Editing Abortion (section)

===Surgical===
[[File:Vacuum-aspiration (single).svg|thumb|A vacuum aspiration abortion at eight weeks gestational age (six weeks after fertilization).<br />'''1:''' [[Amniotic sac]]<br />'''2:''' [[Embryo]]<br />'''3:''' [[Endometrium|Uterine lining]]<br />'''4:''' [[Speculum (medical)|Speculum]]<br />'''5:''' Vacurette<br />'''6:''' Attached to a [[Vacuum pump|suction pump]]]]

Up to 15 weeks' gestation, [[suction-aspiration abortion|suction-aspiration]] or vacuum aspiration are the most common surgical methods of induced abortion.<ref>{{cite web| author=Healthwise |url=http://www.webmd.com/hw/womens_conditions/tw1078.asp#tw1112 |title=Manual and vacuum aspiration for abortion |year=2004 |website=WebMD |access-date=5 December 2008| archive-url= https://web.archive.org/web/20070211155626/http://www.webmd.com/hw/womens_conditions/tw1078.asp| archive-date=11 February 2007| url-status= live}}</ref> ''Manual vacuum aspiration'' (MVA) consists of removing the [[fetus]] or [[embryo]], [[placenta]], and membranes by suction using a manual syringe, while ''electric vacuum aspiration'' (EVA) uses an electric pump. Both techniques can be used very early in pregnancy. MVA can be used up to 14 weeks but is more often used earlier in the U.S. EVA can be used later.<ref name=":3" />

MVA, also known as "mini-suction" and "[[menstrual extraction]]", or EVA can be used in very early pregnancy when cervical dilation may not be required. [[Dilation and curettage]] (D&C) refers to opening the cervix (dilation) and removing tissue (curettage) via suction or sharp instruments. D&C is a standard gynecological procedure performed for a variety of reasons, including examination of the uterine lining for possible malignancy, investigation of abnormal bleeding, and abortion. The [[World Health Organization]] recommends ''sharp curettage'' only when suction aspiration is unavailable.<ref>{{cite book|title=Managing Complications in Pregnancy and Childbirth: A Guide for Midwives and Doctors| author=World Health Organization| publisher=World Health Organization| year=2017| isbn=978-92-4-154587-7| location=Geneva|  chapter=Dilatation and curettage| oclc=181845530| access-date=30 July 2019|chapter-url=https://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html|archive-date=19 May 2009|archive-url=https://web.archive.org/web/20090519162903/http://www.who.int/reproductive-health/impac/Procedures/Dilatetion_P61_P63.html| url-status=live}}</ref>

[[Dilation and evacuation]] (D&E), used after 12 to 16 weeks, consists of opening the [[cervix]] and emptying the uterus using surgical instruments and suction. D&E is performed vaginally and does not require an incision. [[Intact dilation and extraction]] (D&X) refers to a variant of D&E sometimes used after 18 to 20 weeks when removal of an intact fetus improves surgical safety or for other reasons.<ref>{{cite book| title=Dilation and evacuation. In Paul M, Lichtenberg ES Borgatta L Grimes DA Stubblefield P Creinin (eds)Management of unintended and abnormal pregnancy: comprehensive abortion care.| vauthors = Hammond C, Chasen S |publisher=Oxford: Wiley-Blackwell|year=2009|isbn=978-1-4051-7696-5|pages=178–192}}</ref>

Abortion may also be performed surgically by hysterotomy or gravid hysterectomy. [[Hysterotomy abortion]] is a procedure similar to a [[caesarean section]] and is performed under [[general anesthesia]]. It requires a smaller incision than a caesarean section and can be used during later stages of pregnancy. Gravid hysterectomy refers to removal of the whole uterus while still containing the pregnancy. Hysterotomy and hysterectomy are associated with much higher rates of maternal morbidity and mortality than D&E or induction abortion.<ref>{{cite journal | vauthors =  | title = ACOG Practice Bulletin No. 135: Second-trimester abortion | journal = Obstetrics and Gynecology | volume = 121 | issue = 6 | pages = 1394–1406 | date = June 2013 | pmid = 23812485 | doi = 10.1097/01.AOG.0000431056.79334.cc | s2cid = 205384119 }}</ref>

First trimester procedures can generally be performed using [[local anesthesia]], while second trimester methods may require [[Sedation#Levels of sedation|deep sedation]] or [[general anesthesia]].<ref name="NEJMDec2011">{{cite journal | vauthors = Templeton A, Grimes DA | title = Clinical practice. A request for abortion | journal = The New England Journal of Medicine | volume = 365 | issue = 23 | pages = 2198–2204 | date = December 2011 | pmid = 22150038 | doi = 10.1056/NEJMcp1103639 | doi-access =  }}</ref><ref>{{cite journal | vauthors = Allen RH, Singh R | title = Society of Family Planning clinical guidelines pain control in surgical abortion part 1 - local anesthesia and minimal sedation | language = English | journal = Contraception | volume = 97 | issue = 6 | pages = 471–477 | date = June 2018 | pmid = 29407363 | doi = 10.1016/j.contraception.2018.01.014 | url = https://www.contraceptionjournal.org/article/S0010-7824(18)30036-2/abstract | access-date = 20 January 2022 | url-status = live | s2cid = 3777869 | archive-url = https://web.archive.org/web/20220303075142/https://www.contraceptionjournal.org/article/S0010-7824%2818%2930036-2/fulltext | archive-date = 3 March 2022 | doi-access = free }}</ref><ref>{{cite journal | vauthors = Cansino C, Denny C, Carlisle AS, Stubblefield P | title = Society of Family Planning clinical recommendations: Pain control in surgical abortion part 2 - Moderate sedation, deep sedation, and general anesthesia | language = English | journal = Contraception | volume = 104 | issue = 6 | pages = 583–592 | date = December 2021 | pmid = 34425082 | doi = 10.1016/j.contraception.2021.08.007 | url = https://www.contraceptionjournal.org/article/S0010-7824(21)00351-6/abstract | access-date = 20 January 2022 | url-status = live | s2cid = 237279946 | archive-url = https://web.archive.org/web/20220303075141/https://www.contraceptionjournal.org/article/S0010-7824%2821%2900351-6/fulltext | archive-date = 3 March 2022 | doi-access = free }}</ref>