Abortion (Dilation and Curettage)

What Is an Abortion?

Abortion (Dilation and Curettage – D&C or Vacuum Aspiration – MVA) is the procedure of removing tissue from inside the uterus. Abortion is the termination of pregnancy tissue inside the uterus by medical methods. Performed in Turkey within the legal framework, this procedure is a safe and effective medical intervention when carried out under the right conditions. It is applied both for the termination of an unwanted pregnancy (within legal limits) and, for diagnostic or therapeutic purposes, to resolve pathological conditions within the uterus (polyps, excessive thickening, retained tissue after miscarriage). At the clinic of Prof. Dr. Melahat Atasever, all abortion procedures are performed with respect for the patient’s health and legal rights, in adherence to ethical rules, and under high hygiene standards.

Abortion, referred to in medical terminology as “termination of pregnancy” or “abortus,” is the removal of pregnancy tissue from the uterus by surgery or medication. In addition to elective termination of pregnancy, it is also performed as a medical necessity in pathological conditions such as incomplete miscarriage, missed miscarriage, non-viable pregnancy, and hydatidiform mole. The word “curettage” comes from the Latin, meaning scraping with a spoon; today, however, this technique has largely been replaced by far less traumatic vacuum aspiration methods.

Abortion is used not only to terminate pregnancy but also in the diagnosis and treatment of intrauterine pathologies. Taking a tissue sample from inside the uterus (diagnostic curettage), removing polyps, and clearing the uterus after miscarriage are among these applications.

Today, abortion procedures are performed using three main methods: vacuum aspiration, dilation and curettage (D&C), and medical (medication-based) abortion. Which method is applied is determined by the week of pregnancy, the mother’s health status, and the clinical conditions.

Abortion is a surgical procedure performed in gynecology for different purposes:

1. Termination of Pregnancy: According to the Turkish Civil Code, elective termination of pregnancy is performed up to the 10th week of pregnancy, with the spouse’s consent for married couples and with the person’s own consent for those who are not married.
2. Diagnostic and Therapeutic Curettage:
   • Retained Miscarriage Tissue: Clearing tissue remaining in the uterus after a miscarriage or missed abortion (an unnoticed miscarriage).
   • Abnormal Uterine Bleeding: Taking a sample from the uterine lining (endometrium) for diagnostic purposes (Endometrial Biopsy).
   • Polyps and Excessive Thickening (Endometrial Hyperplasia): Removing intrauterine polyps or clearing the endometrium in cases with suspected cancer.

Application Methods

Vacuum Aspiration (MVA): In abortion procedures today, the vacuum aspiration method is preferred over traditional curettage as it is safer and carries a lower risk of complications; it is now accepted as the standard surgical abortion method. It is applied in two forms: manual vacuum aspiration (MVA) or electric vacuum aspiration (EVA). After the cervix is dilated, the pregnancy tissue is aspirated with negative pressure through a thin cannula. The procedure generally takes 5-15 minutes, and the complication rate remains very low. It is widely used between the 6th and 14th weeks of pregnancy. Before the procedure, the patient is usually given general anesthesia, so no pain is felt during the procedure. Vacuum aspiration minimizes the risk of damage to the uterine wall, lowers the risk of bleeding and infection, and shortens the recovery period.

Dilation and Curettage (D&C): In this method, after the cervix is dilated, the inner wall of the uterus is scraped clean with spoon-shaped instruments called curettes. It is frequently preferred in cases of incomplete miscarriage, diagnostic curettage, and hydatidiform mole. As it is a more invasive method compared to vacuum aspiration, its use today remains limited to specific indications.

Medical (Medication) Abortion: First, mifepristone, which has an antiprogesterone effect, is given orally; misoprostol is administered 24-48 hours later. This drug combination triggers uterine contractions, allowing the pregnancy tissue to be expelled from the body. It is generally preferred for pregnancies up to the first 7-9 weeks, and clinical studies report its effectiveness as approximately ninety-five percent. In some cases the method can also be applied at home; follow-up at the clinic is not mandatory but is recommended.

How Is an Abortion Performed? Stages of the Procedure

Preparation and Evaluation Before Abortion: A comprehensive preliminary evaluation is carried out before the abortion. The week of pregnancy is confirmed by ultrasonography, its intrauterine location is verified, and the possibility of ectopic pregnancy is ruled out. Blood group, Rh factor, and hemoglobin level are determined. Anti-D immunoglobulin is administered prophylactically to Rh-negative patients. If there is an active vaginal infection, antibiotic treatment is given first.

Choice of Anesthesia: General anesthesia, sedation (conscious sedation), or local anesthesia can be applied in the abortion procedure. General anesthesia provides complete loss of consciousness, while sedation offers a state in which the patient is calmed but able to respond. In local anesthesia, only the cervical area is numbed. The choice of anesthesia is decided together with the patient’s preference, the week of pregnancy, general health status, and the physician’s assessment.

The Procedure: After the patient lies down on the examination table, a speculum is placed in the vagina to make the cervix visible. If necessary, the cervix is dilated. In the vacuum aspiration method, a thin cannula is placed inside the uterus and the pregnancy tissue is aspirated. The entire procedure takes an average of 10-15 minutes. Once the procedure is completed, the patient is discharged after a short observation period. Most patients can leave the clinic the same day.

Recovery and Follow-Up After Abortion

The procedure generally takes 15-30 minutes, and the patient is discharged the same day after a few hours of observation. Light bleeding and pains similar to menstrual cramps for a few days are normal. It is recommended to avoid activities such as sexual intercourse and swimming pools for about a week. After the procedure, a follow-up examination is performed to check that the uterus is clear and to detect possible complications early.

The First Hours After the Procedure: The patient is kept under observation at the clinic until the effect of the anesthesia wears off. Mild dizziness, nausea, and cramps are normal findings that can be seen in the first hours. Patients who received local anesthesia can stand up and leave the clinic shortly afterward. Patients who received general anesthesia may require a longer observation period.

Points to Consider at Home: Light spotting and menstruation-like bleeding lasting a few days after an abortion are considered normal. Using pads instead of tampons, abstaining from sexual intercourse, and avoiding heavy physical activity are recommended. Swimming pools, the sea, and bathtubs should be avoided for a few weeks. The prescribed antibiotic course must be completed in full. The menstrual cycle generally resumes within four to six weeks.

Possible Risks and Complications of Abortion

In abortion procedures performed by experienced hands and under suitable clinical conditions, the rate of serious complications is extremely low. Nevertheless, as with every medical intervention, certain risks exist. The most frequently encountered problems are infection, excessive bleeding, and cervical injuries. In rare cases, uterine perforation can occur; in procedures performed by an experienced specialist, this risk is minimized.

Repeated abortion procedures increase the risk of intrauterine adhesions (Asherman’s syndrome). Since this condition may negatively affect fertility in the future, it is important to avoid unnecessary abortions and to start an effective method of contraception. An incomplete abortion may lead to tissue remaining in the uterus; in this case, a second procedure may be required. If high fever, severe pain, excessive bleeding, or foul-smelling discharge is observed after the procedure, medical help should be sought immediately.

Prof. Dr. Melahat Atasever makes it a principle to provide patient-specific psychological support and full compliance with legal procedures in all abortion procedures, whether for termination of pregnancy or for treatment. At the first examination, the week of pregnancy is confirmed by ultrasound, the legal documents are prepared, and a treatment plan specific to the patient is created. The entire process is conducted in full compliance with patient confidentiality and ethical values.