Abortion clinic, Californina: Eve Surgical Center abortion clinic serving Los Angeles, Beverly Hills, California

Abortion Services

First Trimester | Second Trimester | Late Term | Therapeutic | RU 486

FIRST TRIMESTER ABORTION - Dilation and Vacuum Curettage ("DVC")

DVC
The cervix is dilated mechanically just enough to pass a small suction tube into the uterus which is emptied by vacuum aspiration. This is the standard method of termination in the first trimester of pregnancy. The chief advantages of this method are that it is simple, quick, and associated with a low risk of complications. It is completed within a matter of minutes and the patient can be sure of the result immediately.

Sedation
A wide variety of pain control methods are available, ranging from general anesthesia to local cervical nerve block with or without intravenous sedation.

Local anesthesia
Most women having abortions under local anesthesia find the pain moderate and a few may describe it as severe.

Local anesthesia with conscious sedation. Some patients do not want to be completely asleep and they can choose conscious sedation along with the local.

Deep Sedation Anesthesia
Most patients choose to be under deep sedation anesthesia during the procedure. The medications are given intravenously and you will not feel, see, hear, or remember anything. The anesthesia will be administered by an anesthetist, who will work with you to make this experience as comfortable as possible.

Regardless of which type of anesthesia you choose, you may request more medication anytime you feel discomfort. For this reason we want all patients to be prepared to have full anesthesia. This requires nothing to eat or drink for 8 hours before the appointment and an adult driver. The medications are short acting, so you will wake up quickly, but some impairment of mental capacity may last for several hours. You will wake up in our procedure room with a nurse at your side. After several minutes you will be assisted to a private recovery room where a family member may join you.

Cervical Dilation
The cervix will be mechanically dilated with graduated dilators until the opening is large enough to insert the suction tube. Although mechanical dilation is adequate in most cases, osmotic dilators or pharmacologic agents are sometimes necessary in the later part of the first trimester to reduce the risk of injury in some women.

Women who have had surgery to their cervix such as freezing, cervical biopsy or LEEP procedures (treatment for abnormal Pap smears) or women with small cervical openings may require additional dilation. In these cases, osmotic dilators called laminaria may be used. Laminaria are small sticks about 2" long that are left in overnight. They absorb moisture and swell causing gentle, gradual dilation of the cervix.

Ultrasound
Before starting the procedure you will be given an ultrasound exam and told exactly how far along you are. Ultrasound is the most accurate way to determine how long you have been pregnant. There is no sound and you will not see the screen unless you request.

Complications
Serious complications are rare in the first trimester of pregnancy and occur less frequently than complications during childbirth. All serious complications require immediate hospitalization and may require surgery including hysterectomy, blood transfusion, IV antibiotics, and very rarely cause death. Minor complications occur in about 1% of patients and can usually be treated as an outpatient. Patients who have asthma, seizure disorders, hypertension, heart disease, and who misuse recreational drugs have higher risk of anesthetic complications.

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SECOND TRIMESTER ABORTION - Dilation and Evacuation ("D&E")

D&E
Second trimester pregnancy termination (greater than 12 weeks from the first day of the last menstrual period or greater than 10 weeks after the conception) requires more dilation of the cervix than a first trimester abortion. Special forceps and larger suction tubes are needed to empty the uterus. In the United States only 12% of pregnancy terminations are done after the 12th week, and D&E accounts for 95% of these procedures.

Cervical Dilation
The cervix is mechanically dilated the first day and then passive dilators called laminaria are inserted and left in place over-night. The laminaria are small sticks about 2 inches long, which are osmotic - meaning they absorb moisture and slowly expand. This gradual dilation of the cervix makes the procedure safer. The uterine evacuation is done on the second day using a combination of special forceps and suction. In some cases, two days of laminaria may be needed. In the early second trimester (13 and 14 weeks) the cervix may be prepared with a pharmacologic agent called misoprostol, which is inserted a few hours before the D&E. The misoprostol can cause sudden expulsion of the pregnancy so it is only used in patients who live a short distance from the facility.

Sedation
A variety of pain control methods are available. Most women having second trimester termination prefer to be asleep so they do not see, feel, or hear anything. The medications are given intravenously by an anesthetist. It is necessary to have a completely empty stomach, which means nothing to eat or drink for 8 hours before the procedure. The medications are short acting, so you will wake up quickly, but some impairment of mental capacity may last for several hours. You will wake up in our procedure room with a nurse at your side. After several minutes you will be assisted to a private recovery room where a family member may join you.

Complications
Serious complications are rare, even in the second trimester. All serious complications require immediate hospitalization and may require surgery, including hysterectomy; blood transfusion; IV antibiotics; and rarely cause death. To help prevent infection, antibiotics are given IV at the time the laminaria are inserted and again during the extraction. The risk of hemorrhage does increase with the gestational age of the pregnancy; therefore we will give you medications to help prevent heavy bleeding. Minor complications are uncommon and can be treated in the facility without hospitalization.

All second trimester abortions in this facility are done under ultrasound guidance to minimize the risk of injury.

