There is much overlap between the suction aspiration/vacuum curettage and dilation and curettage methods. A loop-shaped steel knife, the curette used in D&Cs, is often used in addition to the electrically-powered vacuum pump of the suction aspiration procedure. Pure D&Cs, without the use of suction, are not very commonly used for abortive purposes since the suction aspiration method was developed.

Suction aspiration/vacuum curettage

• dilation of cervix
• insertion of suction curette
• vacuum applied (29 times more powerful than home vacuum cleaner), baby and placenta suctioned into containers
• after 12 weeks, might require forceps assist
• It has been reported that a cut or torn cervix occurs in "fewer than one out of 100 early abortions" and the organ injuries occur in "about one out of 1,000 early abortions."
• most common first trimester method

• dilation of cervix
• insertion of curette
• scrapes contents of uterus manually into basin
• It has been reported that D&C's result in incomplete abortion in "less than one out of 100"
• common after miscarriages and for other uterine problems

Dilation and Evacuation (D&E)

• dilation of cervix — dilators or laminaria or both
• possible injection of urea to speed death of the baby and soften it's tissues, especially late in the second trimester
• insertion of forceps
• pieces of baby and placenta are grasped and pulled out until all are removed
• most common second trimester method

Induction or Instillation Abortions — Saline, Prostaglandin, and Urea:

Intercardiac injections (selective reduction method)

• happens at four months
• used for multi-fetal pregnancies, often due to fertility drugs
• needle inserted into abdomen of mother
• poison such as Digoxin is injected into the targeted fetal heart
• cervix is opened over one to four days using laminaria
• labor is induced
• D&C is performed
• no pain for the baby if the doctor actually hits the heart

Hysterotomy

• incision through the mother's abdomen and amniotic sack (Cesarean section)
• umbilical cord cut before removing the child so that he dies in the uterus
• usually requires 3-day hospital stay or longer
• not common, but is the method most often used in third trimester

Dilation and Extraction (D&X, or partial birth abortion)

• cervix is dilated over 48 hours using up to 25 laminaria
• using ultrasound, the baby is pulled through the birth canal with a forceps, feet first, until the head engages in the cervix
• a cut is made at the base of the baby's head, then a suction curette is used to remove the brain, collapsing the skull, so that the head is easily pulled out
• usually done from 20 - 26 weeks, but also after 32 weeks
• banned in Florida as of June 2004

1. An injection of MTX is given.
2. MTX interferes with (even stops) growth of embryo and placenta by blocking B vitamin folic acid.
3. Five to six days later the patient returns to doctor for insertion of a Misoprostol (Cytotec), an ulcer medicine, suppository.
4. Cramping and bleeding occur, resulting in an abortion ("at home").
5. Drugs take two weeks or more to "work."
6. Patient visits doctor again to confirm that abortion has taken place.

• Unknown since few studies have been done - The drugs are currently being tested.
• Emotional effects could be notable since the woman must wait several weeks, knowing that the abortion is occurring, and will then experience the fetus being expelled at home.
• New FDA labeling for Cytotec warns of possible uterine rupture when used beyond the eighth week of pregnancy.

• Used in higher doses for some cancers and for psoriasis and rheumatoid arthritis
• A treatment to shrink ectopic pregnancies, preventing need for surgery (See #2 above.)

• Nausea, diarrhea, liver damage, and lung disease (Concerned Women of America website)

1. Clinic or physician gives patient three 200 mg. Mifeprex pills, taken orally.
2. The pills are artificial steroids that discourage production by the ovaries of progesterone needed to maintain the pregnancy.
3. Patient returns two days later and receives two 200-mcg. Pills Cytotec. Labor contractions can start approximately two hours later.
4. Cramping and bleeding occur, most abort at the clinic, but about 30% will expel the fetus at home or work up to five days later.
5. Patient visits doctor again to confirm that abortion has taken place.

• May cause heart problems, such as disturbed heart rhythms and heart attack.
• Dangers of complications increase if the woman is a regular smoker, or over 35 years of age.
• Nausea and vomiting are common.
• Excessive uterine bleeding may occur.
• Procedure fails approximately 20-40% of the time without using prostaglandin (Cytotec) and approximately 5% of the time with it. Failure can cause deformities in the surviving baby and added dangers to the mother with inherent complications including infection, bleeding, and a need for subsequent surgery.
• Complications found with this procedure have been noted in France under optimum conditions with prompt medical attention available. Under less ideal situations an increase in complications is likely.
• The effects on future pregnancies are presently not documented.

The resulting abortion, with its labor contractions, is similar to an early delivery or miscarriage, therefore raising a consciousness of childbirth, which later must be resolved.