At
the Cleveland Surgi-Center, second
trimester surgical abortions are provided for women
who are between 13 weeks and 24 weeks pregnant.
There are several steps that you willtake to ensure
your safety and well-being. Ohio law requires a woman
to meet with the physician at least 24 hours before
an abortion procedure. So on day one, the pregnancy
verification, pre-operative evaluation and counseling
are performed and you speak with the physician. The
abortion procedure can be scheduled the next day or
as soon after as possible.
Every patient will have an ultrasound. This advanced
diagnostic technique is used 3 weeks or more after the
last menstrual period to determine the correct length
of the pregnancy. It is an important procedure that
improves the accuracy of the physician's preoperative
diagnosis and further assures the safety of the patient
and the procedure.
PRE-OPERATIVE
EVALUATION
Further
laboratory work is completed to screen all potential patients.
Routine laboratory analysis includes hematocrit testing,
urinalysis and Rh typing.After the laboratory testing,
the medical staff will evaluate your health. This includes
a review of your medical history, a physical exam and
a pre-screening for anesthesia risks. Our facility is
concerned with the success of your termination and we
want to make sure that your current health and size of
your pregnancy will allow the safest of procedures.
COUNSELING
Individual
counseling supplies important information and support
for patients scheduled for a pregnancy termination. Each
woman receives personal confidential attention and care
throughout her visit. All counseling, under the direction
of our social worker, is private and confidential.
Detailed information is provided about the abortion and
birth control. Patient educators are there to help with
feelings and concerns related to the termination and each
patient is treated with warmth, understanding, and sensitivity.
DILATION
AND EXTRACTION PROCEDURE
The Cleveland
Surgi-Center performs abortions up to 24 weeks of pregnancy
by the dilation and extraction method, the most common
method of abortion available today. The procedure involves
the gradual widening of the cervix followed by the removal
of the uterine contents with forceps and suction.
On day one you will receive pre-op testing, counseling,
and your ultrasound. You then return 24 hours or more
later for your first day of your procedure. On the first
day of a two day procedure, you will have laminaria inserted
into your cervix to help soften and dilate your cervix.
This will help ensure that the procedure will go safely
and easily for you and the physician. You will be given
a local anesthetic to numb your cervix. Then laminaria
will be inserted. If you are between 20-24 weeks pregnant,
Digoxin will be injected into the fetus in order to stop
the heart beat. You will then go home or to your hotel
with pain pills and our 24 hour access number for you
to call, if you have any questions or concerns. You will
also be given an antibiotic to take with your last meal
of the day. This is to insure that you do not get a infection.
After midnight we do not want you to eat, drink, smoke
or chew anything except for the pain pills if you need
them. You will be told what time to return to the clinic
to finish your procedure.
A patient who is eligible and chooses to be totally asleep
will receive monitored IV anesthesia and will not remember,
see, or hear anything during the abortion procedure. A
patient who chooses to have sedation anesthesia will also
have medications given through an IV. Sedation anesthesia
is conscious (“awake”) sedation. Patients are relatively
pain-free and tranquil and yet still aware of their surroundings.
Most of the time, a patient doesn’t remember what happened
during the abortion procedure. A patient choosing a local
anesthetic is given an injection which numbs the cervix.
A Medical Assistant is present during the procedure and
the doctor will be explaining what he/she is doing so
that there are "no surprises". After the procedure, patients
with Rh-negative blood type will receive an injection
of Rhogam which is administered for an additional charge.
(See
Fee Schedule)
WHAT
TO EXPECT AFTERWARDS
Your aftercare in the three weeks following an abortion
is very important. Please carefully read the information
below; it will help to insure an easy and worry-free recovery. You
will receive additional information at the time of your
visit.
Bleeding
It is
perfectly normal to experience some bleeding after a pregnancy
termination. Some women have bleeding similar to a normal
period and others bleed very little or not at all. After
your procedure, you will be taking a medication called
methergine/ergonovine for a few days. This medication
helps to control bleeding and contract the uterus. Your
first normal period following the abortion should come
in four to six weeks
.
We
ask that you monitor your bleeding for three days after
your abortion. If your bleeding becomes excessive and
you begin to saturate a full size pad within one hour
or if you are passing clots of blood larger than the size
of a quarter, you should contact us by calling our emergency
telephone number. This number will be given to you during
your visit and provides twenty-four hour emergency access.
Cramping
It is
not unusual to experience cramping after your procedure.
You may take any non-aspirin pain reliever or a pain reliever
that is prescribed by us to relieve your discomfort. Avoid
aspirin as it may thin the blood and cause heavier bleeding.
Breast
Soreness and Mood Changes
As
your hormones shift to the non-pregnant state, you may
feel a slight "down" or "blue" period. These feelings
should subside in a few days. A small percentage of women
experience some increased breast tenderness for a few
days after the procedure and some women produce milk.
This is best remedied by wearing a tight-fitting bra for
24-48 hours, applying ice to the breasts, refrain from
touching the breasts and taking hot showers. Milk production
should diminish in a few days.
Restrictions
In
order to avoid infection and to ensure a healthy recovery,
it is most important that you completely take
your antibiotic prescription.
Also,
there are some restrictions that you must stick to for
three weeks after your abortion and until you have received
a follow-up exam:
1.
Abstain from sexual intercourse
2.
Do not use tampons
3.
No douching, tub baths or swimming
4.
Avoid strenuous activities such as heavy lifting (lifting
anything over fifteen pounds) and all exercise.
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