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Abortion 13 – 22 weeks

A pregnancy termination of 13 weeks or more is called a second trimester treatment. The abortion is carried out with the use of some surgical instruments.
Usually the treatment is done under light anaesthetic, unless this is impossible due to health issues, such as illness or obesity (very high BMI).

Preparation

To prepare the uterus for treatment, an hour in advance you are given the medication Misoprostol to soften the cervix. This medication can make you nauseous and shivery and you may experience cramps.

Anaesthetic

In the surgery you will be given a short-acting sleep-inducing drug through a drip connected to your arm. Within 30 seconds you will fall asleep for the duration of the treatment.

Nil by mouth
For light anaesthetic your stomach needs to be completely empty. This means that from 6 hours before the treatment you are not allowed to eat anything, and from 2 hours before the treatment you are not allowed to drink anything. Before this time, you are allowed to drink some tea or water (but not any dairy products). For 24 hours after the light anaesthetic, you are not allowed to ride a moped or bicycle or drive a car, motorcycle or motor scooter. Don’t take any major decisions during this period.

The abortion treatment

During the treatment you are in a gynaecological examination chair with support for your legs. The treatment is performed by an abortion doctor, assisted by at least one nurse. The doctor inserts a speculum into your vagina to widen your cervix. The embryo (foetus) is removed and the uterus is emptied with the use of special instruments.
For pregnancies up to 15 weeks, following the treatment you can have a hormonal coil (IUD) or contraceptive implant inserted.

After the treatment

After the treatment you will stay in the recovery room for an hour to make sure you are doing OK. For infection prevention you will be given antibiotics.
After the treatment you may experience cramping and bleeding. The symptoms can last from a few days up to several weeks and will gradually diminish. Pregnancy symptoms will diminish after a week. If symptoms persist or if you have a fever or are unwell, please contact us.

Abortion 18 – 22 weeks

This treatment is only performed in Bloemenhove Clinic Haarlem.

For pregnancies between 18 and 22 weeks treatment is always carried out under sedation (light anaesthetic).

Two to three hours prior to the abortion, you are administered the medication Misoprostol to relax your cervix and cause some dilation. When you are ready for the treatment, you will first be put to sleep. The treatment is nearly identical to the treatment for pregnancies of 13 to 17 weeks. Depending on the duration of the pregnancy, the treatment takes between 15 and 25 minutes. You will wake up immediately after the treatment and stay in the clinic for another two hours to make sure you are doing OK.

The total length of stay will be between 6 and 8 hours.

I am overweight or underweight. Does that affect the treatment?

If you are obese (BMI > 40) or underweight (BMI<18), sedation (light anaesthetic) can entail some risks. Make sure to mention you are obese or underweight when booking an appointment.

Will I have general anaesthetic, an epidural or local anaesthetic?

We never administer an epidural. For pregnancies up to 13 weeks you can choose either local anaesthetic or light sedation. Sedation means you are given a short-acting sleep-inducing drug through a drip connected to your arm. From 13 weeks of pregnancy, the treatment is always performed under sedation. For 24 hours after treatment under sedation you are not allowed to ride a moped or bicycle or drive a car or motorcycle.

Can you fit a coil (IUD) after the abortion?

For pregnancies up to 15 weeks, directly after the abortion treatment you can have a coil (IUD) fitted. If you have chosen for the abortion pill, you can have an IUD fitted during the follow-up, four weeks after the abortion.

If you have health insurance in the Netherlands, the IUD insertion procedure is free of charge, but the IUD itself is not free, and can be purchased at our clinic. Both hormonal and non-hormonal IUDs are available. Some health insurances cover (part of) the costs of the IUD. Please contact your health insurer for any medical cover. If you are younger than 18, both IUD insertion procedure and IUD are free.

Can you fit a contraceptive implant (Implanon)?

Yes, we can fit the contraceptive implant Implanon after an abortion. The procedure is free, but you have to pay for the Implanon at the clinic. Also, if you did not have an abortion at the clinic, you can book an appointment to have Implanon fitted. In that case you have to pay for the insertion procedure.

What is the probability that the treatment will fail?

It sometimes happens that the pregnancy is not terminated after the abortion. With the abortion pill this is 1 - 4%, with other abortion methods this is 1 - 2 %. If this happens, we need to perform a (second) suction curettage.

There is also a slight risk of persistent bleeding or severe discharge. This usually occurs when there is some organic tissue left in the uterus after the abortion. If the tissue is not passed naturally, a follow-up treatment is needed to remove these last bits of tissue.

Our clinic has a partnership agreement with a nearby hospital, where medical support can be provided, if necessary.

What is the probability of infection after a day treatment in the clinic?

The chance of infection after an abortion is extremely remote. As an extra precaution to prevent infection, you will be given antibiotics in the clinic after treatment.

Because of risk of infection after the abortion, please follow this advice:

  • For the first two weeks, do not use any tampons.
  • For the first two weeks, do not have sexual intercourse.
  • For the first two weeks, do not take a bath or go swimming; a shower is allowed.

A fever (over 38.5°C), which lasts more than a day, AND stomach pain after treatment can be possible signs of an infection. If this happens to you, please contact us or your GP as soon as possible.

How much bleeding can I expect after an abortion?

Usually most bleeding is expected after 4 to 7 days and can be more severe and last longer than during menstruation. You can also pass clots of blood. The bleeding often ends with brownish discharge.

What symptoms should I be concerned about after an abortion?

Normal symptoms in the first days after the abortion:

  • Bleeding and cramping
  • Abdominal pain or backache
  • Slight temperature
  • Emotional instability
  • Diarrhoea or nausea caused by the antibiotics

Any additional pregnancy symptoms usually disappear within 2 to 14 days. Because your body still contains pregnancy hormones, a pregnancy test may be positive up to 3 weeks after the abortion.

It’s advisable to take a pregnancy test 3 to 4 weeks after the abortion. If the test is (weakly) positive, you still feel pregnant, or have other symptoms, please contact us.

The chance of developing an infection is remote, but if you feel unwell and have a fever (over 38.5°C) that lasts longer than a day and abdominal pain, this could mean you have an infection. In that case, please contact us as soon as possible.