Surgery is considered when the term of pregnancy does not allow a drug-induced abortion.

Professor Philippe Descamps, gynecologist-obstetrician at the University Hospital of Angers and author of the book "Doctor, I still have a question", answers all our questions about this method of abortion.

What is a surgical abortion?

Surgical abortion is a voluntary termination of pregnancy, using a technical procedure called curettage or aspiration.

What are the deadlines to respect?

It can be performed until the maximum possible end of an abortion in France, that is to say 14 weeks of amenorrhea (12 weeks of pregnancy).

Depending on the centers of abortion, it can be performed as early as 6-7 or 8 weeks of amenorrhea. It is used if it is our wish, of course, that the term of the pregnancy corresponds or if we are no longer in time for a drug method.

How is an aspiration abortion performed?

This intervention is prepared upstream: a drug, also used during a drug induced abortion (mifepristone or mifegyn) must be ingested an average of 48 hours before the procedure to dilate the cervix and cause a termination of pregnancy.

The day of the intervention, we receive systematically antalgic drugs, possibly misoprostol to further dilate the cervix, and other drugs according to our needs (anxiolytics, anti-nausea ...).

Surgical abortion can be performed under local anesthesia (in this case, the woman is conscious and receives different types of analgesics, as well as a gas called MEOPA to help dispel difficult feelings), or under general anesthesia.

The doctor then draws the contents of the uterus using a cannula connected to a dedicated device.

Does surgical abortion present risks?

The main risk of surgery is the perforation of the uterus.

Fortunately, this happens very rarely and can be cured very well, without resorting to another intervention.

The second risk is uterine infection some time after the procedure. This is why physicians should be vigilant about screening for Sexually Transmitted Infections before the procedure and that an antibiotic is administered during the procedure.

What are the possible contraindications?

Drug-induced abortion may be contraindicated, either because of the method itself (in a woman with a multi-scar uterus for example), or because of the type of anesthesia.

A woman who has a lot of trouble making her decision will be more oriented towards a general anesthesia because the body is the reflection of the psyche, and very often, in these cases, the intervention under local anesthesia is more complicated because the cervix do not expand.

Similarly, very young women, most of whom have never had a gynecological examination , are preferentially referred to general anesthesia, as are patients with unbalanced psychiatric disorders.

Some pathologies or medical history prevent the use of general anesthesia.

Surgical and medical IVG: what are the differences?

During a medical abortion, one is "actress", one lives it fully in one's body, the intervention of the caregivers has then only aim to accompany us to live this at best. We can also face the uncertainty of when it works, because we can not predict when the pregnancy will be expelled. A situation that can be very uncomfortable for some, and who will prefer in this case to use a surgical abortion.

But it requires to trust a third party, in this case a doctor, for the realization of the gesture because the latter can sometimes be an "intrusion". It is therefore very important to discuss with the medical team the representation that one can have of this intervention.

Finally, for some, the advantage of surgical abortion is to be assured, at the end of the procedure, which lasts an average of 10 minutes, the method worked (an ultrasound is performed at the end of the intervention) .

* author of Doctor, I still have a question, Editions Larousse