Gynaecological procedures and examinations

Surgical abortion is the termination of pregnancy through a surgical procedure. In Estonia, the termination of pregnancy is regulated by the “Termination of Pregnancy and Sterilization Act,” which allows for the termination of pregnancy at a woman’s request and upon the submission of a signed application if the pregnancy has lasted less than 12 weeks.

Preoperative phase

• During a gynecological consultation, the pregnancy is confirmed, its duration is determined, necessary tests are prescribed, and if desired, the person seeking the abortion is counseled by a doctor.
• It is necessary to inform the attending physician about your health condition, any past or current illnesses, medications being taken, and any drug allergies.
• The operation is performed under general anesthesia, and to avoid complications, you must refrain from eating for at least 6 hours and drinking for 4 hours prior to the operation.
• Please carefully read the instructions for those coming in for surgery!

During the procedure

Before the surgical abortion, a gynecological examination is necessary. Surgical abortion is performed under anesthesia, during which the cervix is dilated, and the pregnancy is terminated through vacuum aspiration. Sometimes, cervical preparation is required before the surgical abortion. Medications are administered either vaginally or placed under the tongue for this purpose. The duration of the operation is typically 15-20 minutes.

Postoperative phase

• After the surgery and while recovering from anesthesia, you will be taken to the recovery room in our day surgery unit.
• If you have Rh-negative blood, you will be given a medication (Rhesonativ) after the termination of pregnancy to prevent potential Rh incompatibility in future pregnancies.
• Driving a motor vehicle on the same day after anesthesia is not permitted.
• You will be allowed to go home on the same day.

Possible complications and risks:

Possible complications and indications for seeking emergency care after surgical abortion:

Surgical abortion is generally a safe procedure. However, the following possible complications should be considered:

• Continuing pregnancy (frequency <1:100) – the abortion procedure may need to be repeated.
• Incomplete abortion (2:100) – the abortion procedure may need to be repeated.
• Bleeding >500 ml (the risk of requiring a blood transfusion is <1:1000).
• Perforation of the uterus during the abortion (1-4:1000).
• Cervical injury (<0.2:100).
• Infection of the pelvic organs after abortion is mostly caused by a pre-existing sexually transmitted infection, which can increase the risk of future tubal infertility and ectopic pregnancy. To reduce the risk of infection, tests for sexually transmitted infections are performed before abortion, treatment is prescribed if necessary, or antibacterial prophylaxis is recommended.
• Anesthesia complications, mainly associated with hypersensitivity to medications (0.5:10,000).

In case of certain complications (cervical injury, uterine perforation, bleeding), surgical treatment (laparoscopic or open surgery) may be necessary.

Indications for seeking immediate care from a gynecologist or the emergency department of a hospital after abortion:

• Severe pain or an increase in pain intensity.
• Bleeding heavier than during a regular menstrual period or lasting longer than two weeks.
• High fever for more than 24 hours, chills.
• Foul-smelling or purulent vaginal discharge.

If there is suspicion of continued pregnancy (breast tenderness and enlargement, nausea and vomiting, fatigue, changes in appetite, increased urination, etc.), you should seek immediate consultation with a gynecologist.

After surgical abortion

• The necessity of a follow-up visit is determined and agreed upon by the doctor, taking into account your preferences. In the case of an uncomplicated surgical abortion, follow-up may not always be necessary.
• For two weeks after the abortion, it is not recommended to engage in sexual activity without using condoms, using tampons, taking baths, or swimming.
• The next menstrual period should start 4-6 weeks after the termination of pregnancy. If it does not occur, consult a gynecologist.

Preventing unwanted pregnancies

Fertility is restored immediately after the termination of pregnancy, so to prevent a new pregnancy, it is necessary to start using an effective contraceptive method either before or immediately after the abortion. Hormonal methods of contraception (pills, patches, vaginal rings, mini-pills, implants) are usually started on the same day as the abortion. During the abortion, a healthcare provider may also insert an intrauterine contraceptive device. You can discuss suitable contraceptive methods with a doctor or midwife before the abortion.

Confidos also offers sexual health counseling by our midwives. Book an appointment HERE.