are preferred by abortionists as there is less risk to perforating the woman's uterus.  

 

Manual Aspiration (also referred to as 'Menstrual Extraction')

'Aspiration' refers to removal by suction.  'Manual Aspiration' is an abortion performed with a syringe.3  These abortions are still sometimes referred to as 'Menstrual Extractions' which is what they were first called and women did not want the procedure referred to as an abortion.

Usually they are performed very early in the first trimester, i.e. between 4 - 9 weeks (since LMP).  Before 10 weeks gestation, women rarely need preoperative cervical preparation4 - i.e. the cervix does not need to be opened severely. Very thin tubes called cannulas ranging from 3mm diameter to 9mm diameter can be inserted into the cervix in gradually increasing sizes to dialate it until the necessary size is reached to perform the procedure.   This is the general procedure of a manual aspiration:

  1. Local anesthetic is administered to the woman's cervix so she won't feel much.  There is no anesthetic for the baby.
  2. A thin plastic tube called a cannula is inserted through the cervix to the uterus.   The end of the cannula ('suction tip') has a pointed edged tip and is attached to a suction tube.  The suction cannula may be soft or rigid, straight or bent.  A large syringe is attached to the end of the tube.  
  3. The abortionist runs the tip of the cannula along the surface of the uterus and uses the suction syringe to dislodge and pull out the embryo (or fetus), placenta and other fluid and tissue from the uterus into the syringe.  The pressure that can be generated using a suction syringe is similar to that produced with a vacuum machine.  The embryo or early fetus (at 11 weeks since LMP) is pulled out either whole or in pieces.
  4. The contents of the syringe are examined to ensure the amount of body tissue from the embryo or fetus correlates with the gestational age.

Some sources claim that manual aspiration can be performed throughout the entire first trimester, however most only refer to this procedure being used up to 10 weeks.   Increasingly larger cannulas and syringes need to be used for later weeks in the trimester, otherwise they will be too small to satisfactorily take the larger body of the fetus.  Although the embryo begins very tiny, with each week gestation in the first trimester, he/she grows rapidly.  At only 12 weeks since LMP, the baby is already 3 inches long and by end 13 weeks almost 4 inches long.

 

Vacuum Aspiration

Manual and Vacuum aspirations are the only surgical abortion procedures available for use earlier than the 6th week of pregnancy5. Vacuum aspirations may be used throughout the entire first trimester, i.e. up to 14 weeks (since LMP). The procedure for a vacuum aspiration is very similar to a manual aspiration except that a vacuum pump and collection jar is used instead of a syringe: 

 

  1. Local anesthetic is administered to the cervix of the woman so she won't feel much.  There is no anesthetic for the baby.
  2. Early in the trimester, the cervix is dilated by inserting very thin cannulas (tubes) into the uterus of gradually increasing size until the size cannula appropriate for the procedure is in place.  After about 10 weeks gestation, preoperative dilation may be necessary using a laminaria or prostaglandin drugs to open the cervix satisfactorily.6  'Laminaria japonicas' are small sticks of presterilized seaweed which swell after insertion and cause the cervix to open larger than the physical size of the laminaria.  Alternatively, the drug misoprostol may be given orally or vaginally to assist in opening the cervix.
  3. The cannula inserted into the uterus is attached to a vacuum pump by a flexible hose.  The machine is turned on and the abortionist runs the tip of the cannula along the surface of the uterus and the embryo or fetus is suctioned out.  The little body of the baby is either pulled out whole or pulled apart through the process into the cannula.  Amniotic fluid and the placenta are also suctioned into the tube resulting in a mass of blood, body parts and tissue which collected in a jar.  
  4. The contents of the jar are examined to ensure an adequate amount of body parts and tissue according to the gestational age of the baby are present.

The link below will take you to a medical illustration showing a vacuum aspiration abortion procedure at 9 weeks since fertilization (11 weeks gestation).  

