One-day Procedure For 12 – 19 Weeks

PRE-OPERATIVE INSTRUCTIONS

• • You may not eat, drink or chew anything for eight hours before you come in
  • Smoking is not advised prior to your appointment
  • Please make arrangements for children to be left at home
  • When you come to our office payment in full will be collected prior to any services being rendered. For your convenience our offices accept cash, Visa, MasterCard, Discover, and American Express. Personal checks are not accepted. Medicaid and most insurance plans are accepted, but must be verified prior to your visit
  • You must have an escort to take you home following your procedure. You may not drive yourself home
  • During your visit you will:

– Complete self-medical history and consent forms. – Leave a urine sample for a pregnancy test. – Have a sonogram to estimate the length of pregnancy. – Have a simple blood test by finger stick to determine your blood count and your Rh factor. – Meet with an intake counselor to discuss your medical history forms and to make your payment in full. – Meet with a patient educator who will discuss the abortion procedures, aftercare instructions and birth control options. – Have an examination and receive the cytotec medication (which takes up to 4 hours to work). – Have the abortion procedure under general anesthesia. – Recuperate with the nurse in the recovery room (Approx. 1 hour). – You must have an escort to take you home after receiving general anesthesia.

THE ABORTION PROCEDURE

You may not eat, drink or chew anything for eight hours before you come in Once you’re asleep a speculum is placed inside the vagina to keep the vaginal walls apart. The physcician will determine if there has been sufficient dilation. The physcician will hold the cervix, the opening to the uterus, with an instrument called a tenaculum. The physician will then insert several narrow metal rods, called dilators, into the cervix to further open it. The physician uses a slender suction cannula and other specialized instruments to remove the pregnancy from the uterus. The entire process can take 10-20 minutes.  

Laminaria Insertion

The purpose of laminaria insertion is to dilate the cervix so that the pregnancy can be removed. Laminaria are made from various materials designed to absorb water from the cervix and slowly expand. As the laminaria slowly expand, they gently dilate the cervix. It takes a few minutes for one or several laminaria to be inserted. They may require a few hours or overnight to effectively dilate the cervix. They are removed prior to the surgical procedure, once the patient is under general anesthesia.  

D&E (Dilatation & Extraction)

This procedure is used for later 2nd trimester terminations of pregnancy. The cervix has been dilated with laminaria and/or cytotec over the course of 1 to 2 days depending on the necessary dilation. Under general anesthesia, once adequate dilation is achieved, all products of conception are removed from the uterine cavity. This is done as gently as possible. The procedure takes 5 – 10 minutes and is followed by an ultrasound inspection to assure that the cavity is empty. The patient is taken to the recovery room for approximately 1 – 1 ½ hours.

POST-OPERATIVE INSTRUCTIONS

Prior to your procedure you will be given written after-care instructions. Post-operative care is essential to your wellbeing. To protect against infection, antibiotics are given routinely. If your blood type is RH negative you will be given Rhogam. If the physician deems it necessary, you may also be given Methergine to help your uterus to contract. We are available 24 hours a day for medical emergencies. All patients must have a post-operative exam two weeks after the procedure. We encourage patients to return to their referring physicians. However, complete post-operative care and on-going gynecological services are available to all self-referred patients.

POSSIBLE COMPLICATIONS

Second trimester abortion is a safe surgical procedure and has approximately the same rate of complications as normal childbirth. Complications range from minor to servere, including the very rare event of death. However, deaths that occur during abortions in the second trimester are usually the result of physical complications present prior to the procedure. Therefore, it is very important that you inform us fully about your medical history and any drugs, legal or illegal, that you are using. Complications that can occur during or after the abortion include infection, incomplete abortion (where some of the placenta remains in the uterus), injuries to the uterus, cervical tear, heavy and prolonged bleeding, whole body complications such as blood clotting problems, adverse reactions to the drugs, shock, cardiac arrest, amniotic fluid embolism and possible sterility. If you have a multiple pregnancy, the chances of complications increase. There is also the possibility of cervical incompetence that may result in problems maintaining a pregnancy in the future (possible miscarriage, stillbirth, low birth weight, premature delivery). Should any of these complications arise, antibiotic drugs and blood transfusions may be required. Remember, although many types of complications have been listed, the changes of a complication are minimal. Many complications are also a result of NOT taking care of yourself after you leave our office. It is essential that you follow the post-operative instructions explained to you. Even though complications are rare, you should call us immediately if there is a problem such as those mentioned on your post-operative instruction sheet. Our doctors are on call 24 hours a day. A complication that is detected early is usually easily treated and corrected before it can become a major complication.

PAYMENT

We require your entire procedure fee to be paid before the abortion procedure is begun. Payment can be made in cash, money order, or credit card (MasterCard, VISA, American Express, or Discover). New York State Medicaid and most insurance plans are accepted, but must be verified prior to your visit. You may also have additional fees if the doctor or medical staff determines that you need extra medications or testing. This may include, but is not limited to: injectable antibiotics, early detection urine pregnancy test, urine culture, throat culture, or Rhogam injection. If you have Rh negative blood it is absolutely essential that you receive a Rhogam injection. There are some supplies which you have the option to purchase while in our office. Methergine tablets or the Depo Provera injection (birth control) are both available for an additional charge. Ask the intake counselor if you have questions about the cost of these medications. If the abortion procedure is not performed due to patient request or physician advice, you will be responsible for payment for services already rendered such as the pregnancy test, sonogram and lab tests. All other fees will be refunded.