On the first day of the first trimester abortion (up to 13 weeks), each patient is given a preoperative examination with ultrasonography to determine the length of pregnancy as precisely as possible. This examination also provides the opportunity to identify any unusual or pathologic aspects of the pregnancy or pelvic structures that could affect safety. The ultrasonographic screening exam is included in the patient fee.
Routine laboratory examinations include a hematocrit (test for anemia), blood Rh type, and a basic urine test. These tests are also included in the fee.
Following a session to provide routine information necessary to giving informed consent, the patient meets with the physician (Dr. Hern) so that the doctor can answer any remaining questions, to review follow-up plans, and to review birth control methods to be used after the abortion.
The patient then receives a routine physical examination and pelvic examination by the physician. At that point, one laminaria is inserted into the cervix (opening of the uterus). The laminaria is naturally occurring seaweed about the size of a kitchen matchstick that has the property of absorbing moisture from the body and slowly becoming larger. It has been medically prepared so as to prevent infection. After it has been placed in the cervix, the laminaria expands overnight and dilates the cervix in a gentle, natural manner that reduces pain during the procedure and reduces the risk of uterine perforation.
In addition to Dr. Hern's own experience with more than 30,000 first trimester abortion patients, the medical literature strongly supports the evidence that the use of laminaria reduces the trauma to the cervix and the risk of uterine perforation.
On the second day, the patient returns to the clinic for her abortion. A preoperative narcotic analgesia is provided to make the patient as comfortable as possible. The laminaria is removed, and local anesthesia is placed in the cervix in order to minimize pain. The suction cannula is then inserted into the cervix and the uterine contents removed by vacuum aspiration. When this phase is completed (about 2 minutes), the uterus is explored with other instruments that permit the physician to remove all tissue, thereby reducing the risk of complications.
The patient is observed in the recovery room for a period of up to an hour in order to observe for evidence of any complications.
The patient is then given a follow-up exam appointment unless she plans to visit her own physician or another facility for her follow-up care.