WARNING:  This is a medical drawing and not a photograph, however it may cause you considerable distress, especially if you have already had an abortion in the first trimester.  We do not recommend you view this image if you have had an abortion or if your partner or mother has had an abortion.  We recommend you view, if you are considering an abortion for the first time or you want to see what happens during the procedure after having read the description.

Medical illustration of an vacuum aspiration/suction curettage abortion of an embryo at 9 weeks since fertilization (11 weeks since LMP)

 

Suction Curettage

In a 'Suction Curettage' abortion, essentially the procedure is the same as for a 'Vacuum Aspiration', except that a hard metal instrument called a 'metal curettage' is also commonly used after the plastic cannula and pump is used to suction out the baby, placenta and other contents of the uterus.  The abortionist then goes into the uterus with the metal curette and scapes the lining to check that the uterus is empty and that the embryo or fetus has been satisfactorily removed. Suction curettage abortions are generally performed in the first trimester - i.e. up to approximately 13 weeks.

 

The link below will take you to a medical illustration showing a 9 week suction curettage abortion procedure (same illustration as given for vacuum aspiration above).  

WARNING:  This is a medical drawing and not a photograph, however it may cause you considerable distress, especially if you have already had an abortion in the first trimester.  We do not recommend you view this image if you have had an abortion or if your partner or mother has had an abortion.  We recommend you view, if you are considering an abortion for the first time or you want to see what happens during the procedure after having read the description.

Medical illustration of an vacuum aspiration/suction curettage abortion of an embryo at 9 weeks since fertilization (11 weeks since LMP)

 

Dilation and Curettage (D & C)

A dilation and curettage abortion is usually performed for the treatment of an incomplete abortion.  Suction is not used in this procedure.  The procedure for a dilation and curettage is generally as follows:

  1. The woman is given an anaesthetic so she doesn't feel anything during the operation.  A local anaesthetic may be administered to the cervical area and lower part of the uterus, however this can be quite painful when used on its own.  A combination of a twilight anaesthetic (intravenous sedation) with local anaesthetic is commonly used.  The twilight anaesthetic is given first which makes the woman drowsy and puts her in a dream-like state.  She won't usually remember much of the procedure.  The local anaesthetic is then used.  A woman may alternatively be given a general anaesthetic but not commonly during first trimester due to some health risks with this type of anaesthetic.
  2. The abortionist opens (dilates) the woman's cervix using metal rods called 'dialator rods'.  
  3. The abortionist uses a sharp metal curette to scape the lining of the uterus to cut away the embryo or fetus or any remaining parts and check that the uterus is empty.
  4. The instruments are then withdrawn and the body parts are examined to ensure that all parts of the body have been satisfactorily removed.  The woman proceeds to the recovery room.

 

Sharp Curettage

'Sharp Curettage' is performed only with a sharp metal curette, without the use of suction.  Sharp curettage is really the same as 'Dilation and Curettage' and usually performed later in the first trimester (when the baby too big to be removed satisfactorily with suction) or after an incomplete abortion.

After the cervix has been satisfactorily dilated, the curette is used to scape the uterine lining, cut the baby out and move the pieces out through the cervix.

Sharp curettage is also used in the second trimester and the procedure is described in more detail below.

 

Second Trimester Abortions - Performed from 14 weeks to 27 weeks (since LMP)

A second trimester abortion is performed within the 3 - 6 month period of pregnancy, i.e. from 14 weeks to 27 weeks since last menstrual period (LMP).  The procedure for a second trimester surgical abortion is generally a 'Dilation and Evacuation'.

 

Second trimester development (weeks since LMP): At 14 weeks: the fetus is 5 inches long. 15 weeks: baby responds to light touch virtually anywhere on his/her body. 16 weeks: baby is almost 7 inches long. 18 weeks: if poked with a needle, the fetus releases stress hormones. 20 weeks: baby is 10 inches long with eyebrows and head hair. 21 weeks: baby has breathing cycles. 22 weeks: baby can hear sounds. His/her skin and all its structures are completely formed. At 22 weeks the fetus may survive outside the womb with specialist care.  25 weeks: breathing motions are more frequent, shows blink-startle response. 26 weeks: eyelids open.

