Second Trimester Abortion

There are three medical abortion procedures used in the second trimester: D&C, D&E, and Induced Abortion.

Dilation and Curettage (D&C) Medical Abortion

Gestational Age: up to 16 weeks

Typical Cost of D&C Medical Abortion in Illinois: $600 to $1,300

Procedure (two parts)

  • Part one: Dilation – During the first part of this second trimester abortion, a slender rod (laminaria) is inserted into the lower part of the uterus (the cervix) to widen it; this widening allows for the insertion of larger instruments needed. Sometimes, medication may be used to widen the cervix.
  • Part two: Curettage – A long, spoon-shaped instrument (a curette) is used to scrape the lining of the uterus and remove the placenta and fetus. A cannula attached to a suction device may also be used to ensure that the uterus is emptied. This may cause cramping. A tissue sample is often taken for examination in a lab. 1

This procedure takes approximately 10 to 15 minutes, with a in-clinic recovery period up to 5 hours.

Dilation and Evacuation (D&E) Medical Abortion

Gestational Age: used after 16 weeks

Typical Cost of D&E Abortion in Illinois: $1,000 to $2,800 or more

Procedure (two parts)

  • Part one: Dilation – The cervix will need to be dilated prior to the procedure. Approximately 24 hours before the procedure, a doctor will insert a device into the cervix to slowly open (dilate) the cervical opening. If needed, a medication called Misoprostol will be used to help soften the cervix; this is done several hours prior to the procedure.
  • Part two: Curettage – The patient lies on her back with her feet in stirrups. Depending on how far along she is, additional dilation of the cervical canal may be needed; this is done using probes of increasing size. A cannula (a hollow tube attached to a vacuum) is inserted into the uterus to remove its contents. Some cramping is experienced from this point through the rest of the procedure. Forceps are then used to grab hold of larger pieces of tissue – especially in pregnancies past 16 weeks. A curette (a long spoon-shaped device) is then used to scrape the uterus and make sure it is empty. Suction may again be used to ensure the uterus is empty. 2

Different types of medication are often used with this procedure including pain medication and/or a sedative prior to the process, and medicine after the process to lessen the bleeding that occurs.

The procedure usually lasts about 30 minutes.

Side Effects of D&C and D&E

The most common side effects of a second trimester abortion are:

  • Nausea
  • Bleeding and cramping

Other, rare, complications from a second trimester abortion may include:

  • Infection
  • Damage to the cervix
  • Perforated uterus or bowel
  • Death

Reasons to seek immediate medical care following a second trimester abortion include:

  • Soaking a pad through in an hour or less
  • Passing blood clots larger than a golf ball
  • Development of a fever, pain, abdominal tenderness, or a foul-smelling discharge from the vagina. 1 2

Gestational Age: 16 weeks to the point of viability

Procedure

Medication is injected into the uterus, vagina, and/or into a vein using an IV. The types of medication used include salt water, urea, or potassium chloride into the uterus, prostaglandins into the vagina, and/or pitocin through the IV. These medicines will cause uterine contractions and the start of labor. Because the fetus is unable to survive on its own, it is usually stillborn or dies shortly after delivery. A D&C may be needed afterwards to ensure that the uterus is empty. This medical abortion procedure may require a hospital stay as it can take several hours to several days to complete the process.

Risks and Side Effects of Induced Medical Abortion

The most common side effects are:

  • Nausea
  • Vomiting
  • Diarrhea
  • Fever

Other, rare, complications may include:

  • Adverse reactions to the medication(s) used
  • Cervical lacerations
  • Retained blood clots
  • Heavy bleeding
  • Death

Fetal Development by 21 weeks

The following describes some of the developmental steps of the fetus during the time frame when a woman is eligible for a second trimester abortion prodedure. 5

  • Week 13 Fetus is practicing inhaling and exhaling. Neck is getting longer. Hands are more functional and the fetus may play with his fist
  • Week 15 Legs have grown longer than the arms, and the body is now longer than her head. The hearing ability is beginning to develop and eyebrows are growing.
  • Week 17 Fingerprints are forming. The first poop (called meconium) is accumulating in the colon. Skeletal tissue is turning from firm cartilage into hard bone.
  • Week 19 The fetus has his or her own sleep/wake cycles. Baby teeth buds are forming. In boys, the genitals are recognizable; in girls, the uterus starts to develop. The kidneys are able to make urine.
  • Week 21 The tongue is fully formed. White blood cells which help fight infection and disease are being produced. Average length is about 10.5 inches, and average weight is about 12.5 ounces (comparison: a can of soda weighs 12 ounces).

Are you considering having a second trimester abortion? Schedule an appointment for a free Pre-Termination Evaluation at White Oak Women’s Center to find out what medical abortion procedure you qualify for.

More Information about Abortion

References

  1. Web MD. (n.d.). D&C (Dilation and Curettage) Procedure: Surgery and Recovery. Retrieved from http://www.webmd.com/women/guide/d-and-c-dilation-and-curettage
  2. Web MD. (n.d.). Dilation and Evacuation (D&E) for Abortion. Retrieved from http://www.webmd.com/women/dilation-and-evacuation-de-for-abortion
  3. Web MD. (n.d.). D&C (Dilation and Curettage) Procedure: Surgery and Recovery. Retrieved from http://www.webmd.com/women/guide/d-and-c-dilation-and-curettage
  4. Web MD. (n.d.). Dilation and Evacuation (D&E) for Abortion. Retrieved from http://www.webmd.com/women/dilation-and-evacuation-de-for-abortion
  5. Fetal development: The 1st trimester – Mayo Clinic. (n.d.). Retrieved from http://www.mayoclinic.org/healthy-living/pregnancy-week-by-week/in-depth/prenatal-care/art-20045302?pg=2