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LATE TERM ABORTION - Dilation and Evacuation (D&E)

Late term D&E
Are performed after 18 weeks and usually require two days of cervical dilation. Special forceps are used to remove the fetus. The pregnancy is too advanced to be removed by suction alone. In the United States only 2% of pregnancy terminations are done after the 18th week and D&E accounts for 80% of these procedures.

Dilation and extraction ("D&X") or intact D&E is a combination of serial placement of laminaria to dilate the cervix followed by intact extraction of the fetus. This is offered to patients with special needs- terminations done for fetal abnormalities where the parents would like to see the fetus or autopsy is recommended by the perinatologist. The intact D& X usually requires induction of labor after the cervix is dilated and may require several hours of labor induction. Intact D&X is not an option for elective pregnancy terminations. The exact details of the intact D&X will be discussed by the doctor on an individual basis.

Cervical dilation usually requires 2 or 3 days of laminaria placement with the extraction procedure being done on the 3rd or 4th day. The amount of dilation needed depends on the gestational age of the pregnancy and the number of laminaria placements depends on the compliance of the cervix.

Sedation
Anesthetic choices are the same as for the earlier 2nd trimester terminations. Additional amounts of medications may be required if the final procedure takes longer so you may feel more sedated on the final day. It is mandatory that you have nothing to eat or drink for at least 8 hours before each procedure. The risk of complications from a full stomach increases as the gestational age of the pregnancy increases. Local anesthesia (para cervical nerve block) and IV narcotic sedation will be used for pain relief during induction, should this be necessary. A nurse will be with you to make sure you are kept as comfortable as possible. In most cases, a patient can opt out of the induction and finish the procedure by the traditional D&E if she chooses.

Complications
The risk of any and all complications that may occur with an early 2nd trimester termination increase progressively with increases in the gestational age of the pregnancy. This includes the risk of infection, hemorrhage, injury, and cardio-pulmonary arrest. In the 1980's a large study on the risk of mortality associated with pregnancy termination was done by the Center for Disease Control. The relative risk of mortality was 0.3/100,000 at 8 weeks gestation, 1/100,000 at 12 weeks, 5/100,000 at 16 weeks and 17/100,000 at 20 weeks. This is for comparison only. Many of the techniques we use today make the procedure much safer than it was 20 years ago. In addition to increased gestational age, the risk of late term D&E varies with many other factors such as the experience of the physician; the health of the patient; the presence of uterine abnormalities including fibroids and uterine scars; the compliance of the cervix; and the reason why the pregnancy is being terminated. IV antibiotics are given on each day to help prevent infection. The extraction is done under ultrasound guidance to minimize the risk of injury.

What to Expect
Given the increased complexity of late term abortion the doctor will want to review your medical history and medical records from referring physicians before you come in. For patients who are self-referred, you will need to be examined by the doctor and have an ultrasound performed before we can schedule your procedure. Patients who have adequate documentation about their condition will be scheduled after the doctor has reviewed the records.

Download FORMS - Medical Record Release | Medical History - Elective

THERAPEUTIC ABORTION

Therapeutic abortion is the termination of pregnancy that is performed for medical reasons. The reasons can be either to preserve the health of the mother or for pregnancies, which would result in the birth of a child with defects incompatible with life or associated with significant health issues.

Our physicians and staff are uniquely trained and qualified to provide the emotional and medical care necessary at this difficult time.

This decision is made with the assistance of your obstetrician or other medical specialists. In order to provide the best care, we request that your referring physician fax all medical records to (310) 204-3190 before your appointment.

The following comments/compliments are taken from actual patient letters and cards:

“I have no idea what would have come of this situation if you would not have had the heart and sympathy to open your office. I want you all to know that each one of you has made a profound impact on my life. I truly cannot thank you enough.”

“I wanted to take this time to thank all of you for your care and concern for my family at our time of loss.”

“Words can not describe how much I appreciate your kindness and compassion during what was an absolutely heart breaking time for me & my husband. God bless each of you.”

“Our deepest appreciation goes out to all of you for helping us through such a difficult time in our lives. Your professionalism, support and kindness were exceptional and much appreciated. You all went the extra mile to ensure our comfort as much as possible."

“Also, thank you for performing the baby blessing. I was put to ease and I knew that the decision my family and I made was the best for my baby."

“I am so thankful that we were all able to make the trip together. We would have never had the chance to meet such wonderful loving people. You made us all feel so much better about the difficult decision."

Download FORMS - Medical Record Release | Medical History - Therapeutic

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RU 486/MEDICAL ABORTION

The abortion pill/RU 486 has been used by more than half a million women in Europe to end an early pregnancy. In 2000, this early option was approved by the FDA and became available to women in America. Since that time, many women have chosen medical abortion because it was more private and "more like a miscarriage".

Based on our clinical experience and 30 years of excellence in providing abortion services , we choose to terminate early pregnancies by the surgical approach. While we recognize and support all options for women, we no longer offer RU 486 to our patients. This decision is based on the ongoing medical evaluation of complications associated with RU 486. It is doubtful that the reported deaths were caused by RU 486, but until there is conclusive evidence to support this, we feel it's best to discontinue it's use.