 

Dilation and Evacuation (D & E) 

'Dilation and Evacuation' is the most common method of second-trimester termination for experienced providers.7 A combination of suction curettage and use of forceps is used to remove the fetus and placenta.7  Use of an ultrasound during the procedure is preferred.

Here is the procedure of a dilation and evacuation abortion:

  1. The woman is treated with a local anesthesia or combination of twilight anaesthetic (intravenous sedation) with local anesthesia.  A general anesthestic may be used. 
  2. The cervix must be forceably opened at this stage in the pregnancy, and dilation using laminaria seaweed sticks or misoprostol may take many hours or in some cases, days.  Dilator rods may be used at the time of the procedure.
  3. Firstly suction is used to rupture the membranes and suction out the amniotic fluid.  This causes the uterus to contract.
  4. The abortionist inserts forceps into the uterus and using an ultrasound an assistant may push the baby down and towards the instruments.  The abortionist grabs the fetus with the forceps and starting with the baby's limbs twists and pulls to tear off parts of the baby and removes one piece at a time.  The head of the baby is the hardest to remove and may need to be crushed by the forceps before it can be removed.8
  5. The placenta is removed by forceps and/or suction.  Curettage using a metal curette may be used to check that the uterus is empty.
  6. The body parts of the baby are examined to ensure that all the baby has been removed and the placenta is identified.

The links below will take you to a medical illustration showing a D & E abortion procedure at 14 weeks since fertilization (17 weeks since LMP) and anther medical illustration showing a D & E abortion later in the second trimester at 24 weeks (26 weeks since LMP).   

WARNING:  These are medical drawings and not photographs, however may cause you considerable distress, especially if you have already had an abortion.  We do not recommend you view these images if you have had an abortion or if your partner or mother has had an abortion.  We recommend you view, if you are considering an abortion for the first time or you want to see what happens during the procedure after having read the description.

Medical illustration of an abortion at 14 weeks since fertilization (17 weeks since LMP)

Medical illustration of an abortion at 23 weeks gestation since fertilization (25 weeks since LMP)  

 

Sharp Curettage

Suction Curettage used in a second trimester abortion is usually part of a Dilation and Evacuation abortion.  After the fetus has been pulled out, the sharp curettage is performed with a sharp metal curette to remove any remaining parts of the fetus or placenta.

 

Surgical Abortion After Potential Viability (the baby could survive if born): from 22 weeks since LMP

The following second trimester abortion procedures may occur after the baby is viable (may live outside the womb).  It is important to note that when these abortion procedures are done at or after potential viability, unless the baby is killed by an intra-amniotic or intrafetal injection there is the risk that the baby is alive if he/she is partially or fully delivered as part of the abortion procedure.9

 

(Intact) Dilation and Extraction (IDX)

This procedure has usually been used later in the second trimester.  The baby is removed mostly intact:

  1. The woman is given appropriate anesthetic and the cervix is dilated using the same methods as for a Dilation and Evacuation procedure but it may take a number of days to open the cervix wide enough.  
  2. Prior to the actual IDX procedure an injection of digoxin may be made into the amniotic fluid or directly into the fetus to cause the death of the baby.  However, this injection is not required to perform an IDX abortion.  In some countries such as the US, it is illegal to perform this procedure on a live fetus10  Other countries, such as Australia do not legally restrict the procedure.
  3. The abortionist reaches up the birth canal and into the uterus to grab the baby's leg which he/she pulls down, followed by the other leg, then body, arms and shoulder until all that is left of the baby within the uterus is his/her head.  
  4. Instead of fully delivering the baby, the abortionist inserts scissors into the base of the baby's skull, separates the blades and inserts a suction tube.  Pressure is applied which sucks out the baby's brains.  At this point the baby dies if he/she was not previously injected with poison.  Since the baby's head is made of cartilage, it then collapses and passes through the cervix.

