Second Trimester Abortion (13–24 weeks)
Dilation and Evacuation (D&E)
At this point in pregnancy, the fetus’s body is too large to be broken up by suction and will not pass through the suction tubing. The cervix (the opening to the uterus) must be more dilated (opened) than in a first-trimester abortion. This is usually accomplished by inserting laminaria (a porous material which expands with moisture in order to open and soften the cervix) a day or two before the abortion. The physician then dilates the cervix and dismembers the body and crushes the skull to facilitate removal.
Risks and Considerations for D&E
- If the cervix is not dilated enough from the laminaria then it will be manually opened using metal dilating rods. There is a possibility that the cervix may be cut, torn, or damaged, resulting in excessive bleeding that requires surgical repair.
- Most women experience some pain that will require a pain-killer either locally by shots in the area of the cervix or, on rare occasions, by general anesthesia.
- Complications from general anesthesia used during abortion surgery may result in convulsions, heart attack, and in extreme cases, death. It also increases the risk of other serious complications.
- Up to 16 weeks, the procedure involves primarily the aspiration technique where the fetus is suctioned out of the uterus. Any remaining fetal parts are removed with forceps and, if necessary, a curette to scrape out any remaining tissue.
- Scarring of the uterine lining can occur by the abortion instruments that may result in miscarriages in consecutive future pregnancies and possible infertility.
- There is a risk that the uterus and nearby organs (like the bladder) may be punctured or torn by the abortion instruments. Perforation of the uterus may result in surgery that could include removal of the uterus (hysterectomy). These two bullet points are from above paragraphs
- Complications resulting in a damaged cervix and/or perforated uterus are rare but be sure to contact your doctor if you have any of the following symptoms:
- Heavy or prolonged bleeding or blood clots
- Abdominal Tenderness
- Foul-smelling discharge from the vagina
- After 16 weeks, much of the procedure is performed using forceps to remove the fetus in pieces due to the fetus’ size. The doctor keeps track of all fetal body parts to ensure none are left inside. A curette and suction are used to remove any remaining tissue or blood clots, since they can cause infection and bleeding if left inside.
What are the physical risks of a second trimester surgical abortion?
- Retained tissue, including the placenta.
- Uterine perforation causing severe pain and blood loss. As a result, major surgery may be required for treatment, including possible hysterectomy.
- Cervical laceration, perforation, and heavy bleeding.