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 16 weeks’ gestation. Meanwhile, the other methods are generally used for later second-trimester abortions, namely, Dilatation and Evacuation (D&E) andInduction Abortion [2]. Today, we’re going to discuss one of the lesser talked about methods in the second trimester, which is Induction abortion.
What to prepare before the procedure
It’s strongly recommended that those choosing to undergo induction abortion complete a physical and general assessment to identify potential risks and complications. An ultrasound should also be performed if needed, 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 go on with the procedure at late second trimester, 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 ideally pre-procedure. People undergoing induction abortion usually do not have to receive prophylaxis antibiotics, but in case of detection of any ongoing infection, it should rather be treated before going ahead with the procedure [3]. Prior to the induction procedure, dilators or medication may be used for up to two days to soften and open the cervix [4].
Induction abortion procedure
This type of procedure is most commonly used for pregnancy beyond the 16-week gestation mark. Induction abortion is a medically induced procedure, meaning it uses one or more medications to initiate and stimulate contractions, and the delivery of the fetus vaginally [5]. It may be recommended in place of a D&E as a less interventionist management and for cases an intact fetus needs to be assessed for diagnostic purposes, for example for fetuses with abnormalities. 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 a few cases, the placenta delivery could delay longer than expected and require extra surgical management 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 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 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 an operating 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.
- 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 1-3 days in a facility.
- Expulsion (vaginal delivery) following repeated administration doses of medication.
- Requires skilled nurses, midwives or an obstetrics-trained provider.
- Short-term or continuous analgesia provided during cervical dilation and expulsion.
- Intact fetus may be observed for viewing/holding and/or autopsy needs.
- 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), medical care is required immediately. Patients should also note any 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 very soon. To prevent unplanned pregnancies, some people consider using contraception as soon as possible. It is good to know that having unprotected sex not only exposes someone to the possibility of becoming pregnant, but also to the risk of an STI during this time.
Find out the contraception method best suited to your needs by clicking on this link: https://findmymethod.org/compare-methods/.