 

Induction of Labour

This procedure usually causes the delivery of a fetus who cannot survive outside the womb without specialist care.  Hence the baby usually dies during the procedure or shortly after delivery without the necessary care.  The procedure is as follows:

 

  1. The woman is administered misoprostol which induces labour over a number of hours.  Alternatively prostaglandin hormone drugs may be injected into the amniotic sac inducing a violent labour.
  2. The abortionist may rupture the membranes prematurely.
  3. The baby is delivered prematurely and if alive, is usually left to die.11

 

Hysterotomy

This is similar to a C - section (Cesarean), although the intent may be to kill and not to save the baby through surgical removal.  This is the general procedure of a hysterotomy abortion:

 

  1. The woman is given the appropriate anesthetic and prepared and draped for adominal surgery.
  2. A skin incision is made and the anterior abdominal wall opened.
  3. An incision is made in the uterus and the abortionist removes the fetus from the uterus in the sac, or the membranes are ruptured, the fetus is delivered and the cord is clamped.   The placenta is then removed.  The baby is usually born alive and struggles before dying.  Abortionists have been known to drown the baby in a bucket of water or use other methods to quickly kill a baby born alive after this abortion method.

 

Hysterectomy

A hysterectomy abortion is one in which the whole uterus is permanently removed from the woman with the baby.  Again, the intent may be to kill and not to save the baby through surgical removal. 

 

Cord Occlusion Techniques

These techniques are used to selectively abort babies in multiple pregnancies.  Using various methods, the abortionist causes a blockage in the umbilical cord which suffocates the baby.

 

Third Trimester Abortions - Performed from 27 weeks (since LMP) to birth

A third trimester abortion is performed within the 6 - 9 month period of pregnancy, i.e. from 27 weeks since last menstrual period (LMP) up until birth.  The procedures for a third trimester abortions are  'Dilation and Extraction (IDX)', 'Induction', ' Hysterotomy' or 'Hysterectomy' abortions and because babies can survive birth at this late stage in pregnancy, the abortionist may inject a chemical either into the amniotic fluid or directly into the fetus to cause the death of the baby before delivery. These abortions combine medical and surgical abortion methods.

 

Footnotes:

1  In many countries, such as the UK and Australia, on a national level, statistics are not presently kept on the number of abortions or at what stage in the pregnancy they occur.  However, the US government does collect some records on abortion from a majority of its states and produces a MMWR report which periodically gives statistics on the number of abortions performed every year and at what stage in pregnancy: 

MMWR - Morbidity and Mortality Weekly Report. Nov 29, 2010. Centers for Disease Control and Prevention (US Dept. of HHS).  http://www.cdc.gov/mmwr/pdf/ss/ss6208.pdf . Retrieved July 22, 2014. For selected states, the total percentage of abortions that occurred at or greater than 21 weeks gestation was 1.2%, which equated to 6,217 out of 518,088 babies aborted in those states in 2010.  No further information is provided on how many of these abortions occurred in the third trimester.

2  In the US, approximately 90% of abortions were performed at or before 13 weeks gestation (since LMP) in 2010.  MMWR - Morbidity and Mortality Weekly Report. Nov 29, 2010. Centers for Disease Control and Prevention (US Dept. of HHS). Table 7, p 25.  http://www.cdc.gov/mmwr/pdf/ss/ss6208.pdf  Retrieved July 22, 2014.  

3  Trupin, Suzanne R. 2014. Elective Abortion Treatment and Management: First Trimester Surgical Abortion. Medscape Reference. http://emedicine.medscape.com/article/252560-treatment#a1128 Retrieved July 22, 2014.

4  Trupin, Suzanne R. 2014. Elective Abortion Treatment and Management: Surgical Procedures. Medscape Reference.  http://emedicine.medscape.com/article/252560-treatment#a1128 Retrieved July 22, 2014.

