What happens during a surgical abortion, by trimester

Before the procedure

MedlinePlus says you may have a pelvic exam, a pregnancy test, an ultrasound and a blood test to check your blood type. If your blood type is Rh negative, you may get a shot of Rh immune globulin. You may also be given an antibiotic to lower the chance of infection.

First trimester: vacuum aspiration, step by step

Vacuum aspiration (also called suction aspiration) is the usual procedure in the first trimester. ACOG says it is usually offered up to 13 weeks, and some doctors use a hand-held version up to about 16 weeks.

1. Getting ready. You lie on an exam table with your feet in stirrups, as for a pelvic exam. A speculum is placed to hold the vagina open.
2. Numbing. The doctor usually numbs the cervix with an injection. Some clinics also offer medicine to help you relax.
3. Opening the cervix. The cervix is gently widened with a series of thin rods called dilators. Sometimes medicine is given beforehand to soften it.
4. Suction. A thin tube is passed through the cervix into the uterus. Suction, from a hand-held syringe or a machine, removes the embryo or fetus, the pregnancy sac and the lining of the uterus.

The procedure itself usually takes about 5 to 10 minutes. Cramping during and just after is common. You then rest in a recovery area, often for a few hours.

At this stage the embryo or fetus is small but developing quickly. Cardiac activity can usually be seen on ultrasound from about 6 to 7 weeks, and by about 9 to 10 weeks all of the essential organs have begun to form. See fetal development week by week.

Second trimester: dilation and evacuation (D&E)

D&E is the procedure most often used after about 13 to 15 weeks. By then the fetus is larger, so suction alone isn't enough, and the cervix needs to open wider.

Preparing the cervix

Opening the cervix often begins hours or a day before the procedure. ACOG notes this can mean a visit the day before. The doctor may place small dilators that slowly absorb fluid and swell (such as laminaria), give medicine such as misoprostol or mifepristone to soften the cervix, or use both.

The procedure

D&E is usually done with sedation or another kind of anesthesia. Once the cervix is open enough, the doctor removes the fetus and placenta using suction and surgical instruments called forceps. ACOG's language guide notes that this can mean the fetus is removed in parts. Suction is then used to make sure the uterus is empty.

For more on what has developed by this stage, how common second-trimester abortion is, and why some people have one, see second-trimester abortion.

Injections to stop the fetal heart before some later procedures

Before some procedures later in pregnancy, the doctor first injects a medicine into the fetus or the fluid around it to stop the fetal heart. The medicines used are digoxin, potassium chloride or lidocaine. Digoxin can take hours to work.

The Society of Family Planning, in guidance written with the Society for Maternal-Fetal Medicine, recommends this near and after viability (the point where a baby may survive outside the womb). It does not recommend it routinely before viability. The guidance notes patient preference is also a common reason it's used.

Pain relief and anesthesia

• Local numbing: a numbing medicine injected around the cervix is common for first-trimester procedures.
• Sedation: mild sedation (you're relaxed and drowsy) or deep sedation may be offered, depending on the place and the stage of pregnancy.
• Other anesthesia: ACOG says some type of anesthesia may be given for second-trimester procedures, and in some places a regional block such as an epidural is available.

If you're given sedation, you'll need someone to drive you home, since you may still be drowsy.

Recovery

• Cramping: usually lasts a day or two, and soreness can last a few days.
• Bleeding: bleeding or spotting can last about a week, and up to about two weeks.
• Getting back to normal: physical recovery usually takes a few days. It can take longer the further along the pregnancy was.
• Your period: usually returns 4 to 6 weeks later. You can get pregnant again before that first period.

Your feelings may take longer than your body. Relief, sadness, grief or mixed emotions are all common. See what happens after an abortion for what the research says about emotional recovery.

Risks

MedlinePlus describes procedural abortion as very safe and says serious complications are rare. They can include:

• Heavy bleeding
• Infection of the uterus or fallopian tubes
• Tissue left behind in the uterus, which may need a second procedure
• Injury to the cervix or uterus, including a hole in the wall of the uterus (perforation). ACOG notes that, rarely, the bowel or bladder can also be injured and need surgery in a hospital to repair.
• Scarring inside the uterus
• Reactions to medicines or anesthesia, such as breathing problems

The risk goes up the further along the pregnancy is. An NIH clinical review reports that major complications (needing a hospital stay, surgery or a blood transfusion) rise from about 2 in 1,000 procedures at 8 weeks to about 15 in 1,000 at 20 weeks.

Looking ahead, ACOG says an abortion without complications doesn't cause infertility. A 2016 analysis of observational studies found that a prior procedure to empty the uterus (after an abortion or a miscarriage) was linked to a modestly higher risk of preterm birth in a later pregnancy, higher after more than one.

Still deciding?

You don't have to decide today. A free ultrasound can tell you how far along you are, and a pregnancy center can talk through every option with you, including parenting, adoption and help with costs. You can also compare this with every type of abortion and the abortion pill.

Sources

1. ACOG. Induced abortion (patient FAQ) and Abortion language guide.
2. MedlinePlus. Abortion: surgical (reviewed 2024).
3. StatPearls (NIH Bookshelf). Abortion (updated 2025).
4. Society of Family Planning. Induction of fetal asystole before abortion (2024).
5. MedlinePlus. Fetal development.
6. Lemmers M, et al. Dilatation and curettage increases the risk of subsequent preterm birth: a systematic review and meta-analysis. Human Reproduction 2016;31(1):34–45.

Last updated 2026-11-02. Medical facts on this page are drawn from the sources listed at the end and on our sources page. This is general information, not medical advice.