Labor induction abortion in the second trimester: What you need to know

Abortion methods in the second trimester

The definition of the second trimester of pregnancy varies but it usually refers to the period of pregnancy between the 13th- 28th week of gestation [1]. According to our safe2choose abortion resources, there are currently several methods for those seeking an abortion in the second trimester [2]. Amongst those, two are meant only for early second-trimester abortions: Manual Vacuum Aspiration (MVA), meant for use up to 14 weeks’ gestation, and Electric Vacuum Aspiration (EVA), meant for use only up to 15 weeks’ gestation. Meanwhile, the other methods are generally used for later second-trimester abortions, namely, Dilatation and Evacuation (D&E) and Labor Induction Abortion [2]. Today, we’re going to discuss one of the lesser talked about methods in the second trimester, which is a labor induction abortion.

What to prepare before the procedure

It’s strongly recommended that those choosing to undergo a labor induction abortion complete a physical and mental assessment to identify potential risks and complications. An ultrasound should also be performed to confirm how far along the pregnancy is and whether the method is suitable for that particular pregnancy. An ultrasound may also aid in navigating the location of the placenta and other placental conditions that may prove risky if you proceed with the procedure, such as placenta previa and placenta accreta. People who are suspected of having a sexually transmitted infection should also be screened for those infections and given proper treatment pre-procedure. People undergoing labor induction abortion usually do not have to receive prophylaxis antibiotics, but as discussed above, those with sexually transmitted diseases should be treated before going ahead with the procedure [3]. Prior to inducing labor, dilators or medication may be used for up to two days to soften and open the cervix [4].

Labor induction abortion procedure

This type of procedure is most commonly used for pregnancy beyond the 16-week gestation mark. Labor induction abortion is medically induced, meaning it uses one or more medications to initiate labor and delivery of the fetus [5]. It may be recommended in place of a D&E when an intact fetus is to be assessed for diagnostic purposes, for example for fetuses with birth defects. It is recommended that the procedure be performed in-clinic or in-hospital as induction may take more than 24 hours [3].

The 2022 guideline recommended by the World Health Organization (WHO) is as follows:

• Mifepristone administered orally, followed one–two days later by repeat doses of 400mcg misoprostol administered buccally, sublingually, or vaginally every three hours.
• The minimum recommended interval between use of mifepristone and misoprostol is 24 hours [7].

In some cases, the placenta does not separate easily and a scraping of the placenta is performed to remove it [4].

How does it compare to surgical abortion in the second trimester?

Although both techniques are relatively safe, surgical abortion is generally preferred by both clinicians and patients [6].

Studies comparing the safety of surgical abortion to labor induction abortion in the second trimester are limited, although there is some evidence that induction has a higher rate of adverse events and the subsequent need for a D&E [8][9]. There are key risks and benefits between surgical abortions and medical abortions in the second trimester as so helpfully defined and highlighted by the Society of Obstetricians and Gynecologists of Canada [3]:

Surgical abortion in second trimester

• One – two days of cervical preparation before the procedure followed by a post-anesthetic recovery time.
• Performed by surgical extraction.
• Requires a procedure room, a D&E-trained provider, skilled staff, and local/moderate sedation.
• Short-term analgesics and/or anesthesia provided before and during the procedure.
• Likely will not provide an intact fetus for viewing/holding and may limit autopsy results.
• Cremation and burial may be offered.
• Potential complications such as heavy bleeding, uterine perforation, infection, incomplete abortion, transfusion (<1%), and hysterectomy.

Labor induction abortion in second trimester

• Procedure lasting hours to days with a stay of one – three days in a facility.
• Expulsion (delivery) following repeated administration of medication.
• Requires skilled nurses and an obstetrics-trained provider.
• Short-term or continuous analgesia provided during cervical dilation and expulsion.
• Intact fetus may be observed when viewing/holding and/or autopsy to be performed.
• Cremation and burial may be offered.
• Potential complications such as heavy bleeding, infection, transfusion (<5%), and hysterectomy. May result in an incomplete abortion requiring a D&C (Dilatation and Curettage).

After-abortion care

After an induction abortion, vaginal bleeding should be monitored. Pregnancy symptoms should subside in 24 – 48 hours following an induced abortion. If pregnancy symptoms persist or vaginal bleeding is heavy and fast (soaking two maxi pads per hour, for two hours or more), you should seek medical care immediately. Patients should also note signs of infection, such as a fever above 38 degrees Celsius or foul-smelling vaginal discharge. All these symptoms should prompt the patient to seek medical care as soon as possible. Fertility can return as soon as 10 days after an abortion, so the person can get pregnant again during sex very soon. When they do not want to get pregnant, some people consider using contraception in case they engage in unprotected sex. It is good to know that having unprotected sex not only exposes an individual to becoming pregnant but also to an STI infection. Find out the contraception method best suited to your needs by clicking here.