5 Healthwise staff, Marshall, S. August 2012. Manual and vacuum aspiration for abortion. http://www.webmd.com/women/manual-and-vacuum-aspiration-for-abortion Retrieved July 22, 2014.

6  'Abortions in the late period of the first trimester are performed with or without preoperative cervical dilation with laminaria or misoprostol.'  Trupin, Suzanne R. 2014. Elective Abortion Treatment and Management - First Trimester Surgical Abortion. Medscape Reference. http://emedicine.medscape.com/article/252560-treatment#a1128  Retrieved July 22, 2014.

7  Trupin, Suzanne R. 2014. Elective Abortion Treatment and Management: Second-trimester dilation and evacuation. Medscape Reference.  http://emedicine.medscape.com/article/252560-treatment#a1128  Retrieved July 22, 2014.

8  This is a testimony of an abortion doctor who performed many D & E abortions.  Warning: this testimony is very descriptive and disturbing:  http://youtu.be/t--MhKiaD7c  Retrieved July 22, 2014.

9  Testimonies from Planned Parenthood representative and abortion doctor are shown here http://youtu.be/BtpdYlcbVRQ?list=PLRCroccSjXWRLfM4IQ4kJyy_Z3IILXLnq  Retrieved July 22, 2014.

10  American Medical Association testimony on procedure of an IDX does not include lethal injection of baby: http://www.ama-assn.org/ad-com/polfind/Hlth-Ethics.pdf.  Retrieved July 22, 2014.

US Federal law - 'Partial-Birth Abortion Ban Act of 2003'.  https://www.govtrack.us/congress/bills/108/s3#summary/libraryofcongress.  Retrieved July 22, 2014.

Some exceptions to this ban at state level in US.  Laws are confusing -  Guttmacher Institute. 2014. Bans on 'Partial Birth Abortion'. http://www.guttmacher.org/statecenter/spibs/spib_BPBA.pdf  

11 So many babies aborted by Christ Church Hospital in Illonois, US were born alive they even had a comfort room where the babies were taken to die, sometimes held by the parents.  Testimony of nurse who witnessed babies alive after an abortion and left to die  http://www.jillstanek.com/Testimony,%20IL%20Senate%20Health%20%26%20Human%20Services,%203-12-03.pdf

This coronial inquest fround that baby, Baby Jessica Jane, or Baby J as she is referred, lived for 80 minutes before dying without receiving any medical assistance after an abortion procedure in Darwin, Australia.  http://www.nt.gov.au/justice/courtsupp/coroner/findings/other/babyj.pdf  Retrieved July 22, 2014.

 

 

WARNING:  GRAPHIC MEDICAL ILLUSTRATIONS (DRAWINGS) OF SURGICAL ABORTION PROCEDURES FOLLOW.

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Suction and Curettage Abortion of a 9 Week Old Fetus (11 Weeks since LMP)  Click or hover to enlarge. Phone users: click.

Medical Illustration Copyright © 2014 Nucleus Medical Media, All rights reserved. www.nucleuscatalog.com

 

 

 

 

 

 

 

 

 

 

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WARNING - ILLUSTRATION OF ABORTION OF A 14 WEEK OLD FETUS FOLLOWS..

 

  

Dilation and Evaculation Abortion of 14 Week Old Fetus (16 Weeks since LMP)  Click or hover to enlarge. Phone users: click.

Medical Illustration Copyright © 2014 Nucleus Medical Media, All rights reserved. www.nucleuscatalog.com

 

  

 

 

 

 

 

 

 

 

 

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WARNING - ILLUSTRATION OF ABORTION OF A 23 WEEK OLD FETUS FOLLOWS..

 

 

Dilation & Evacution Abortion (D&E) of 23 Week Fetus (25 Weeks since LMP)  Click or hover to enlarge. Phone users: click.

Medical Illustration Copyright © 2014 Nucleus Medical Media, All rights reserved. www.nucleuscatalog.com

 

  

 

 

 

 

 

 

 

 

 

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